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11.18 Herpes Zoster (Shingles)

Presenhtion: Patients complain of pain, paresthesia, or an itch that covers a specific dermatome and then develops into a characteristic rash. Prior to the onset of the rash, zoster can be confused with pleuritic or cardiac pain, cholecystitis, or ureteral colic. Approximately 3-5 days from the onset of symptoms, an eruption of erythematous macules and papules will appear, first posteriorly then spreading anteriorly along the course of the involved nerve segment. In most instances grouped vesicles will appear within the next 24 hours. Herpes zoster most often occurs in the thoracic and cervical segments.

What to do:

What not to do:


Zoster results from reactivation of latent herpes varicella/zoster (chickenpox) virus residing in dorsal root or cranial nerve ganglion cells. Two-thirds of the patients are over 40 years old. This is a self-limiting, localized disease and usually heals within 3-4 weeks. Postherpetic neuralgia in patients over 60 years old, however, can be an extremely painful, recurrent misery. Before the availability of anti-viral agents, the best prophylaxis was systemic corticosteroids, but these have not been shown to improve outcome when added to a week of anti-viral treatment.


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD