Herpes zoster commonly known as shingles, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe. The initial infection with varicella zoster virus causes the acute illness chickenpox, and generally occurs in children and young people. Once an episode of chickenpox has resolved, the virus is not eliminated from the body but can go on to cause shingles; an illness with very different symptoms; often many years after the initial infection.
Shingles is a skin rash caused by the same virus that causes chickenpox. This virus is called the Varicella zoster virus (VZV) and is in the Herpes family of viruses. After an individual has chickenpox, this virus lives in the nervous system and is never fully cleared from the body. Under certain circumstances, such as emotional stress, immune deficiency (from AIDS or chemotherapy), or with cancer, the virus reactivates and causes shingles. In most cases of shingles, however, a cause for the reactivation of the virus is never found.
In an immunocompromised individual, perhaps years or decades after a chickenpox infection, 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 corresponding dermatome (an area of skin supplied by one spinal nerve) causing a painful rash. Although the rash usually heals within two to four weeks, some sufferers experience residual nerve pain for months or years, a condition called postherpetic neuralgia.
Anyone who has ever had chickenpox is at risk for the development of shingles, although it occurs most commonly in people over the age of 60. The herpes virus that causes shingles and chickenpox is not the same as the herpes viruses that causes genital herpes (which can be sexually transmitted) or herpes mouth sores. Shingles is medically termed Herpes zoster.
â€¢ Varicella zoster virus.
SITE OF PATHOLOGY
â€¢ Posterior root ganglion.
â€¢ Physical injury.
â€¢ Mental trauma.
â€¢ Febrile illness.
â€¢ Any condition decreasing local skin resistance.
â€¢ Adults, old subjects.
â€¢ 7-21 days.
CLINICAL FEATURES of Herpes Zoster
â€¢ Trunk (intercostal nerves).
â€¢ Face (trigeminal distribution).
â€¢ Neck (cervical).
The first symptom is usually one-sided pain, tingling, or burning. The pain and burning may be severe.
Red patches on the skin form, followed by small blisters that look very similar to early chickenpox. The blisters break, forming small ulcers that begin to dry and form crusts. The crusts fall off in 2 to 3 weeks.
The rash usually involves a narrow area from the spine around to the front of the belly area or chest. It may involve face, eyes, mouth and ears.
Additional symptoms may include:
â€¢ Abdominal pain
â€¢ Difficulty moving some of the muscles in the face
â€¢ Drooping eyelid (ptosis)
â€¢ General ill-feeling
â€¢ Genital lesions
â€¢ Hearing loss
â€¢ Joint pain
â€¢ Loss of eye motion (ophthalmoplegia)
â€¢ Swollen glands (lymph nodes)
â€¢ Taste problems
â€¢ Vision problems
â€¢ Severe neuralgic pain.
â€¢ Local hyperaesthesia.
â€¢ Develop 3 days after onset of attack.
â€¢ Start as reddish plaques.
â€¢ Unilateral distribution, along segmental distribution of affected nerve root.
â€¢ Crops of vesicles appear.
â€¢ Speedily increase in size.
â€¢ Become confluent.
â€¢ Vesicles contain serous fluid.
â€¢ In few days content become opaque.
â€¢ Absorption of contents occurs.
â€¢ Brown adherent crusts form.
â€¢ In few weeks crusts separate leaving pigmented scars.
â€¢ Regional lymph glands enlarged, painful.
Involvement of the facial nerve may cause Ramsay Hunt syndrome, which can lead to loss of movement in the face, hearing loss, loss of taste, and other symptoms.
Other complications may include:
â€¢ Another attack of shingles
â€¢ Blindness (if lesions occur in the eye)
â€¢ Infection, lesions in body organs, encephalitis or sepsis in persons with weakened immune systems
â€¢ Post-herpetic neuralgia
â€¢ Secondary bacterial skin infections
â€¢ Ramsay-hunt syndrome (if geniculate ganglion is affected).
â€¢ Corneal ulceration (if ophthalmic division is affected).
GENERAL MANAGEMENT of Herpez zoster / Shingles
â€¢ Light, nutritious, easily digestible diet.
â€¢ Keep affected parts clean.
â€¢ Adequate physical, mental rest.
â€¢ Arsenicum album.
â€¢ Hepar sulph.
â€¢ Mercurious solubilis.
â€¢ Ranunculus bulbosus.
â€¢ Rhus toxicodendron.
