Dermatology: Herpes Zoster Essay

Dermatology: Herpes Zoster Essay

Dermatology: Herpes Zoster Essay

Dermatology: Herpes Zoster

Patients with Herpes Zoster have painful erythematous maculopapular rash distributed along 1-3 dermatomes, and may evolve into vesicles, rupture within 5 days, and form crusts, and necrotic bases. Malaise, myalgia, headache, itching, paresthesia, and photophobia may be present. Herpes Zoster is caused by reactivation of varicella-zoster virus leading to shingles.

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Differential Diagnosis

The differential diagnoses include Dermatitis herpetiformis, contact dermatitis, Coxsackievirus infection, cellulitis, superficial pyoderma, and acneform eruptions. Work-up includes history and clinical exam, Tzanck smear of vesicular fluid, PCR assay, direct fluorescent antibody testing, and CSF studies.

Treatment plan

 Pharmacological treatment includes Acyclovir cream, calamine lotion as an antipruritic and to prevent infections, and topical lidocaine. Antivirals decrease the time taken to form new vesicles, and prevent complications (Koshy et al., 2018). Analgesics for pain control and prevent postherpetic neuralgia (PHN) and other complications (Cohen, 2021). Adjuvant corticosteroids for patients with CNS or cranial nerve neuralgia, for resolution of symptoms and improving patient’s quality of life, prednisolone is preferred. Anticonvulsants like gabapentin are indicated for PHN. 

 Preventive measures

Prevention includes contact isolation for hospitalized patients. Recombinant zoster vaccine for patients above 50 years where vaccination is not contraindicated and immunocompromised persons (Gagliardi et al., 2019).

Appropriate referrals

Ophthalmologist consultation in patients with ocular involvement. Pain specialists for refractory or severe pain or in PHN. Neurologists may also be consulted for neurological complications such as Ramsay Hunt Syndrome or meningitis.

Screening tools

Zoster Brief Pain Inventory for assessing the severity of pain, and Zoster Impact Questionnaire to evaluate the effect of the disease on the patient’s life. Diagnostic-specific scales include the Ramsay Hunt Syndrome grading system and the eye disease quality of life questionnaire to assess visual function and impact on life.

Considerations for the Geriatric Population

  Geriatrics have a weak immune system and should receive zoster vaccination. They are also prone to severe complications of herpes zoster such as PHN which may lead to chronic pain. Moreover, they may have coexisting medical conditions and medications that may affect the course of the disease or interact with the treatment.

References

Cohen E. J. (2021). Commentary on Herpes Zoster and Postherpetic Neuralgia. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 73(9), e3218–e3219. https://doi.org/10.1093/cid/ciaa1192

Gagliardi, A. M., Andriolo, B. N., Torloni, M. R., Soares, B. G., de Oliveira Gomes, J., Andriolo, R. B., & Canteiro Cruz, E. (2019). Vaccines for preventing herpes zoster in older adults. The Cochrane Database of systematic reviews, 2019(11), CD008858. https://doi.org/10.1002/14651858.CD008858.pub4

Koshy, E., Mengting, L., Kumar, H., & Jianbo, W. (2018). Epidemiology, treatment, and prevention of herpes zoster: A comprehensive review. Indian Journal of dermatology, venereology and Leprology, 84(3), 251–262. https://doi.org/10.4103/ijdvl.IJDVL_1021_16

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Outline typical presentation, etiology, common differential diagnosis, typical diagnostic work-up, treatment plan including pharmacological and nonpharmacological interventions, preventative measures, appropriate referrals, screening tools/diagnostic-specific scales/tools (if any), and additional information that would be important to the geriatric population regarding one of the following conditions. Support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources.

Herpes Zoster

Dermatologic Findings Related to Systemic Disease