Herpes zoster or zoster or shingles or zona,
is a viral disease characterized by a painful skin rash with blisters
often in a stripe in a limited area on one side of the body. The initial
varicella zoster virus (VZV) infection causes the acute (short-lived)
illness chickenpox in children and young people. After chickenpox has resolved,
the virus is not eliminated from the body but become latent in the nerve cell
bodies and sometimes in non-neural satellite cells of dorsal root, cranial
nerve or autonomic ganglion without causing any symptom. Years or decades
after a chickenpox infection (after age of 50 years), the virus may break out
of nerve cell bodies and travel down nerve axons to cause viral infection
of the skin in the region of the nerve. The virus may spread from one or more
ganglia along nerves of an affected segment and infect the area of skin
supplied by the spinal nerve (called dermatome) causing a painful
rash. Although the rash usually heals within three to five weeks, some
sufferers experience residual nerve pain for months or years, a condition
called post-herpetic neuralgia. Exactly how the virus remains latent in the
body, and subsequently re-activates is not understood.
Signs
and symptoms
The earliest symptoms of herpes zoster,
which include headache, fever and malaise, are commonly followed by burning
pain, itching, hyperesthesia (oversensitivity) or paresthesia ("pins
and needles" sensation, tingling, pricking or numbness). The pain may
be mild to extreme in the affected dermatome, sometimes aching, throbbing and
quick stabbing, agonizing pain occurs. The pain radiates along the path of a
single spinal nerve (a dermatomal distribution). In children,
herpes zoster is often painless.
The initial phase of 2 days to 3 weeks is
followed by the appearance of the skin rash. The pain and rash mostly occurs on
the body but can appear on the face, eyes or other parts of the body. At first
the rash may simulate to hives but herpes zoster skin changes are limited to a
dermatome normally resulting in a stripe or belt-like pattern that too, to one
side of the body and it never crosses the midline. Zoster sine herpete is
a condition “zoster without herpes" where a patient who has all of the
symptoms of herpes zoster except the characteristic rash.
Later the rash is tuned into painful, small
blisters filled with serous exudates, with the fever and general malaise.
The vesicles become cloudy or darkened as fill with blood. They crust over within
seven to ten days; which fall off and the skin heals, but sometimes, after
severe blistering, scarring and discolored skin remain.
Depending on the dermatome involved
some additional symptoms may occur. Herpes zoster ophthamicus involves the orbit of the eye, due
to the virus reactivating in the ophthalmic division of trigeminal nerve. The
symptoms may include conjunctivitis, keratitis, uveitis and optic nerve palsies that
can sometimes cause chronic ocular inflammation, loss of vision, and
debilitating pain. Herpes zoster oticus, or Ramsay Hunt syndrome
type II ( It has variable presentation which may include Bell’s palsy,
deafness, vertigo and pain) involves the ear. Here
the virus spreads from the facial nerve to the vestibulo-cochlear nerve.
Symptoms include hearing loss and vertigo (rotational dizziness).
Most people have history of episode of chickenpox in child
hood. Repeated attacks of herpes zoster are rare and rarely a patient suffers
more than three recurrences. Although it can occur at any age, but most commonly
occurs after the age of 50 years. In contrast to herpes simplex
virus the latency of VZV is poorly
understood. The virus has not been recovered from human nerve cells by cell
culture and the location and structure of the viral DNA is not known.
Virus-specific proteins continue to be made by the infected cells during the
latent period, so true latency, as opposed to a chronic low level infection,
has not been proven. Although VZV has been detected in autopsies of
nervous tissue, there is no method to find dormant virus in the ganglia in
living people.
Uncompromised immune system suppresses
reactivation of the virus and prevents herpes zoster. Why this suppression sometimes
fails is not known, but aging, immunosuppressive therapy, psychological stress,
or other factors impair immune system.
A person has no immunity to Varicella
zoster virus may get chickenpox but not shingles immediately. Until the herpes rash has developed crusts, a
person is extremely contagious. A person is not infectious before blisters
appear, or during post herpetic neuralgia (pain after the rash is gone).
