Herpes Zoster: Shingles

Herpes Zoster (Shingles)

• Shingles, also known as herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus (VZV).
• VZV is the same virus that causes chickenpox.

Etiology and Pathophysiology

• VZV remains dormant in the dorsal root ganglia of sensory nerves after a person recovers from chickenpox.
• Shingles emerges when the virus reactivates.
• The reactivated virus travels along nerve pathways to the skin, leading to a painful rash.
• Reactivation is often linked to weakened immune defenses due to aging, stress, immunosuppressive medications, or other underlying conditions.
• A unilateral rash characterizes it, appearing as a band or strip on one side of the body, which corresponds to the affected nerve dermatome.
• The rash includes vesicles which are small, fluid-filled blisters which erupt, break open, and crust over.

Clinical Manifestations

• A painful rash is the primary symptom, often preceded by burning, itching, tingling, or numbness in the affected area.
• The rash commonly appears as a single stripe of blisters on the torso.
• The rash can also affect the face, eyes, or other body areas.
• Additional symptoms include fever, headache, fatigue, and sensitivity to touch.
• The acute phase typically spans 2 to 4 weeks.

Complications

• Postherpetic neuralgia (PHN) is the most common complication, marked by persistent pain in the area where the rash occurred, lasting for months or even years.
• Ophthalmic zoster arises when shingles affects the ophthalmic branch of the trigeminal nerve.
• Ophthalmic zoster can potentially lead to vision loss or other eye problems.
• Disseminated zoster is a rare but serious complication.
• Occurs when the virus spreads beyond the initial dermatome, affecting multiple body areas.

Diagnosis

• Shingles is typically diagnosed based on the clinical presentation of a unilateral, dermatomal rash consisting of vesicles.
• A Tzanck smear, viral culture, or polymerase chain reaction (PCR) assay can confirm VZV presence in the lesion fluid.
• Blood tests to detect VZV antibodies may support the diagnosis, particularly in atypical rash cases.

Treatment

• Antiviral medications like acyclovir, valacyclovir, or famciclovir are the primary treatment.
• Antivirals should be initiated within 72 hours of rash onset to reduce the severity and duration of symptoms.
• Pain management involves analgesics, such as NSAIDs, opioids, or topical agents like lidocaine or capsaicin.
• Corticosteroids may be prescribed to reduce inflammation and pain, but their use is controversial and should be carefully considered.
• Supportive measures, including rest, proper wound care, and stress reduction, can help promote healing and alleviate symptoms.
• Vaccination with the recombinant zoster vaccine (RZV) is recommended for adults aged 50 years and older, regardless of prior chickenpox or shingles.
• Vaccination helps prevent shingles and its complications.

Nursing Management

• Assess the pain level and administer analgesics as prescribed, monitoring for effectiveness and side effects.
• Provide wound care to prevent secondary bacterial infections, keeping the rash clean and dry, and applying dressings as needed.
• Educate about adhering to the prescribed antiviral medication regimen and completing the full treatment course.
• Teach about potential complications like PHN and ophthalmic zoster, advising prompt medical attention if symptoms worsen or new ones arise.
• Encourage rest, a healthy diet, and stress management to support the immune system and promote healing.
• Emphasize RZV vaccination for adults aged 50 years and older to prevent shingles and its complications.
• Monitor for signs of disseminated zoster like widespread rash, fever, or other systemic symptoms, and promptly report any concerns.