Understanding Shingles

December 26, 2018 0 Comment



What Causes It

 Herpes zoster, also called shingles Is an infection caused by the varicella virus (VZV). An individual contracts chicken pox, which is the primary source of infection. The chicken pox virus then becomes dormant in the dorsal ganglia of the spinal cord. After this stage, the virus may resurface in the form of shingles. This especially happens when the immune system weakness. HIV/ AIDS weakens the immune system, elderly individuals also have a weaker immune system.

The shingles infection causes a rash. However, there can be pain before a rash develops. This rash is described as maculopapular lesions, meaning a rash that has both raised and flat areas. It usually clusters and only involves a small to moderate area of skin. This occurs near the area of ganglia involvement. Over the course of between 7-10 days the rash evolves from postules, and ulceration, with crusts, scabs or both. This can last an entire 30 days in the acute phase. A number of patients often describe this as being very painful, that is stinging and burning in nature.

Physical examination may also include an area of crusted, sometimes red, or brown colored rash, depending on the individual’s skin tone. Another characteristic is, it never crosses the midline of the body. It is either on the right or left side of the body. It typically occurs on the chest or face. It may also include other areas of the body such as the abdominal and buttocks area.

Emergency room diagnosis is based on the pattern and characteristic of the rash, and the area of involvement, it also includes the patients’ description of the pain sensation. There is no definitive tests done in the emergency room to confirm a diagnosis of herpes zoster, similar conditions may include contact dermatitis or herpes simplex. Treatment for herpes zoster include oral antiviral therapy of either acyclovir, valtrex, and famciclovir. These drugs have been clinically proven to decrease the severity and duration of infection. Topical preparation of these medications are said to be in effective. In addition to the antiviral therapy, a prescription of pain medications may also be given. These may include but are not limited to narcotics and anti inflammatory such as NSAIDS, a lidocaine patch may also be helpful. Other supportive therapy may be needed at home, if there is fever or malaise. Family members can help an individual feel better by assisting with activities of daily living (ADL).

Please note the virus can be transmitted from person to person in the form of chicken pox. One cannot contract shingles from a person infected with shingles. They may contract chicken pox that  will later manifest as shingles, as was earlier mentioned. A person who has already had the chicken pox virus may not contract the singles virus. As nurses, we often collaborate with colleagues, and those who have already had chicken pox, will be on the frontline as caregivers for these patients, otherwise contact isolation is paramount. Isolation for chicken pox is droplet and contact precautions. Vaccines are also available, you can discuss this with your healthcare provider. Always pay close attention to the progress of treatment, and return for follow up, if condition worsens, or symptoms persist.

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