Trigeminal_herpes_with_uveitis_and_keratitis.jpg

Definition

[1]
Shingles is a reactivation of Varicella Zoster Virus (chicken pox) and causes a characteristic dermatomal rash.
Raymond Hunt Syndrome refers to Shingles of the Facial Nerve (7th Cranial Nerve)

Incidence

[2]
3.4 per 1000 people in the UK

Age

>50

Gender

No difference between males and females

Risk Factors

[3]

Signs and Symptoms

[4]
  • Pain in a single dermatome
  • Dermatomal rash
  • Eye pain (if the trigeminal nerve is affected)
  • Visual disturbance (if the trigeminal nerve is affected)
  • Ear pain, Loss of Hearing, Tinnitus, External Canal vesicles (Raymond Hunt Syndrome)

Pathophysiology

[5]
Following Varicella Zoster Infection, the virus enters a latent phase in the dorsal root ganglia and cranial nerve ganglia. In immunocompetent people, the infection may become reactivated and usually only affects a single dermatome. Reactivation may also occur in conditions such as HIV, malignancy, during chemotherapy, or chronic use of corticosteroids which reduce the immune systems ability to stop the virus.

Reactivation of the virus causes inflammation and damage to the affected nerves, a rash with vescilces over the dermatome of the affected ganglia. Sometimes motor neurons may also be affected by the inflammation.
Investigations
[6]

Other

PCR of vescicle swab - positive for herpes zoster

Diagnosis

[7]
Diagnosis is usually made clinically with a characteristic dermatomal pain and rash

Differentials to rule out

Treatment

[8]

Non-Pharmacological

  • Skin moisturiser

Pharmacological

Management

[9]
Patients should be put under contact precautions. Patients who have neurological, eye, motor or skin complications after a week of treatment should be closely monitored.

Complications

[10]
  • Eye involvement (if the trigeminal nerve is affected)
  • Skin infection
  • Postherpetic neuralgia

Prognosis

[11]
Prognosis is usually good; however, it can be life threatening in immunocompromised patients.

See Also

BMJ Best Practice - Herpes Zoster Infection
Oxford Handbook of Clinical Medicine - 9th edition p400
  1. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/23.html
  2. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/23.html
  3. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/23.html
  4. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/23.html
  5. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/23.html
  6. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/23.html
  7. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/23.html
  8. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/23.html
  9. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/23.html
  10. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/23.html
  11. ^ http://bestpractice.bmj.com.ezp.lib.unimelb.edu.au/best-practice/monograph/23.html