Homeopathic Remedies for Herpes zoster or Shingles
Herpes typically affects the lips, the face and intercostal region. The eruptions are confluent ith intense burning sensation in the blister. Patient is worse after midnight and from cold in any form. Patient feels better by warmth. Associated with herpes, patient feels very thirsty and gets prostrated very easily. Herpetic eruptions alternate with internal affections.
Great Prostration, with rapid sinking of the vital forces; fainting. The disposition is:
a. Depression, melancholy, despairing, indifferent.
b. Anxious, fearful, restless, full of anguish.
c. Irritable, sensitive, peevish, easily vexed.
The greater the suffering the greater the anguish, restlessness and fear of death. Mentally restless, but physically too weak to move. Indicated by its periodicity and time aggravation: after mid-night, and from 1-2 a.m. And by its intense restlessness, mental and physical: its anxiety and prostration.
Adapted to persons with impaired nutritional scrofulous diathesis who have a tendency to grow fat; herpes with burning and jerking pains which are worse in cold at night. Herpes with thick corrosive scabs which have yellow pus beneath them. Suppressed herpes causes central nervous system disorders.
Calc carb suits to person with Leucophlegmatic constitution, blond hair, light complexion, blue eyes, fair skin; tendency to obesity in youth. Psoric constitutions;
pale, weak, timid, easily tired when walking. Disposed to grow fat, corpulent, unwieldy. Children with red face, flabby muscles, who sweat easily and take cold readily in consequence. Large heads and abdomens; fontanelles and sutures open; bones soft, develop very slowly. Curvature of bones, especially spine and long bones; extremities crooked, deformed; bones irregularly developed. Head sweats profusely while sleeping.
Herpetic eruptions on shoulders, neck, around nipples and chin, face. Herpes preputialis. Herpes zoster. There is itching burning pain which is worse in open air, in clear fine weather and is bitter in damp weather and from walking.
Adapted to persons with dark hair and rigid fibre; weakly, psoric, with excessively yellow, sallow complexion; subject to affections of respiratory and urinary tracts.
Graphites has a special affinity for folds of skin, e.g. joints, behind ears, groins, neck. Herpes in obese females with delayed and scanty menses. Herpes appearing at climateric. Large blisters from umbilicus to the spine, mainly affecting left side. Itching spots on various parts of the body which oozes a watery sticky fluid. Itching as though foreign matter would pass out through the skin. Circular herpes, feels hard to touch and is wrinkled. The itching is worse at night, during and after mensturation and is better from wrapping up.
Suited to – Excessive cautiousness; timid, hesitates; unable to decide about anything. Fidgety while sitting at work. Sad, despondent; music makes her weep; thinks of nothing but death.
Face, hands, genitals and bends of knees and elbows are the commonly affected regions. Herpes after abuse of mercury. Adapted to persons with unhealthy skin which suppurates easily. Patients are highly sensetive to cold. Herpes zoster from spine forwards, especially the left side. The eruption is the seat of acute neuralgic pains which are worse at night; vesicles on an inflamed base associated with splinter like pains, severe itching and scratching. There is marked aggravation at naight, from cold; touch and the patient feels better in damp weather and from wrapping up wramly. Eapecially suited to persons with a sour body odour. Herpes circinatus.
For torpid lymphatic constitutions; persons with light hair and complexion, slow to act, muscles soft and flabby. The slightest injury causes suppuration. Diseases where the system has been injured by the abuse of Mercury. In diseases where suppuration seems inevitable, Hepar may open the abscess and hasten the cure. Oversensitive, physically and mentally; the slightest cause irritates him; quick, hasty speech and hasty drinking. Patient is peevish, angry at the least trifle; hypochondriacal; unreasonably anxious. Extremely sensitive to cold air, imagines he can feel the air if a door is opened in the next room; must be wrapped up to the face even in hot weather; cannot bear to be uncovered; takes cold from slightest exposure to fresh air.
Mercurius has a marked affinity for right side. Herpes of right forearm, wrist & hand. Herpes prepucialis of the right side extending across the abdomen. There is itching which changes to burning on scratching & shooting pains which are worse at night & in cold damp weather. Herpetic eruptions which are surrounded by small pimples. Herpes with a tendency to suppurate especially in persons with profuse sweat.
Nervous affections after suppressed discharges especially in psoric patients. Glandular and scrofulous affections of children.