Shingles

Question 1

What is the classic look of shingles?

Answer 1

Rash only on one side of the body (unilateral), affects older ppl, pain can occur before the rash appears

Question 2

is chicken pox more common in children or adults?

Answer 2

Children
Children who have had chicken pox can get shingles when they are older
Chicken pox in children is very tolerable, shingles as adult = not so much

Question 3

What are shingles?

Answer 3

the re-activation of chickenpox virus (10%-20% of ppl)

Question 4

What could you see in a patient with shingles?

Answer 4

they tend to be older (50 years after the pox)
Pain is possible before the rash appears
Bumps turn into blisters over time
There will be small red blisters along nerve pathways
Blisters can break, causing oozing/crusting

Question 5

What are the most common sites for shingles?

Answer 5

T1 to L2 vertebrae
The virus lies dormant in these nerve pathways
trunk area and lower back

Question 6

What do we do if a patient comes in with no rash, but all the sx of shingles?

Answer 6

We can’t do anything without seeing the rash
We have to refer as beyond our scope

Question 7

What do we do if we see a patient with shingles on the face?

Answer 7

Medical territory, need MD assessment

Question 8

How long does shingles last for?

Answer 8

3-4 weeks

Question 9

What are the treatments for acute phase shingles?

Answer 9

Antivirals within 72 hours of rash’s initial appearance (otherwise won’t be effective)
Analgesics - acet or NSAIDs
cool compress/ calamine for the itch

Question 10

Can we put calamine on a shingles patient without a rash?

Answer 10

No, need the rash otherwise it will irritate the skin

Question 11

Can antivirals be used on everyone with shingles?

Answer 11

No, they work the best if the patients are over 50 years old

We can still give it to them if they are under if they request it

Question 12

How long are antivirals used for in shingles patients?

Answer 12

7 days

Question 13

What is the 50-50-50 rule?

Answer 13

American academy of family physicians recommends giving the antiviral within 50 hours of the rash, to people 50 years or older, and to those with 50 or more rash lesions

Age, hours, lesions

Question 14

Are shingles very common?

Answer 14

No, tinea is more common than shingles

Question 15

Can we use NSAIDs in chicken pox, acute shingles, or chronic shingles?

Answer 15

We can only use NSAIDs for the zoster virus in acute shingle cases

Question 16

What oral meds can be given to people under 20 years for chicken pox?

Answer 16

Acet for soreness -YES
ASA - No, due to Reyes syndrome
Ibu - no

Question 17

Why can’t ibuprofen be used for children with chicken pox?

Answer 17

because it has been associated with life-threatening bacterial skin infections

Question 18

Explain chronic shingles

Answer 18

Also known as post-herpetic neuralgia
The rash is gone, but the virus is still doin damage
The patient will experience nerve pain
Occurs in 10-15% of shingles cases

Question 19

What is the treatment for post-herpetic neuralgia?

Answer 19

TCAs - good for nerve pain
gabapentin/Lyrica/ carbamazepine
capsaicin

Question 20

What is the difference between neuropathic and somatic pain?

Answer 20

neuro - like hitting your funny bone, you will feel buzzing
somatic is outside damage such as banging your elbow

Question 21

Are NSAID such as ibu good for neuropathic pain?

Answer 21

No, use acet and TCAs because they are much better

Question 22

What is capsaicin? What is it good for?

Answer 22

It is in the same realm as rub A535
designed to irritate the skin, but it reduces substance P in nerves
Has a hospital smell to it - not well received by the public

We can’t use it for classic acute cases because the med will irritate the rash
It is for post-herpetic neuralgia only

Applied TID where the pain is
Needs constant application in order to depleted the substance P in the nerve fibers

Question 23

Can you get shingles from someone with shingles? Can you get chicken pox from someone with shingles?

Answer 23

No; yes

Question 24

What is the name of the more effective shingles vaccine? how is it administered? How long is the coverage?

Answer 24

The Shingrix vaccine 600$
there are 2 doses
immunity lasts for 4 years

Question 25

What is pityriasis?

Answer 25

It is a spotty rash that is not super common
It occurs in young adults
One large pink-red scaly blotch is characteristic followed by more red spots

Question 26

What is the special patch spot in pityriasis callled?

Answer 26

Herald patch

Question 27

Explain the clinical presentation and treatment for pityriasis

Answer 27

aka Xmas tree rash
6-8 weeks
not contagious
Tx - generally nothing, can use anti-itch products such as HC1% crm, anti-he, moisturizer, no hot showers

contact the Dr if over 3 months

Question 28

How common is the itch in pityriasis?

Answer 28

No itch 25%
Mild-mod itch 50%
severe itch 25%

Question 29

What is different about pityriasis compared to tinea, eczema, psoriasis, and hives?

Answer 29

tinea - does not spread nearly as fast
eczema - different spots and itchier
psoriasis - classic silver plaques seen - harder to differentiate with pity
hives - move around very fast, no scaling

Question 30

What is lupus erythematosus?

Answer 30

Characterized by a butterfly rash on the face
Very broad spectrum condition
chronic inflammatory disease
common in women between 15-45 years old