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Herpes zoster, or shingles, is a painful blistering rash caused by reactivation of the herpes varicella-zoster virus. Herpes zoster can occur in childhood but is much more common in adults, especially the elderly, sick or immune suppressed.
The first sign of herpes zoster is usually pain, which may be severe, in the areas of one or more sensory nerves, often where they emerge from the spine. Post-herpetic neuralgia is defined as persistence or recurrence of pain more than a month after the onset of shingles.
The chosen drug should be stopped if it does not produce the desired effect or causes unacceptable side effects at appropriate dose and duration. Amitriptyline, imipramine, dothiepin, clomipramine, desipramine and doxepin have been shown to have analgesic effects in patients with neuropathic pain, independent of their antidepressant action.
Tricyclics may also have analgesic effect when used topically, but no topical formulation is available in New Zealand. Although SSRIs have some analgesic properties and are safer, they appear to be less effective than the tricyclics. These have widely differing methods of action so it is logical to try other agents if the first is unsuccessful.
Gabapentin may have an action on the alpha delta 2 subunit of a calcium channel and inhibit glutamate release. L’herpes zoster oticus e un’entita clinico-patologica caratterizza da un’infiammazione a carico della conca auricolare sostenuta dal virus della varicella-zoster. Il virus della varicella-zoster (VZV) e un Herpesvirus responsabile della varicella e dell’herpes zoster. Attivazione umorale: i linfociti B attivati producono anticorpi di classe IgM e poi IgG in grado di ‘‘rivestire’’ le particelle virali facendo in modo che esse non possano piu legarsi al loro recettore cellulare. Attivazione citotossica: le cellule infettate da VZV espongono i peptidi virali attraverso le MHC di classe I. Il quadro infiammatorio si caratterizza da otalgia piu o meno intensa, stato astenico ed iperpiressia. L’esame obiettivo risulta essere sufficiente a porre diagnosi se svolto in un adeguato contesto anamnestico.
La sintomatologia dolorosa tende a persistere a lungo, anche dopo risoluzione del quadro infettivo-infiammatorio.
Albera e Rossi, Otorinolaringoiatria – II edizione, Torino, Edizioni Minerva Medica, 2008.
If you have had chicken pox during the initial stages of your life, then you are probably, at the risk of developing Shingles or Herpes Zoster disease, sometime later in your life. But, there is no need to panic, as this condition does not necessarily appear in all the people that have had chicken pox.
The children who have had chicken pox, when they were less than one year old, or people who are above the age of fifty, are more prone to this disease than normal healthy people. Herpes Zoster is a painful condition of the skin, which causes blisters and rashes on the affected area.
Due to some reasons, which are not yet very clear, this virus becomes active again after some time and causes Herpes zoster, leading to highly irritable and painful rashes, leading to equally painful blisters.
In the beginning of this infection, you may feel tingling, pain and burning on some parts of your skin, which may later on develop rashes. The treatment needs to be started within a time span of 72 hours, when the symptoms start appearing. Patients suffering from mild symptoms of Herpes Zoster may take analgesics by prescription or simply over the counter, to get relief from pain. Some doctors also prescribe anti-histamine tablets or anti-histamine lotions, to their patients.

Patients can apply OTC lotions containing calamine, for example, Caladryl, on the skin for soothing effect.
Corticosteroids are administered orally to the patients suffering from Herpes Zoster, to enhance their healing process.
Acyclovir, valacyclovir and famciclovir are the most commonly prescribed anti-viral drugs to the patients having Herpes Zoster virus. These drugs have been so far considered the most standard treatment for Herpes Zoster and are administered during moderate as well as acute conditions.
Also, staying away from stress and taking ample rest is recommended by the doctors, as your body is busy fighting off the virus and so, it requires complete rest. Herpes Zoster or Shingles is a condition that has no cure, and it wears off in 3 to 4 weeks, by itself.
But, the above mentioned treatments are very effective in reducing the gravity of the situation and making it bearable. If diagnosed in initial stages, the treatments would become more effective and so, you may not have to go through that much of unbearable pain or irritation. It is infectious, resulting in chickenpox in those who have never developed primary immunity, both from virus in the lesions and in some instances the nose and throat. In uncomplicated cases recovery is complete in 2-3 weeks in children and young adults, and 3 to 4 weeks in older patients. Polypharmacy can be useful to allow lower doses to achieve analgesia but side effects and drug interactions can be risky.
More potent opioids are sometimes required short term, but can result in escalating dose requirements.
They have an effect on the inhibitory serotonergic pathway, noradrenergic pathway, sodium channels, NMDA receptors and adenosine receptors. In doses of up to 500 mg bd it is associated with many adverse effects including severe allergic rashes (toxic epidermal necrolysis), hepatic enzyme induction, hyperlipidaemia, hyponatraemia and weight gain.
In alcuni casi e possibile in coinvolgimento delle strutture vestibolo-cocleari con sindromi vertiginose ed ipoacusia. Nei bambini, in seguito all’esposizione dell’epitelio respiratorio di laringe, trachea o bronchi al VZV, si ha replicazione del virus nei linfonodi che drenano le strutture dell’albero respiratorio. Tali anticorpi hanno un ruolo protettivo nei confronti delle future infezione da VZV e possono essere prodotti anche in seguito alla vaccinazione con virus vivo attenuato (ceppo OKA). Tale sistema permette il riconoscimento di tali cellule da parte dei linfociti T CD8 che sono in grado di provocarne l’apoptosi. In rari casi, molto gravi, puo manifestarsi la sindrome di Ramsay-Hunt tipo II (paralisi del nervo faciale), sordita improvvisa per coinvolgimento del nervo cocleare e crisi di vertigine oggettiva per coinvolgimento del nervo vestibolare. In rari casi si puo assistere a paralisi del nervo faciale e deficit uditivo solitamente irreversibile. Also, those who have weakened immune system, due to long term illness or medications are also at the risk of developing this condition. This condition is caused by the virus, varicella zoster, which also causes chicken pox. Actually, once a person has been infected by chicken pox, this virus goes to certain nerves of his body and lays in dormant or inactive stage for years. Once these rashes start appearing, accompanied with other symptoms, like fever, headache and a persistent sense of malaise, you should rush to see your dermatologist. Usually, this condition subsides in 2 to 4 weeks, but it is better to get treatment to reduce its severity and pain. OTC (over the counter) medicines like aspirin, acetaminophen and ibuprofen can be taken to reduce the pain in case, it is mild, but in severe cases, you may have to resolve to prescription drugs, like, morphine and other narcotics.
These anti-histamine tablets when taken orally, reduce the itching and same effect is derived from local application of anti-histamine creams and lotions over the skin having Shingles.
These antibiotic lotions reduce the burning sensation and pain and promote drying of the blisters.

