An insight into a nagging dosh often called so by Indians in which a stripe of blisters occur anywhere on the patient’s body, wrapping around it like a snake.
Introduction
Sarpasutta often referred to as in local language and known by names like Shingles or Herpes Zoster is a viral disease often characterized by a painful rash with blisters on the skin in a localized area. It occurs in a strip-like pattern either on the left or the right side of the body or face. It is caused by a virus called Varicella zoster virus which is the same virus causing chicken pox thus there is a close relationship between the lifecycle of both of these diseases. It is considered as a continuation of chickenpox infection in which even after this infection is resolved, the virus lives in one’s body for years in the dorsal root ganglia and later reactions to Herpes Zoster.
Fig: Shingles
Clinical features
The patients with this virus latent in their body show reactivation signs with the rash formation on the trunk along the dermatome, most commonly being T5 and T6. The most frequently involved cranial nerve dermatome is the ophthalmic division of the trigeminal nerve.
Depending on the skin tone, the rash can appear dark pink, dark brown, or purplish. The rash is painful, itchy or tingly which develops into a cluster of vesicles. These vesicles continue to form over three to five days and progressively dry and crust over. Healing takes place within two to four weeks but might result in permanent pigmentation changes and scarring on the skin. They can appear anywhere on the body having dermatomes in relation. In some, it occurs in and around the eyes referred to as ophthalmic herpes zoster. A blistering rash may appear on your eyelids, forehead, and sometimes on the tip or side of your nose. A throbbing sensation may take place around the eyes accompanied by redness, swelling and blurred vision. Although the rash may disappear, there is persistent pain due to nerve damage. A second location common for its appearance is the posterior region of one’s body. They may vary from developing on one side of the waistline to stripes of blisters on one side of one’s back or lower back region. A third commonly noticed region is one’s buttocks. It’s restricted only to either of the buttocks. The initial symptoms include tinging, itching or pain followed by a red rash or blister formation. This pain may give rise to insomnia in May of the patients.
Treatment
The treatment of herpes zoster mainly should focus on areas of treatment of acute viral infections, the acute pain associated and prevention of any complications.The medications include antiviral agents which have been shown to reduce the duration of herpes zoster as well as its severity of pain. But the criteria are only applicable to those who receive these medications within 72hours of onset. The main drug under this is Acyclovir prototype antiviral drug is a DNA polymerase inhibitor that is given orally but intravenously in immunocompromised patients who are unable to take medications orally. Corticosteroids including Prednisone used in conjunction with acyclovir have been shown to reduce the pain associated with herpes zoster. The reason is decreasing the degree of neuritis caused by active infection and with reduced residual damage to affected nerves.Analgesics are given to reduce the mild to excruciating pain. If severity increases addition of narcotic medication is given.Lotions containing calamine may be used on open lesions to reduce pain and pruritus. Once the lesions have crusted over, capsaicin cream may be applied. Topically administered lidocaine and nerve blocks may also help in reducing pain.
Conclusion
In most of the cases Herpes Zoster is self limiting and suffices with analgesics. It can affect any age group. The requirement of herpes zoster increases with advancing age.More studies are required to confirm the gender specificity, seasonal variations, and regional distribution of herpes zoster.Despite several therapeutic modalities for herpes zoster and its complications, the treatment remains a challenge.
Pratiksha Baliga, Youth Medical Journal 2022
References
[1]Clinic, C. (2020). Shingles (herpes zoster): Symptoms, treatment & prevention. Cleveland Clinic. Retrieved November 29, 2021, from https://my.clevelandclinic.org/health/diseases/11036-shingles.
[2]Camila K Janniger, M. D. (2021, July 22). Herpes zoster. Practice Essentials, Background, Pathophysiology. Retrieved November 29, 2021, from https://emedicine.medscape.com/article/1132465-overview.
[3]Practo Health Wiki. (n.d.). Shingles/herpes zoster: Symptoms, complications, and treatment. Practo. Retrieved November 29, 2021, from https://www.practo.com/health-wiki/shinglesherpes-zoster-symptoms-complications-and-treatment/72/article.
Youth Medical Journal 