Practice diagnosis and treatment of shingles

2021-03-25 12:00 AM

The shingles rash usually goes away on its own after a few weeks, with no complications. About 50% of people with shingles after the age of 60 can experience pain and irritation in the affected area, lasting up to 6 months.

Shingles, also known as herpes zoster, is a viral infection caused by the virus that causes chickenpox, the varicella-zoster virus.

Shingles have a fairly high prevalence. In the United States, about 20% of the population has it at some point in their lives, and about half a million people get it each year. The incidence increases with age and is more common in people with compromised or weakened immune systems.

Reason

The direct cause is the varicella-zoster virus, but the mechanism of the disease has not been completely clarified. The currently accepted theory is that after having chickenpox, the varicella-zoster virus enters the nerve tissue on either side of the spine. For this reason, shingles always develop on one side of the body. Viruses reside in nerve tissues for many years under the control of the body's immune system. When there is a reason for the body's immune system to weaken, such as old age, disease, injury ... the virus will start to work and cause inflammation of nerve cells. Blisters begin to develop on the skin just above the inflamed nerve cells, forming a shingles rash that is characteristic of the disease.

The shingles rash usually goes away on its own after a few weeks, with no complications. About 50% of people with shingles after the age of 60 can experience pain and irritation in the affected area, lasting up to 6 months.

A shingles rash can provide lifelong immunity to the disease.

Possible complications

Secondary bacterial infection of the skin, usually caused by scratched blisters, with yellow or scaly patches of skin.

Neuropathic pain that lasts after the rash has gone, is common in the elderly.

Diagnose

Initially, the patient feels tingling or maybe a burning sensation in the affected area. Over the next 24 hours, a series of herpes will emerge. Usually small red bumps at first, then become itchy, then blister, and gradually develop into pustules, crusting, and eventually scaring.

The shingles rash usually appears only on one side of the body, most commonly areas extending from the upper half of the spine to the chest, but areas of the face, abdomen, and limbs are sometimes affected. 

Treatment

Often use pain relievers to relieve symptoms.

When there are signs of secondary infection, treat with antibiotic ointment or cream on the skin, or take flucloxacillin 250mg oral tablet 4 times a day.

To treat neuralgia after the rash has resolved, amitriptyline 25mg every evening, increasing the dose to 25mg 3 times daily for young patients. Can also be replaced by carbamazepine 100mg per day, can increase the dose to 100mg, 4 times per day. There is evidence that the pain caused by shingles can be mitigated when taking valaciclovir oral tablet at a dose of 1g, 3 times daily for 7 days in patients over 50 years old, within 72 years. hours immediately after symptoms appeared.

If the shingles rash involves the eyes, refer the patient to an ophthalmologist for examination. If the rash spreads rapidly, the patient should be referred for hospital treatment.