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Herpes zoster (or simply zoster), commonly known as shingles and also known as zona, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body (left or right), often in a stripe. The initial infection with varicella zoster virus (VZV) causes the acute, short-lived illness chickenpox which generally occurs in children and young adults. Once an episode of chickenpox has resolved, the virus is not eliminated from the body and can go on to cause herpes zoster often many years after the initial infection. Herpes zoster is not the same disease as herpes simplex, despite the name similarity; both the varicella zoster virus and herpes simplex virus belong to the same viral subfamily Alphaherpesvirinae.
Signs and symptoms
A case of shingles that demonstrates the typical dermatomal distribution, in this case C8/T1
The earliest symptoms of herpes zoster, which include headache, fever, and malaise, are nonspecific, and may result in an incorrect diagnosis.These symptoms are commonly followed by sensations of burning pain, itching, hyperesthesia (oversensitivity), or paresthesia ("pins and needles": tingling, pricking, or numbness). The pain may be mild to extreme in the affected dermatome, with sensations that are often described as stinging, tingling, aching, numbing or throbbing, and can be interspersed with quick stabs of agonizing pain.
Herpes zoster in children is often painless, but older people are more likely to get zoster as they age, and the disease tends to be more severe.
Pathophysiology
The causative agent for herpes zoster is the varicella zoster virus (VZV)—a double-stranded DNA virus related to the Herpes simplex virus. Most individuals are infected with this virus as children, and suffer from an episode of chickenpox. The immune system eventually eliminates the virus from most locations, but it remains dormant (or latent) in the ganglia adjacent to the spinal cord (called the dorsal root ganglion) or the ganglion semilunare (ganglion Gasseri) in the base of the skull.
Herpes zoster occurs only in people who have been previously infected with VZV; although it can occur at any age, approximately half of the cases in the USA occur in those aged 50 years or older.Repeated attacks of herpes zoster are rare, and it is extremely rare for patients to suffer more than three recurrences.
Treatment
The aims of treatment are to limit the severity and duration of pain, shorten the duration of a shingles episode, and reduce complications. Symptomatic treatment is often needed for the complication of postherpetic neuralgia. However, a study on untreated herpes zoster shows that, once the rash has cleared, postherpetic neuralgia is very rare in people under 50 and wears off in time; in older people the pain wore off more slowly, but even in people over 70, 85% were pain free a year after their shingles outbreak.
Analgesics
People with mild to moderate pain can be treated with over-the-counter pain medications. Topical lotions containing calamine can be used on the rash or blisters and may be soothing. Occasionally, severe pain may require an opioid medication, such as morphine. Once the lesions have crusted over, capsaicin cream (Zostrix) can be used. Topical lidocaine and nerve blocks may also reduce pain. Administering gabapentin along with antivirals may offer relief of postherpetic neuralgia.
History
Herpes zoster has a long recorded history, although historical accounts fail to distinguish the blistering caused by VZV and those caused by smallpox,ergotism, and erysipelas. It was only in the late 18th century that William Heberden established a way to differentiate between herpes zoster and smallpox,and only in the late 19th century that herpes zoster was differentiated from erysipelas. In 1831, Richard Bright hypothesized that the disease arose from the dorsal root ganglion, and this was confirmed in an 1861 paper by Felix von Bärensprung.
Use this medication on the skin only. Follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist.For the cream, gel, and lotion forms, apply a thin layer of medication to the affected area and rub in gently and thoroughly. You may want to use a cotton ball/swab or latex glove to apply the medication to avoid touching the medication with your hands.Do not apply the medication in the eyes, mouth, nostrils, or genitals. If you do get the medication in those areas, flush with plenty of water. Also, do not apply this medication to skin that is injured or irritated (e.g., cut, scraped, sunburned).Do not apply this medication immediately before or after activities such as bathing, swimming, sun bathing, or heavy exercise. Do not bandage or wrap the affected area or use a heating pad on that area. Doing so may increase the risk of side effects.After applying the medication, wash your hands unless you are using this medication to treat the hands. If treating the hands, wait at least 30 minutes after applying the medication to wash your hands.Use this medication regularly to get the most benefit from it. To help you remember, use it at the same times each day.This medication may sometimes take up to 2 months to work. Tell your doctor if your condition persists for more than 7 days, if it worsens, or if it keeps returning. If you think you may have a serious medical problem, seek immediate medical attention
Thismedication is used to treat minor aches and pains of the muscles/joints (e.g., arthritis, backache, sprains). It may also be used to treat nerve pain. Capsaicin works by decreasing a certain natural substance in your body (substance P) that helps pass pain signals to the brain.
