Herpes zoster (or simply zoster), commonly known as shingles and also known as zona, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body (left or right), often in a stripe. The initial infection with varicella zoster virus (VZV) causes the acute, short-lived illness chickenpox which generally occurs in children and young adults. Once an episode of chickenpox has resolved, the virus is not eliminated from the body and can go on to cause shingles—an illness with very different symptoms—often many years after the initial infection. Herpes zoster is not the same disease as herpes simplex, despite the name similarity; both the varicella zoster virus and herpes simplex virus belong to the same viral subfamily Alphaherpesvirinae.
Signs and symptoms
The earliest symptoms of herpes zoster, which include headache, fever, and malaise, are nonspecific, and may result in an incorrect diagnosis.These symptoms are commonly followed by sensations of burning pain, itching, hyperesthesia (oversensitivity), or paresthesia (“pins and needles”: tingling, pricking, or numbness). The pain may be mild to extreme in the affected dermatome, with sensations that are often described as stinging, tingling, aching, numbing or throbbing, and can be interspersed with quick stabs of agonizing pain.
Herpes zoster in children is often painless, but older people are more likely to get zoster as they age, and the disease tends to be more severe.
In most cases after one to two days, but sometimes as long as three weeks, the initial phase is followed by the appearance of the characteristic skin rash. The pain and rash most commonly occurs on the torso, but can appear on the face, eyes or other parts of the body. At first the rash appears similar to the first appearance of hives; however, unlike hives, herpes zoster causes skin changes limited to a dermatome, normally resulting in a stripe or belt-like pattern that is limited to one side of the body and does not cross the midline. Zoster sine herpete (“zoster without herpes”) describes a patient who has all of the symptoms of herpes zoster except this characteristic rash.
Later the rash becomes vesicular, forming small blisters filled with a serous exudate, as the fever and general malaise continue. The painful vesicles eventually become cloudy or darkened as they fill with blood, and crust over within seven to ten days; usually the crusts fall off and the skin heals, but sometimes, after severe blistering, scarring and discolored skin remain.
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Herpes zoster may have additional symptoms, depending on the dermatome involved. Herpes zoster ophthalmicus involves the orbit of the eye and occurs in approximately 10% to 25% of cases. It is caused by the virus reactivating in the ophthalmic division of the trigeminal nerve. In a few patients, symptoms may include conjunctivitis, keratitis, uveitis, and optic nerve palsies that can sometimes cause chronic ocular inflammation, loss of vision, and debilitating pain. Herpes zoster oticus, also known as Ramsay Hunt syndrome type II, involves the ear. It is thought to result from the virus spreading from the facial nerve to the vestibulocochlear nerve. Symptoms include hearing loss and vertigo (rotational dizziness).
Apis mellifica Small pustules with burning, smarting, stinging, and which forms dry, scaly, laminated, brownish scabs, worse from warm, better from cold application.
Arsenicum album Severe burning pain worse at night and great restlessness, better external heat.
Bovista lycoperdon Herpes which bleed easily. Bovista produces relaxation of entire capillary system and that favours haemorrhagic diathesis.
Graphites Herpes zoster especially on the left side. The eruption discharges a sticky glutinous fluid. Herpes in females with scanty menses. Iris versicolor Herpes zoster on right side, associated with gastric derangement.
Kalmia latifolia Facial neuralgia after zoster.
Mercurius solubilis Herpetic spots and suppurating pustules, sometimes running together, forming dry, scaly spots or crusts with acrid discharge is said by some to be specific for relieving the burning, and preventing the appearance of new crops. Right sided, extending across the abdomen.
Mezereum Is strongly recommended, and said to prevent and cure the succeeding neuralgia inter costalis. Herpes zoster, with severe neuralgic pains. The vesicles – form brownish scabs, and itch violently. Chilly even in warm room.
Ranunculus bulbosus Vesicles appear on skin and are filled with serum. Some times these vesicles have a bluish black appearance, there is marked burning and itching, worse contact. Especially is Ranunculus indicated when the trouble follows the course of the supra-orbital or inter-costal nerves and is followed by sharp stitching pains.
Rhus toxicodendron Where there is fever, restlessness, burning and itching, confluent vesicles, containing milky or watery fluid. Herpetic eruptions, alternating with pain in chest and dysenteric stools. The eruption is attended with incessant, itching, burning and tingling.
Thuja occidentalis Herpes zoster white, scaly, dry mealy tetter. Eruption only on covered parts, burn violently after scratching. Worse from cold water, from heat of bed at night.
Zincum metallicum Herpes zoster, followed by neuralgia. Violent itching especially in bends of joints. Fidgety feet, with lancinating pains; suppurating herpes.