Herpes Zoster Skin Disease Diagnosis and Treatment Quick View

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Herpes Zoster Diagnosis and Treatment

Isolation of VZV in tissue culture, detection of VZV DNA by PCR, or direct immunofluorescent staining of cells from the lesion base

Herpes Zoster

Seroconversion or a fourfold or greater rise in antibody titer between convalescent- and acute-phase serum specimens. The fluorescent antibody to membrane antigen (FAMA) test, immune adherence hemagglutination test, and enzyme-linked immunosorbent assay (ELISA) are the most frequently used techniques.
Note the fluid filled vesicles, on one side of the body, affecting one dermatome. The distribution is diagnostic of Herpes Zoster (Shingles). Redness around the vesicles denotes active stage.
Eruption of grouped vesicles on an erythematous base usually limited to a single dermatome (“shingles”); disseminated lesions can also occur, especially in immunocompromised pts. Tzanck preparation reveals multinucleate giant cells; indistinguishable from herpes simplex except by culture. Postherpetic neuralgia, lasting months to years, may occur, especially in the elderly
Very early eruption is seen over at the back end

• Zoster of the facial nerve presents with lesions in the external auditory canal (Ramsay Hunt syndrome)
• Disseminated zoster may present with widespread cutaneous and visceral lesions
• Extensive and haemorrhagic vesicles may develop in patients with AIDS
the redness of skin which appears first. Then tiny vesicles form, and gradually enlarge filled with a clear fluid.The second picture shows a later stage , where vesicles are drying and scabs are formed
Trigeminal zoster may affect:: the ophthalmic nerve (causing severe conjunctivitis)
- the maxillary nerve (causing vesicles on the uvula or tonsils)
- the mandibular nerve (causing vesicles on the floor of the mouth and on the tongue
Observe the blebs and vescicles over the left side of the abdomen and back, which stop at the midline, at both ends.
Painful, Vescicular rash stopping in midline is the classic picture of Herpes zoster, which affects a single dermatome.
The redness around the blebs, and fluid filled blebs, means that it is acute erupting rash. So anti-viral drugs should be given.
Later scabs will form,and then fall off

Antiviral therapy: Acyclovir for children <12 years of age (20 mg/kg q6h, if initiated early in disease) and for adolescents and adults (800 mg five times daily for 5–7 days for chickenpox of le24 h duration) is recommended. Valacyclovir and famciclovir are probably as efficacious or more so.
Good hygiene, meticulous skin care, and antipruritic drugs are important to relieve symptoms and prevent bacterial superinfection of skin lesions.
Zoster: Lesions heal more quickly with antiviral treatment: acyclovir, 800 mg five times daily for 7–10 days; famciclovir, 500 mg tid for 7 days (one study also showed twofold faster resolution of PHN with this agent); or valacyclovir, 1 g tid for 5–7 days.