Herpes zoster, more commonly referred to as shingles or zoster, is an infection that is caused by the varicella zoster virus (VZV). It is the same virus that is responsible for the outbreak of chickenpox. The VZV usually affects people who have a lowered immune system. This condition is caused by the reactivation of the VZV virus, which means that this virus first attacks the body of a person and causes chickenpox. After the infection has been cured, the varicella zoster virus settles into the cells of the nervous system and remains in a dormant state. It can thus reactivate and affect a person anytime. It is this reactivation after a bout of chickenpox that leads to a painful rash known as herpes zoster. Interestingly, only those people who have had chickenpox can be affected by this disease. If a person has not had chickenpox and is affected by the virus, he will only get infected with chickenpox first, and not herpes zoster.
What is Disseminated Herpes Zoster
The herpes zoster virus affects the body by forming an itchy and painful rash over the skin, which usually affects the upper section of the body (above the midline); in some cases, it can affect your face and infrequently, can affect lower section of the body as well. Moreover, it affects only a particular portion of the body (most commonly on the trunk along the thoracic dermatome) at a given time. However, in some people, the virus spreads from one particular dermatome and affects 2-3 areas of the body. This severe infection is called disseminated herpes zoster. Usually, this condition only affects people once in their lifetime, but in rare cases, it can resurface three times to a person in his/her lifetime.
The main complication that can develop from this condition is the emergence of postherpetic neuralgia. The emergence of this condition is supposed to be risky because it can cause serious damage to the sensory nerves and parts of the spinal cord. It can continue to cause tremendous pain, even after the herpes zoster has run its course.
Signs and Symptoms
- The rash that comes on the skin is usually in the form of a band. It may continue to develop over a few weeks.
- The rash will develop in small clusters in the areas of the trunk, face and waistline. In case of the disseminated herpes zoster, they will not remain limited to those areas, but spread to the other areas as well.
- The rash will slowly give rise to the emergence of small boil-type structures called vesicles (bubbles formed under the skin).
- The vesicles may continue to develop over a 2-3 day period, then begin to dry, and eventually crust over in a week or two week's time.
- During this entire period, certain specific symptoms are experienced. These include severe pain, uncontrollable sensations of itching, burning and tingling.
- Some people may experience rise in their body temperature (fever) and face an upset stomach as well.
- Other signs include severe headaches and sensitivity to light in some patients.
- The rash may or may not leave permanent scars.
Precautions to be Taken
It is very important that proper precautions are undertaken when dealing with someone who has developed the virus. Even though it is not possible to contract the virus externally, there might be chances that it will get transferred under certain circumstances. These include:
- If there is direct contact with ulcerated lesions and blisters of a patient (especially the blisters that are open and active), then the other person is most likely to get infected with the virus (if he is not immune to the virus). If a person has not had chickenpox before, then he might develop chickenpox, but not shingles.
- People who have a compromised immune system need to be kept away from patients of this condition. These include those who have been diagnosed with HIV or cancer, or have had bone marrow or organ transplants and those who are undergoing treatment for any of the above mentioned conditions.
- Health care workers should be immune to chickenpox before administering care.
- Health care workers who have lesions from shingles should not be brought in contact with patients and put them at risk.
- It is important to make sure that anyone who comes in contact with the patients has taken proper precautions and care by way of wearing gloves and masks and washing their hands.
- There is a risk that in some rare cases the disseminated herpes zoster can be fatal as well, therefore those patients who are susceptible to this, need to be isolated.
- The most important precaution against the virus is to take the shingles vaccine which will prevent the virus from affecting a person, and even if a person is affected, it will not be severe.
The treatment for this condition includes 3 factors - treating the infection, treating the pain that is brought on due to the condition and the prevention of the emergence of postherpetic neuralgia. In this direction, usually the following steps are administered.
Antiviral agents may contain systemic steroids, and it has been proven that they help to treat and prevent the infection. They should be started early (within 72 hours of the first symptom) so that they are successful in shortening the duration of the condition. They prevent the virus from multiplying, heal the lesions quickly and reduce the pain to a great extent.
As mentioned earlier, the pain associated with this virus is severe and therefore, there is a need to administer pain medication for pain relief. This can be either oral or through steroid injections or in the form of a shingles vaccine. These medication forms include Tricyclic antidepressants, Capsaicin supplements, anti-seizure medications, topical anesthetics and analgesics.
Treatment of Postherpetic Neuralgia
The main treatment of this condition includes dealing with the severe pain that is brought by the virus. This includes administering all the pain medication (mentioned above). Other than that, lotions and creams that can be applied over the lesions are also used. Other than pain management with medication, other treatment methods also include biofeedback, nerve blocks and transcutaneous electric nerve stimulation (TENS).
Along with these three factors, it is very important to maintain a sanitized and hygienic environment so that it leads to a speedy recovery and can prevent further infections from taking place.
Though the disseminated herpes zoster virus cannot be contracted by breathing the same air as that of a person who has contracted the virus, it still needs to be carefully monitored. It can be highly contagious for those people who have never developed this condition, thus making them susceptible to chickenpox and eventually the herpes zoster virus. It is therefore important to ensure that all the vaccines and necessary precautions, along with the treatment methods are duly administered; even though it is not considered a serious condition, there have been rare fatalities due to lack of administering.