Xylocaine or Lidocaine and nerve blocks are also applied externally, to reduce the pain and inflammation of infected parts. Patients can also take starch bath and colloidal oatmeal bath, which act as soothing agents for blisters, to get relief. These anti-viral drugs help fight against the virus that causes this condition and are quite successful in shortening the duration of infection. It is a highly contagious disease, so you should keep your belongings to yourself and prevent direct physical contact with others. The most important step that should be taken in this regard is consulting your doctor, as soon as the symptoms start appearing, preferably within 24 hours. Like herpes simplex, the virus persists in selected cells of dorsal root ganglion before it is reactivated.
Within one to three days of the onset of pain, crops of closely grouped erythematous papules develop within the unilateral dermatome(s).
Muscle weakness arises in about one in twenty patients because the motor nerves are affected as well as the sensory nerves. Anticholinergic effects include dry mouth, blurred vision, constipation, urinary hesitancy, tachycardia and ejaculatory difficulty. The dose should be very slowly increased over six weeks up to 400mg once daily, to reduce the risk of skin rash. A seguito di questa localizzazione si ha la ‘‘prima viremia’’: in questa fase il virus viene trasportato dal torrente ematica in tutti i distretti corporei, compreso il tessuto sottocutaneo e la cute. La reazioni immunitaria nei confronti delle cellule della cute e responsabile dell’esantema tipico della varicella (macula, papula, vescicola, pustola, crosta). Questo significa, ad esempio, che il gruppo neuronale che e responsabile dell’innervazione cute del dorso puo essere infettato da VZV dopo una comune varicella; in questi neuroni VZV entra in latenza (assenza di infezione clinicamente manifesta).
A livello della cute del padiglione auricolare sono presenti le tipiche vescicole o pustole che si trasformano in croste in seguito a rottura. L’impiego di antibiotici va limitato ai casi in cui sia manifesta la sovrainfezione batterica. Viceversa, la sintomatologia vertiginosa, intensa nei primi 2 giorni, tende a scomparire in circa 2 settimane.
The external dust particles can make the condition worse and elongate the process of healing, so maintain your personal hygiene.
New papules continue to appear for several days, each blistering or becoming pustular then crusting over. The pain may be continuous and burning with increased sensitivity in the affected areas, or a spasmodic shooting type, or, rarely, itching and crawling (formication). As there are differing adverse effects, it is sometimes worth trying several different agents.
In seguito ad una riduzione della sorveglianza immunitaria (malattie influenzali, immunosoppressione farmacologica, stress, anziani defedati) VZV puo riattivarsi e percorrere in senso contrario i nervi per manifestarsi nuovamente nella porzione cutanea corrispondente; la manifestazione clinica corrispondente e chiamata ‘‘herpes zoster’’ o fuoco di Sant’Antonio. There is a 50% chance of complete recovery and in time some improvement can be expected in nearly all cases. The overlying skin is numb or exquisitely sensitive to touch (hyperaesthesia and allodynia).
Se la latenza del virus avviene a carico del nervo faciale, lo zoster puo manifestarsi a livello della cute del padiglione auricolare, provocando l’herpes zoster oticus.
Other side effects include dry mouth, peripheral oedema, weight gain, abnormal gait, amnesia, confusion, hypaesthesia, abnormal thinking, dyspnoea, amblyopia.

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