Diagnosis:
Diagnosis is mostly made by a visual
examination of the rash, since the rash in a dermatomal pattern. In absence of
rash (early or late in the disease, or in the case of zoster sine herpete, a
condition in which pain occurs without appearance of rash), herpes zoster can
be difficult to diagnose.
Prevention:
A live vaccine for VZV exists.
Adults also receive an immune boost from contact with children infected with
varicell (chicken pox), a boosting method that prevents about a quarter of
herpes zoster cases among unvaccinated adults,
In a controlled study it was found that
intake of fresh fruit is associated with a reduced risk of developing shingles.
People who consumed less than one serving of fruit a day had three times more
risk than those who consumed more than three serving. For those aged 60 or
more, vitamins and vegetable intake had a similar association.
Treatment
The aims of treatment are to limit the severity and duration
of the episode and pain and reduce complications of post herpetic neuralgia. Post-herpetic
neuralgia is very rare in people less than 50 years age and it wears off in
time; even in people over 70 in 85% people the pain wore off one year after
their shingles outbreak.
Homoeopathic medicines
Homoeopathic
medicine is always prescribed on individualizing indications; the case given
here is a good example. Iris versicolor was selected for the specific location
of herpes that was right side of abdomen with acidity and constipation. Some of
the homoeopathic medicines commonly indicated for herpes zoster/zona are –
Iris versicolor,
Mercurius solubilis, Mezerium, Ranunculus bulbosus., Rhus toxicodendron, Arsenicum
album, Carbolicum acidum., Clematis, Graphites, Heper sulphuricum, Kali bichromicum.,
Kali chlororicum., Lachesis, Natrum muriaticum, Nitricum acidum., Petroleum,
Prunus spinosa., Sarsaparilla, Sepia, Silicea, Sulphur, Thuja, Variolinum.
Zona with neuralgic pain – Ars. alb., Dolichos, Kalmia, Mezerium, Ran.b.,
Stillingia sylvatica, Zincum metalicum.
With stomach complaints – Iris. ver.
Cold application ameliorates – Apis melifica.
Warm application ameliorates – Ars. alb.
Prognosis
The rash and pain generally subside within three to five
weeks, but about twenty percent patients develop post-herpetic neuralgia which
is a very painful condition and often difficult to manage. Sometime there
occurs zoster sine herpete due
to reactivation of the virus. Sometimes complications affect several
levels of the nervous system and cause many cranial neuropathies,
polyneuritis, myelitis or aseptic meningitis. Other complications that may
occur in some cases include partial facial paralysis (usually temporary),
ear damage or encephalitis. Chickenpox during pregnancy, may lead to infection
of the fetus and complications in the newborn but chronic infection or herpes are
not associated with fetal infection. Though the mechanism is not clear but after
a herpes zoster infection an increased risk of developing cancer has been
observed. Other
complications – Secondary bacterial infection, motor involvement – including
weakness especially in "motor herpes zoster". Eye involvement –
trigeminal nerve involvement (as seen in herpes ophthalmicus) should be
treated early and aggressively as it may lead to blindness. Involvement of tip
of the nose in the zoster rash is a strong predictor of herpes ophthalmicus.
Case – Mr. Ajit Bhatnagar 52 yrs.
Male married bank manager hindu
nonvegetarian
Diagnosis
– Herpes zoster.
The
patient was suffering from painful herpes eruption on right side of abdomen for
last three weeks which were persisting in spite of various treatments and
medication. He was also having indigestion, burning, sour eructation and
rumbling in abdomen with constipation.
03/12/09
Rx 1. Iris vers. 30 twice a day for 5 days.
2.
P. L. 200 two doses at 10 minutes interval.
08/12/09
Pains were relieved after second dose of Iris. Eruptions started drying. Bowel
clear and regular. Rumbling and eructation were relieved.
Rx 1. Rubrum 30
twice a day for 5 days.
2. P. L. 200
two doses at 10 minutes interval.
14/12/09
No pain or burning. No more eruption except marks. The patient was continued on
the last prescription for next 10 days. It was full recovery without after
pains of herpes in last 20 months.
Dr. M. K. Tyagi
D.H.M.S., Dip. N.I.H.
Research Officer
Research Officer
Sewa Mandir
Mobile" 09829157926
Email: manju_mkt2003@yahoo.co.in
