HERPES ZOSTER
(Shingles, Zona)

Causative agent is Varicella-zoster virus (VZV) belongs to Herpesvirus group. Neurotropic and dermatropic virus contaminates the people in childhood and varicella occurs as primary infection. After healing, virus deposits in the dorsal root of the spinal ganglions in medulla spinalis. Herpes zoster occurs with the highest frequency in those dermatomes in which the rash during varicella achieves the greatest density. Because areas of the skin with a denser rash during varicella transmit larger amounts of virus to the corresponding spinal ganglion.

Provoking factors as spinal trauma, x-rays, chronic infections (tuberculosis or syphilis), CO poisoning or malignancies (Hodgkin's disease) may interfere up to 50% of the cases. Other group is considered as idiopathic.

Herpes zoster involves one half of the body. Firstly pain occurs on a dermatome. This pain is felt especially as a half of a belt, because intercostals nerves are especially involved. Then grouped vesicles appear on this painful dermatome. Pain is a symptom that firstly appears and lastly disappears. Perineural fibrosis occurs in some of the patients, so the pain persists. The complication is called as "post-herpetic neuralgia".

Herpes zoster may spontaneously heal, but treatment is necessary for the severe pain. Acyclovir or its derivatives are useful, but they must be begun in the first 5 days of the pain. 5 x 800 mg/day acyclovir is used for one week. Additionally pain relieves systemically, moist compresses or powders locally may be useful.