Herpes Zoster (shingles)

AETIOLOGY

• - Shingles is caused by reactivation of the varicella virus that has lain dormant in the dorsal root ganglion.
• - The varicella zoster virus is believed to enter the sensory nerve endings in the skin during a chickenpox infection, travelling up the nerves to the ganglia.
• - Painful blisters develop following the underlying route of the nerves that are inflamed by the virus.

INCIDENCE

• - Every year about 200,000 people in the UK have an attack of shingles.
• - It mainly affects adults: 60 per cent of people who have shingles are over 50 and five per cent are under 15.
• - It more frequently affects people with weakened immune defences and is, therefore, more common in older people or those with chronic conditions such as leukaemia or AIDS.
• - Most people only have shingles once. However, people with impaired immune systems, may have repeated episodes.

DIAGNOSIS

• - The pain and rash of shingles is characteristically unilateral.
• - Past history of chickenpox.
• - May start after a period of debility.
• - Some blisters may weep fluid.

SIGNS AND SYMPTOMS

• - Painful blisters form in the area supplied by one nerve root. This usually affects only one side of the body.
• - The initial symptom is usually a tingling sensation in the affected area.
• - Pain and discomfort, which can be severe, begins about five days before the rash emerges.
• - Red papules develop into blisters, which crust over and heal within three to four weeks.
• - Malaise and fever are common and this, coupled with pain, makes shingles a debilitating condition.

TREATMENT

• - Analgesic such as ibuprofen or co-codamol to control pain.
• - Oral antiviral agents help if taken in the first 72 hours.
• - Advise patient to:
• - Keep rash dry;
• - Rest, especially while malaise is a problem;
• - Stay away from newborn infants, pregnant women and anyone who is frail or unwell;
• - See his or her doctor if the rash becomes worse;
• - See his or her doctor if the pain is not controlled with simple analgesics.

COMPLICATIONS

• - Secondary infection can cause tissue damage and result in scarring.
• - Post-herpetic neuralgia, where pain persists beyond the normal two-to-three week period, lasting for months and sometimes years is a distressing complication that is more common with increasing age.
• - Damage to the inner ear can result in deafness and vertigo.
• - Involvement of the eye can cause ulceration and permanent scarring of the cornea.

NURSING IMPLICATIONS

• - A patient with shingles can transmit chicken pox to a susceptible individual but a patient with chickenpox cannot transmit shingles.
• - Creams and lotions are not recommended for treatment of the skin rash as there is a risk of spreading skin bacteria into the blistered area.
• - Prompt referral to a doctor is important for patients with:

Concurrent illness;

Pain that is not managed with simple analgesia;

Anyone over 75;

If the face or eyes are affected.

• - Immediate treatment with antiviral drugs can reduce the severity and duration of an attack.

FURTHER READING
Ankrett, V., Williams, I. (1999)Quick Reference Atlas to Dermatology. Tunbridge Wells: MSL.

Johnson, G. et al (2000)The Minor Illness Manual. Oxford: Radcliffe Medical Press.

Youngson, R. (2002)The Royal Society of Medicine Health Encyclopaedia. London: Bloomsbury Publishing.

WEBSITES
Information for patients is available from StudentHealth: www.studenthealth.co.uk

National Institute of Neurological Disorders and Stroke: www.ninds.nih.gov/health_and_medical disorders/shingles doc.htm

British Association of Dermatologists: www.bad.org.uk/patients/patient_s

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