Herpes Zoster

What is the cause :
Varicella zoster virus. This virus that previously attacked human body, infected and caused Varicella (Chicken pox). This, remained dormant within dorsal root ganglia. In which condition are immunocompromised, the virus will be reactivated.
 

  Clinical Manifestation:
The clinical manifestation divided into different phase
1. Preeruptive phase
    the period is 48-72 hours with prodromal symptoms : malaise, myalgia, headache, photophobia, fever
2. Acute eruptive phase
    the period is 3-5 days with appearance of primary and secondary efflorecense : erythematous papule --> vesicular lession --> ulcerate --> crustae (tend to resolve over 10-15 days)
3. Chronic phase
   lasting 30 days : Post Herpetic Neuralgia (PHN) with persistent or recurring pain after infection

How to make diagnosis :
- Painfull vesicular lession and finding erythematous base with dermatomal affected
- may affect single or multiple dermatome
- Tzang smear test

Predilection site :

- Thoracic, Trigeminal, lumbosacral, cervical, usually/mostly unilateral site.

Treatment :

-          Acyclovir 5 x 800 mg for 7 days , or

-          Valacyclovir  1 g q8hr for 7-10 days,

-          and Acyclovir ointment 5% q3hr (6 times daily for 7 days)

-          Consider analgetic, corticosteroid (controversial). Topical corticosteroid should not be used

 Complication :  
-  PHN

- Herpes zoster Opthalmicus  - blindness, if affected nose --> Hutchingson's sign

- Herpes zoster Oticus -->  Ramsay hunt Syndrome

- Meningoencephalitis

- Bacterial infection of damaged skin. 

Source :

- Fitz patrick Colour Atlasand Synopsis

- Rook's Textbook of Dermatology ed.8th, Volume 4th

- Uptodate.com

- emedicine.medscape.com