How to use Salonpas-Hot topical
Use this medication on the skin only. Follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist.
For the cream, gel, and lotion forms, apply a thin layer of medication to the affected area and rub in gently and thoroughly. You may want to use a cotton ball/swab or latex glove to apply the medication to avoid touching the medication with your hands.
Do not apply the medication in the eyes, mouth, nostrils, or genitals. If you do get the medication in those areas, flush with plenty of water. Also, do not apply this medication to skin that is injured or irritated (e.g., cut, scraped, sunburned).
Do not apply this medication immediately before or after activities such as bathing, swimming, sun bathing, or heavy exercise. Do not bandage or wrap the affected area or use a heating pad on that area. Doing so may increase the risk of side effects.
After applying the medication, wash your hands unless you are using this medication to treat the hands. If treating the hands, wait at least 30 minutes after applying the medication to wash your hands.
Use this medication regularly to get the most benefit from it. To help you remember, use it at the same times each day.
This medication may sometimes take up to 2 months to work. Tell your doctor if your condition persists for more than 7 days, if it worsens, or if it keeps returning. If you think you may have a serious medical problem, seek immediate medical attention.
Warmth, stinging, or burning on the application site may occur. If any of these effects persist or worsen, contact your doctor or pharmacist promptly.
Coughing, sneezing, watery eyes, or throat irritation may occur if you breathe in the dried residue from the medication. Use caution to avoid inhaling the residue.
If your doctor has directed you to use this medication, remember that he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Stop using this medication and tell your doctor right away if you have any serious side effects, including: blistering/swelling at the application site, increased/unusual pain at the application site.
A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
Before using capsaicin, tell your doctor or pharmacist if you are allergic to it; or to zucapsaicin; or to hot peppers (from the Capsicum family); or to lidocaine or other local anesthetics that may be in your brand; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.
If you have any of the following health problems, consult your doctor or pharmacist before using this product: injured/irritated skin in the affected area.
If you are going to have an MRI test, tell testing personnel if you are using the patch. Some patches may contain metals that can cause serious burns during an MRI. Ask your doctor whether you will need to remove your patch before the test and apply a new patch afterward, and how to do so properly.
During pregnancy, this product should be used only when clearly needed. Discuss the risks and benefits with your doctor.
It is not known whether this product passes into breast milk. Consult your doctor before breast-feeding.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Before using capsaicin products containing lidocaine or other local anesthetics, tell your doctor or pharmacist if you also take class I antiarrhythmic drugs (such as mexiletine, procainamide, quinidine).
Capsaicin is very similar to zucapsaicin. Do not use medications containing zucapsaicin while using capsaicin.
If overdose is suspected, contact a poison control center or emergency room immediately.Symptoms of overdose may include: nausea, vomiting, loss of appetite, sweating, stomach/abdominal pain, extreme tiredness, yellowing eyes/skin, dark urine.
Notes
Acetaminophen does not cause the stomach and intestinal ulcers that NSAIDs such as aspirin, ibuprofen, and naproxen may cause. However, acetaminophen does not reduce swelling (inflammation) like the NSAIDs do. Consult your doctor for more details and to see which medication might be right for you.
Missed Dose
If you are taking this medication on a regular schedule and miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.
Storage
Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.
Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised May 2014. Copyright(c) 2014 First Databank, Inc.
