Herpes zoster syndrome (shingles)

158 Herpes zoster syndrome (shingles)



Instruction


Look at this patient.



Salient features



History




• Pain, particularly in the ophthalmic branch of the trigeminal nerve (Fig. 158.1), and in the lower thoracic dermatomes (postherpetic neuralgia occurs in about 50% of patients with zoster over the age of 60 years)


• Past history of chickenpox


• Presence of an underlying immunocompromised state (e.g. recurrent zoster indicates a poorer prognosis in patients with established AIDS). Zoster occurs at least seven times more frequently in homosexual men with HIV infection than in HIV-negative controls.


image

Fig. 158.1 Vesicular rash and pain in the ophthalmic branch of the trigeminal nerve.



Examination




• Vesicular rash along a dermatome (usually affects thoracic and lumbar dermatomes)


• Enlargement of a draining lymph node.


Remember: The virus affects both the posterior horn of the spinal cord and the skin supplied by sensory fibres that pass through the diseased root ganglion (Fig. 158.2).


image

Fig. 158.2 Rash in skin supplied by sensory fibres of the nerve.



Diagnosis


This patient has a vesicular rash along the sixth thoracic dermatome (lesion) caused by herpes zoster (aetiology), and has severe local pain (functional status).



Advanced-level questions




In which layer of the skin are the vesicles formed?


They are formed in the prickle-cell layer of the epidermis as a result of the ‘balloon degeneration’ of cells and serous exudation from the corium.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Herpes zoster syndrome (shingles)

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