Treatment of Herpes Zoster

About the disease

Herpes zoster is a painful viral disease that manifests itself as a rash. It mostly develops in one part of the body, such as the neck, face or an arm, for example, and takes the form of a red stripe of small, closely scattered blisters. Before the stripe appears, a tingling or itching sensation will be felt a few days before the actual rash appears. This pre-rash symptom also occurs with chickenpox. This can be explained by the fact that herpes zoster and chickenpox are caused by the same highly contagious virus.

When a child suffers from chickenpox, the virus cells are deactivated once the child recovers. However, these cells lie dormant in the child’s body. In adulthood, these cells can be reactivated due to certain triggers, causing herpes zoster.

The most common trigger of herpes zoster is a weak immune system. People who have HIV/AIDS, receive immunosuppressants for the treatment of autoimmune diseases or suffer from a generally poor immune system, are most at risk of developing herpes zoster. Older people are also at risk, as they have a weaker immune system due to the changes that come with age. It is also believed that children who contract chickenpox before the age of 18 months are more prone to developing herpes zoster later in life.

Herpes zoster usually only lasts a few days. If it is localized on one small area of the skin, it is rarely dangerous. However, if it develops in the eye area, the rash may lead to vision problems, even blindness in some cases. Herpes zoster can also be dangerous if it develops on large areas of the skin. The good news is that people can get vaccinated against the zoster virus, even late in their adulthood, which greatly lessens the risks of developing it in the future. If someone develops herpes zoster after being vaccinated, the symptoms are much less severe.      

Symptoms

• Itching and tingling sensation before rash appears
• Red stripe of blisters
• Pain in the affected area
• Fever in some cases
• Fatigue
• Weakness

Diagnosis

• During a general examination, the doctor will examine the patient’s skin to see if there is a rash. It is usually easy to identify a herpes zoster rash as it has a characteristic pattern: a red stripe of small blisters.
• The doctor will also ask the patient if their skin was itchy or if they noticed a tingling sensation before the rash appeared.
• The doctor will ask the patient if they ever had chickenpox as a child and, if so, how old they were. Information about any diseases of the immune system is also important.
• A smear test and a blood test are sometimes required if there is a suspicion of another infection or if the doctor is unsure about the exact type of herpes zoster.  

Treatment

• Conservative treatment, such as topical lotions and creams may be prescribed to soothe the rash and alleviate the pain. In most cases, herpes zoster will clear up after 2-3 days.
• If the rash is not localized and lasts for longer than 2-3 days, the patient may be prescribed antiviral medications and corticosteroids to precipitate recovery and lessen the pain.

Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed