Herpes Zoster

Question 1

Who is the shingles vaccine available to?

Answer 1

people aged 70-79
the vaccine is live-attenuated and given subcutaneously

main CI: immunosuppression

Question 2

What is the management of shingles?

Answer 2

PO aciclovir

this reduces the incidence of post herpetic neuralgia

Question 3

What is post herpetic neuralgia?

Answer 3

most common complication from shingles

where the pain from shingles becomes chronic (constant or intermittent stabbing/burning pain) due to permanent herpes-zoster induced nerve damage

Question 4

How do you manage post herpetic neuralgia?

Answer 4

Paracetamol
Codeine may be prescribed
Gabapentin/Amitriptyline

Wear loose fitting clothes, apply protective dressing (e.g. cling film)

If severe, refer to pain clinic

Question 5

What is herpes zoster ophthalmicus? What are the symptoms/signs of it?

Answer 5

reactivation of the zoster virus involving the ophthalmic branch of the trigeminal nerve.

pain and altered sensation on one side of forehead
zoster rash affecting upper forehead and eyelid
general malaise, headaches, fever
conjunctivitis may also be seen

HSV keratitis is different as it is not associated with a cutaneous eruption in a dermatomal pattern

Question 6

What is the management of herpes zoster ophthalmicus?

Answer 6

Non pharmacological: avoid contact with those at risk of getting the infection

Aspirin, paracetamol, ibuprofen

Aciclovir orally 800mg