I am publishing this as it might be of interest to our viewers.
Dear Lucky
I am sorry to hear that you are down with Herpes Zoster.
I started replying as soon as I saw your email but it got lost.
I may be repeating what you already know and please forgive me if I am repeating.
Herpes Zoster is referred to as “shingles” commonly.
The primary varicella infection is chicken pox.
Chicken pox is primarily an infection of children, whereas varicella and post- herpatic neuralgia become more common in adults and the elderly.
The virus remains dormant after an attack of chicken pox but becomes reactivated later in life manifesting as
1. Herpes Zoster ( shingles)
2. Post herpatic neuralgia
While there may not be an obvious cause for the reactivation of the virus other than advancing age there are sometimes reasons which become apparent as to the reactivation such as;
Factors that decrease the immune function, and reduce one’s ability to fight infections are; 1. Human immunodeficiency virus infection
2. Those receiving cancer treatment ( chemotherapy)
3. Malignancies (cancers)
4. Chronic corticosteroid use.
The classic condition one tends to get following the infection -herpes zoster, is the dermatomal rash and pain (called post herpatic neuralgia)
It is called dermatomal as the rash and the pain is distributed from the dorsal spine along the route of a spinal nerve and radiating to the side of one’s thorax.
It is a burning pain and typically precedes the rash by several days.
The pain called post-herpatic neuralgia can sometimes persist for months after the initial rash and it can be debilitating.
Treatment.
Herpes Zoster is usually treated with a drug by the name of ACYLOVIR.
The other drugs used are;
-famciclovir
-valacyclovir
These drugs are most effective when started within 72 hours after the onset of the rash.
The addition of a corticosteroid can provide some benefit in reducing the pain and the incidence of postherpatic neuralgia.
Ocular (eye) involvement in herpes zoster can lead to serious complications and merits referral to a ophthalmologist.
The pain (post herpatic neuralgia) May require narcotics such as morphine and Tricyclic antidepressants or anticonvulsants (drugs used to treat epilepsy). These drugs
Are usually given in low doses.
Others are Capsaicin, lidocaine patches.
Rarely one may have to resort to nerve blocks. Directly injected analgesics in to the dermatome ( the nerve root)
The majority do not get the complications after the initial rash vanished and hope you will recover soon
The other predisposing conditions not applicable to you but for completeness are are those patients with HIV and those with Hodgkin Lymphoma.
Another bit about shingles;
Although herpes zoster is not as contagious as the primary varicella (chicken pox) it can still be transmitted to non immune subjects.
About 20 percent with HZ can develop post herpatic neuralgia.
In some instances when the pain preceded the rash it can be diagnosed as due to myocardial infarction (heart attack )
Ocular complications occur in 50 percent of cases.
I have seen few cases of herpes with and without the complications.
I am sure you must be having the best treatment and I wish you a speedy recovery.
Very kind regards and best wishes
Conrad
I am sorry to hear that you are down with Herpes Zoster.
I started replying as soon as I saw your email but it got lost.
I may be repeating what you already know and please forgive me if I am repeating.
Herpes Zoster is referred to as “shingles” commonly.
The primary varicella infection is chicken pox.
Chicken pox is primarily an infection of children, whereas varicella and post- herpatic neuralgia become more common in adults and the elderly.
The virus remains dormant after an attack of chicken pox but becomes reactivated later in life manifesting as
1. Herpes Zoster ( shingles)
2. Post herpatic neuralgia
While there may not be an obvious cause for the reactivation of the virus other than advancing age there are sometimes reasons which become apparent as to the reactivation such as;
Factors that decrease the immune function, and reduce one’s ability to fight infections are; 1. Human immunodeficiency virus infection
2. Those receiving cancer treatment ( chemotherapy)
3. Malignancies (cancers)
4. Chronic corticosteroid use.
The classic condition one tends to get following the infection -herpes zoster, is the dermatomal rash and pain (called post herpatic neuralgia)
It is called dermatomal as the rash and the pain is distributed from the dorsal spine along the route of a spinal nerve and radiating to the side of one’s thorax.
