Saturday, 30 November 2013

Shingles - The Symptoms

I. Shingles also known as herpes zoster or zona is defined as a viral disease with condition of a painful, blistering skin rash on one side of the body of  that can continue to be painful even after the rash have long disappeared(1), as a result of varicella-zoster viral causes of a nerve and skin inflammation.

II. Symptoms
1. Headache
There is a report of a 60-year-old man presented after burning the roof of his mouth on hot soup five days earlier. The burned sensation resolved after one day; however, a couple of days later, he noticed tingling on the right side of the hard palate that progressed to a scalded sensation. This was accompanied by tenderness along the right temporal area and discomfort below the right ear. He denied a history of oral lesions. Doctors in the  Mayo Clinic, the presence of multiple vesicles that vary in size and are confined to the right side of the hard palate (i.e., cranial nerve V2 distribution) accompanied by neuralgia and erythema in ipsilateral cutaneous portions of the right trigeminal nerve suggests herpes zoster over oral herpes simplex virus (HSV) infection(2).

2. Other symptoms
Dr. Goh CL, and Dr. Khoo L. at the Institute of Dermatology, National Skin Center, in a retrospective study of the epidemiology and morbidity of herpes zoster and the risk factors for herpes zoster morbidity in Singapore,  suggested that The common presenting symptoms were pain (90%), feelings of helplessness and depression (20%), and flu-like symptoms (12%). The commonest prodromes were pain (41%), itching (27%), and paresthesia (12%).  Pain was experienced by almost all (95%) patients during the course of their disease. It tended to be more severe in older patients. Burning (26%), stabbing (15%), and shooting (15%) pain were the most common types experienced. Post-herpetic neuralgia was significantly more common in older patients. The prevalence of post-herpetic neuralgia decreased over time in all age groups. A higher proportion of older patients (more than 50 years of age) (20%) suffered from post-herpetic neuralgia compared with younger patients (less than 30 years of age) (7%) (not significant). Patients in all age groups considered acute pain (46%) and persistent pain (25%) to be their most unbearable symptoms during the course of herpes zoster. The most significant problems caused by herpes zoster pain were insomnia (25%), misery (feeling helpless and depressed) (20%), limitation of movement (9%), and inability to continue work (8%).(3)

3. Not all patients with herpes zoster adjacent to the eye will develop ocular involvement, but in those that do, there can be a wide variety of manifestations
a. Eyelid with Rash and vesicles in acute case and Scarring, loss of lashes in chronic case
b. Conjunctiva with Conjunctivitis in acute case
c. Cornea with Corneal ulcers in acute case and Corneal inflammation and scarring, loss of corneal sensation in chronic case.
d. Retina with Retinitis in acute case and Cystoid macular edema (swelling of the central retina) in chronic case
e. Etc.(4)
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