-shingles: herpes zoster
-etiology: Herpes Varicella Zoster virus
-transmission: direct contact with fluid from vesicle, respiratory droplet such as coughing or sneezing, direct contact with sore from person with shingles and transplacental
-household transmission rate: 80-90%
-rash: 200-500 itchy blisters that appear in successive crops
>severe pruritus, scratching will cause scarring. Starts on scalp and trunk and then spreads to face, arms, and legs
>start 2-4 days before rash
>end: final lesion crusted
-efficacy of acyclovir:
>shortens time of viral shedding
>most effective if started within 24 ho
>more rapid healing
-acyclovir x 7 days
-contagious: before rash until all blisters crust
-rash: macule, papule, vesicles
-itching, fever, rash x 3-5 days
-malaise, HA total 5-7 days
-the vesicle becomes cloudy and depressed in center (umbilicated) with an irregular (scalloped) border
-a crust forms in the center and eventually replaces the remaining portion of the vesicle at the periphery
-Varivax: 1 dose at 12-15 months and
-Varivax booster is now recommended for anyone 4-5 and old who has had one prior Varivax
>13 years-2 doses, 4-6 weeks apart
>2 doses will provide 80-90% immunity
-Anyone who has had chickenpox has the risk for developing shingles later in life,
-The reactivated virus responsible for these conditions is called the Varicella Zoster virus.
-Incidence is rising, 1 in 3 Americans will experience Shingles.
-More than half of all cases occurs in in >60 yrs of age.
-FDA recommendation: Everyone age 50 or older should get vaccinated-whether they have had Shingles or not.
-Virus can lie dormant for years in the nerve roots of the spinal cord. Stress causes virus to replicate and travel down the nerve to cause Shingles.
-Risk for Recurrence of Shingles. Shingles can recur
-stabbing nerve pain (Postherpetic Neuralgia)
-blistering rash clears in 3-4 weeks, but pain may remain
-may reoccur, especially if first episode lasted greater than 30 days
>Acyclovir: 800 mg five times daily for seven to ten days;
>Famciclovir: 500 mg three times daily for seven days;
>Valacyclovir: 1 g three times daily for seven days.
-Pain medication is often necessary as the pain level is very high in many people. The pain is often so intense that people cannot have any clothing touch the skin area with shingles. NSAIDs, APAP, codeine, & morphine around the clock for acute pain.
-A three-week course of prednisone has also been recommended: prednisone 60 mg once daily for one week, then 30 mg once daily for one week, then 15 mg once daily for one week.
-Oatmeal baths or calamine lotion may help reduce itching.
-Local anesthetics such as pramoxine may be indicated.
-Local astringents may also be useful.
-Options: narcotics, gabapentin, pregabalin, or TCAs.
->60 yo, or >50 yo if they want it
-Reduces the risk of shingles by 50%.
-If shingles does occur it is mild.
-Reduces postherpetic neuralgia by 67%.
-Zostavax appears to be effective in the 60 plus age group for at least five years, although benefit decreases after about 3 yrs.