Herpes zoster, also known as shingles, is the disease that results from reactivation of the varicella --zoster virus---the same virus that causes chickenpox---within clusters of nerve roots known as the "dorsal root ganglia." According to the Mayo Clinic website, herpes zoster produces a painful, blistering rash that usually affects just one side of the body. Although the rash itself resolves without treatment, doctors often recommend antiviral drugs because herpes zoster is associated with a high rate of complications.
Types of Complications
Herpes zoster produces two types of complications: complications that relate to the rash and complications that result when the virus spreads to areas other than the skin. Complications related to skin include secondary bacterial infections, scarring and a chronic pain syndrome called post-herpetic neuralgia. When herpes zoster spreads to areas other than the skin, the result is complications such as pneumonia, hepatitis, kidney problems, blindness, seizures, stroke, paralysis and other problems, according to University of Alabama Medical School Professor Richard J. Whitely in the 2008 edition of "Harrison's Principles of Internal Medicine."
Time Frame
According to Whitely, most complications develop three to five days after skin symptoms appear. In the case of post-herpetic neuralgia, pain associated with the shingles rash simply never stops, even after the rash has healed. Most complications subside with treatment. According to University of Texas dermatologist Stephen K. Tyring, M.D., post-herpetic neuralgia subsides within six months for 50 percent of patients. For others, it may be permanent.
Treatment
Prompt initiation of antiviral drugs can prevent or control complications of herpes zoster, depending on when drugs are initiated. According to the Mayo Clinic website, doctors typically prescribe one of three drugs: acyclovir, valacyclovir and famciclovir. For patients with non-skin-related complications, says Whitely, doctors often start with intravenous acyclovir, sometimes transitioning to oral preparations of acyclovir or one of the other drugs when symptoms are under control.
Supportive Care
Supportive care targets the symptoms of herpes zoster, rather than the virus itself. For people with complications of herpes zoster, supportive care can be lifesaving. The type of supportive care depend on the complication. Common examples include supplemental oxygen for people with pneumonia, anticonvulsants for people who seize due to brain inflammation and intraocular steroids for people with blindness due to herpes zoster.
Prevention
In 2006, according to the National Institute of Neurological Disorders and Stroke, the Food and Drug Administration approved a vaccine, Zostavax, to prevent herpes zoster in people over 60. People who get the vaccine are 50 percent less likely to develop herpes zoster, explains NINDS, adding that those who do get sick are two-thirds less likely to develop complications such as post-herpetic neuralgia.
References
- "Harrison's Principles of Internal Medicine, 23rd Edition;" A.S. Fauci et al.; 2008
- "Journal of the American Academy of Dermatology"; Management of Herpes Zoster and Post Herpetic Neuralgia; S.K. Tyring; December 2007
- National Institute of Neurological Disorders and Stroke: Shingles: Hope Through Research
- Mayo Clinic: Shingles
- Mayo Clinic: Shingles: Treatment and Drugs