It is a burning pain and typically precedes the rash by several days.
The pain called post-herpatic neuralgia can sometimes persist for months after the initial rash and it can be debilitating.
Treatment.
Herpes Zoster is usually treated with a drug by the name of ACYLOVIR.
The other drugs used are;
-famciclovir
-valacyclovir
These drugs are most effective when started within 72 hours after the onset of the rash.
The addition of a corticosteroid can provide some benefit in reducing the pain and the incidence of postherpatic neuralgia.
Ocular (eye) involvement in herpes zoster can lead to serious complications and merits referral to a ophthalmologist.
The pain (post herpatic neuralgia) May require narcotics such as morphine and Tricyclic antidepressants or anticonvulsants (drugs used to treat epilepsy). These drugs
Are usually given in low doses.
Others are Capsaicin, lidocaine patches.
Rarely one may have to resort to nerve blocks. Directly injected analgesics in to the dermatome ( the nerve root)
The majority do not get the complications after the initial rash vanished and hope you will recover soon
The other predisposing conditions not applicable to you but for completeness are are those patients with HIV and those with Hodgkin Lymphoma.
Another bit about shingles;
Although herpes zoster is not as contagious as the primary varicella (chicken pox) it can still be transmitted to non immune subjects.
About 20 percent with HZ can develop post herpatic neuralgia.
In some instances when the pain preceded the rash it can be diagnosed as due to myocardial infarction (heart attack )
Ocular complications occur in 50 percent of cases.
I have seen few cases of herpes with and without the complications.
I am sure you must be having the best treatment and I wish you a speedy recovery.
Very kind regards and best wishes
Conrad
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12 Jun 2020, 17:28 (15 hours ago)
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Dear Conrad (we are very informal on this blog!),
ReplyDeleteThank you for this very informative email. What are your thoughts about the shingles vaccine? Should Lucky get it even if he has had one bout of shingles?
Hi,Srianne,
ReplyDeleteConrad might have exhausted with his recommendations or he is busy with his clinical commitments.
My research work consisted of reading Medical literature about available avenues for the management of Postherpetic neuralgia.
Reading through the management protocol from Mayo clinic,I find that no single treatment relieves postherpetic neuralgia for everyone.It often takes a combination of treatments.
Anticonvulsants,Lidocaine skin patches,Capsaicin patch,antidepressants,Opioids,steroid injections,life style and home remedies,topical analgesia and anaesthetic patches.
persistent chronic pain may need the help of pain clinic.
The medical management consists of anticonvulsants(gabapentin,pregabalin)
antidepressants(Amitriptyline,nortriptyline,Duloxetine,venlafaxine)
Opioids(tramadol,oxycodone)only short term therapy
Steroid injections(intrathecal,epidural)
Life style and home remedies-wearing comfortable clothing,capsaicin patches,topical analgesics& anaesthetics(Aspirin crushed and mixed into an absorbing cream or lidocaine cream might reduce skin hypersensitivity.Using cold patches also can help.
Resort to practicing meditation,which will take the mind away from the chronic pain.CBT may not be available in SriLanka.I am sure there are plenty of Acupuncture therapists in Private practice.
Wish,Lucky is in the correct tract with regard to his management.
It is nice to keep the brain active by reading on common day medical scenarios,in spite of the advancing age.
Hi,
ReplyDeleteSpeedy,Have you got anything else to add to my blog.I am sure you have seen enough of PHN,while working in SriLanka,as a junior and a Neurologist.I can not remember seen any cases during my student days and 10 yrs service,in SriLanka.I have treated a few cases during my service to NHS.Surely,you must have come across at least a few during your work as a Consultant in the NHS.As you are well aware,uncomplicated cases are tackled at Primary care level and there are enough guidelines,for use.
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