Shingles and Pityriasis

Question 1

Who is susceptible to shingles?

Answer 1

anyone who had chicken pox (even if it was sub-clinical)
-it is the re-activation of chicken pox later in life

Question 2

What are the differences between shingles and chicken pox?

Answer 2

chicken pox:
-can be passed on
-new varicella-zoster virus
-itchy rash over body
-milder
-affects children more
shingles:
-cant be passed
-reactivated varicella-zoster virus
-painful rash localized
-more serious
-affects adults more

Question 3

What are the symptoms of shingles?

Answer 3

before rash appears, pain is possible
small red blisters along nerve pathways
blisters will break–>oozing/crusting
USUALLY unilateral

Question 4

How long does shingles last?

Answer 4

3-4 weeks

Question 5

About how long does shingles appear after chicken pox?

Answer 5

~50 years after chicken pox

Question 6

Where are the most common sites for shingles?

Answer 6

T1 to L2 (upper back/chest to waist area)

Question 7

True or false: shingles can present without a rash

Answer 7

true

Question 8

What is the treatment for the acute phase of shingles?

Answer 8

antivirals within 72 hours of rash initial appearance
analgesics (acet, NSAIDs)
for itch-cool compress or calamine

Question 9

What is the critical aspect of treating the acute phase of shingles with antivirals?

Answer 9

hitting it within 72 hours of rash appearance

Question 10

Which age group are the antivirals most effective in for the treatment of the acute phase of shingles?

Answer 10

patients older than 50
-if younger than 50 recommend non-pharm or OTC treatment
-can consider antivirals for those <50yrs if patient requests

Question 11

What are the dosage regimens of the antivirals for the acute phase of shingles?

Answer 11

acyclovir 800mg five times a day
famciclovir 500mg three times a day
valacyclovir 1000mg three times a day
all are for 7 days

Question 12

Can NSAIDs be used for the following forms of the zoster virus: chicken pox, shingles (acute), shingles (chronic) ?

Answer 12

chicken pox: no
shingles (acute): yes
shingles (chronic): no

Question 13

What has NSAID treatment for chicken pox associated with?

Answer 13

life-threatening bacterial skin infections

Question 14

What happens in 10-15% of shingles cases?

Answer 14

development of post-herpetic neuralgia for months/years

Question 15

What is post-herpetic neuralgia?

Answer 15

chronic form of shingles
rash is gone but the virus is still doing damage
nerve pain

Question 16

What is the treatment of PHN?

Answer 16

TCAs
gabapentin/Lyrica/carbamazepine
capsaicin

Question 17

Differentiate between somatic and neuropathic.

Answer 17

somatic: traumatic pain
neuropathic: pain all the time

Question 18

True or false: NSAIDs are considered effective in treating neuropathic pain

Answer 18

false

Question 19

What is capsaicin used for?

Answer 19

PHN
-not for acute shingles (rash phase)

Question 20

What is the dosing of capsaicin for PHN?

Answer 20

TID to where the pain appears to be
not dosed PRN

Question 21

Why is capsaicin not dosed PRN?

Answer 21

it needs consistent application in order to deplete Substance P in the nerve fibers

Question 22

What are the common side effects of capsaicin?

Answer 22

burning
stinging
skin redness

Question 23

True or false: an old man with shingles could spread chicken pox to a kid

Answer 23

true
shingles cant give someone shingles but it can give someone chicken pox

Question 24

Which shingles vaccine is considered to be the more effective vaccine?

Answer 24

Shingrix
-better than Zostavax
-2 doses
-immunity lasts 4 years

Question 25

What is the presentation of pityriasis?

Answer 25

a rash that starts with one large pink-red scaly blotch
more spots develop in the following weeks
upper back or lower back are common (Christmas Tree Rash)
most common in young adults
unknown cause (viral?)
not contagious

Question 26

How long does pityriasis last?

Answer 26

6-8 weeks

Question 27

What is the treatment for pityriasis?

Answer 27

generally nothing
maybe anti-itch products (Jeff would go calamine)

Question 28

If you are suspecting pityriasis in a derm case, what would be a good question to ask?

Answer 28

“Did this all start with one main spot on their back?”

Question 29

Which conditions is pityriasis similar to?

Answer 29

tinea
psoriasis
eczema
hives

Question 30

What is lupus?

Answer 30

chronic inflammatory disease that can affect almost any part of the body
no two people have identical forms
most common in women (especially 15-45 yr olds)

Question 31

What is a classic symptom of lupus?

Answer 31

butterfly rash
-but lupus is a very broad condition

Question 32

What is a pretty big hint that the skin condition is psoriasis, and not pityriasis?

Answer 32

scalp involvement
-pityriasis commonly hits the chest and back