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$Unique_ID{BRK03818}
$Pretitle{}
$Title{Herpes Zoster}
$Subject{Herpes Zoster Shingles Zona Acute Posterior Ganglionitis Geniculate
Zoster, also known as Ramsay Hunt Syndrome Ophthalmic Herpes Zoster Bell's
Palsy Chickenpox Herpes Simplex (Cold Sores) Trigeminal Neuralgia (Tic
Douloureux) }
$Volume{}
$Log{}
Copyright (C) 1987, 1988, 1989, 1991 National Organization for Rare
Disorders, Inc.
457:
Herpes Zoster
** IMPORTANT **
It is possible the main title of the article (Herpes Zoster) is not the
name you expected. Please check the SYNONYMS listing on the next page to
find alternate names, disorder subdivisions, and related disorders covered by
this article.
Synonyms
Shingles
Zona
Acute Posterior Ganglionitis
DISORDER SUBDIVISIONS
Geniculate Zoster, also known as Ramsay Hunt Syndrome
Ophthalmic Herpes Zoster
Information on the following disorders may be found in the Related
Disorders section of this report:
Bell's Palsy
Chickenpox
Herpes Simplex (Cold Sores)
Trigeminal Neuralgia (Tic Douloureux)
General Discussion
** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Herpes Zoster is a common central nervous system infection caused by the
varicella-zoster virus. This is the same virus that causes chickenpox. The
disorder is characterized by eruption of blisters, nerve pain, and severe
itching of the skin.
Symptoms
Preliminary symptoms of Herpes Zoster include chills, fever, and a feeling of
discomfort three or four days before distinctive features of the disease
develop. Pain may or may not occur along the site of the future skin
eruption. On the 4th or 5th day, characteristic crops of blisters appear on
a red base, distributed on skin areas that are served by one or more
posterior root nerve centers (ganglia) along the spine. The involved skin
area is usually hypersensitive, and the associated pain may be severe. The
eruptions occur most often in the chest area and may spread only on one side
of the body. They begin to dry and form scabs about the 5th day after their
appearance. Herpes Zoster rarely becomes generalized. If it spreads or if
the lesions persist beyond two weeks, additional special medical evaluation
may be necessary.
One attack of Herpes Zoster usually gives the patient immunity from
subsequent attacks. Most patients recover without any after effects except
for occasional scarring of the skin. However, in a minority of cases, nerve
pain (neuralgia) may persist for months or years, most frequently in elderly
persons.
Geniculate Zoster (Herpes Zoster Oticus or Ramsay Hunt Syndrome) involves
part of the facial nerve near the internal ear (geniculate ganglion). Pain
in the ear and facial paralysis (rarely permanent) may occur on the affected
side. Blisters may erupt in the external ear canal, the outer ear, the soft
palate, and the top part of the throat.
Ophthalmic Herpes Zoster involves Herpes Zoster affecting the ganglion of
the fifth cranial nerve (trigeminal or gasserian ganglion). Pain and an
eruption of blisters in the distribution of the branch of the 5th nerve
serving the eye occur. A 3rd nerve paralysis may be present. Blisters on
the tip of the nose indicate that the branch of the 5th nerve serving the
nose, eyes, eyebrows (nasociliary branch) and the cornea are involved.
Development of corneal ulcerations and clouding may also occur.
Causes
Herpes Zoster is caused by the varicella-zoster virus, the same virus that
causes chickenpox. This virus may be activated by local lesions involving
the posterior root nerve ganglia, by diseases involving a decreased immune
system (particularly Hodgkin's disease), or by immunosuppressive drugs.
Affected Population
Herpes Zoster is a common viral infection which may occur at any age.
However, it is most common after age 50. It affects males and females in
equal numbers. While the disorder is common for the elderly population,
long-term complications of Herpes Zoster are rare, and in rare cases,
children or young adults may be affected.
Related Disorders
Symptoms of the following disorders may be similar to those of Herpes Zoster.
Comparisons may be useful for a differential diagnosis:
Bell's Palsy is a one-sided facial paralysis of sudden onset resulting
from inflammation and/or compression of the facial nerve (cranial nerve VII).
It is nonprogressive, benign, and may be partial or complete. The affected
muscles usually regain their function after one or two months, although in
cases of extensive nerve damage, all or part of the paralysis may be
permanent. (For more information on this disorder, choose "Bell's Palsy" as
your search term in the Rare Disease Database.)
Chickenpox is an acute children's disease which is caused by the same
Herpes Zoster virus. It usually begins with mild constitutional symptoms
such as a mild headache, moderate fever and discomfort followed by an
eruption appearing in itchy crops of flat or elevated spots and blisters,
which form crusts. It is highly contagious.
Herpes Simplex (Fever Blister; Cold Sore) is a recurrent infection by the
relatively large herpes simplex virus. It is characterized by the appearance
on the skin or mucous membranes of clusters of small blisters, filled with
clear fluid on slightly raised inflamed bases. There are two types of Herpes
Simplex. Type 1 causes infections around the lips and in the cornea. Type 2
usually affects the genital areas and is transmitted primarily by direct
contact with lesions, most often during sexual intercourse.
Trigeminal Neuralgia (Tic Douloureux) is a nerve disorder characterized
by attacks of acute pain at the side of the mouth and nose, along the
distribution of the trigeminal nerve. (For more information on this
disorder, choose "Trigeminal" as your search term in the Rare Disease
Database.)
Therapies: Standard
There is no specific therapy for Herpes Zoster. However, corticosteroids (if
given early), may relieve pain in severe cases. Locally applied wet
compresses may be soothing. Aspirin, alone or with codeine, may relieve
pain. Immunosuppressed patients with Herpes Zoster may benefit from
treatment with the antiviral drug adenine arabinoside (vidarabine), or
intravenous immunoglobulin. Immunoglobulin can also be beneficial for
prevention of Herpes Zoster infection in immune suppressed patients.
The drug Zovirax (aciclovir) is now listed as standard therapy for Herpes
Zoster. It is manufactured by Burroughs-Wellcome.
Therapies: Investigational
Transfer factor from a Herpes Zoster patient during the healing phase is
being tested as treatment for immunosuppressed patients. Postherpetic
neuralgia (intractable pain following shingles) has been observed in rare
cases. Zostrix (capsaicin), a new drug for treating this pain, was
introduced into the United States and Canada in 1987. For more information,
physicians can contact:
GenDerm Corporation
425 Huehl Road
Northbrook, IL 60062
(312) 382-7404
Skin eruptions may heal faster with fibroblast interferon infused into
the abdominal cavity. Low-frequency electrotherapy has also been used
successfully. However, more research with these forms of treatment is needed
to establish their safety and effectiveness. Injection of anesthetics into
the painful nerves (nerve block) has been found beneficial for severe cases
of postherpetic neuralgia.
Clinical trials are being conducted on the experimental drug Arabinosyl
adenine (ARA-A) for treatment of Herpes Zoster (shingles). For additional
information, physicians can contact:
Ives Laboratories
Professional Service
P.O. Box 8299
Philadelphia, PA 19101
This disease entry is based upon medical information available through
September 1989. Since NORD's resources are limited, it is not possible to
keep every entry in the Rare Disease Database completely current and
accurate. Please check with the agencies listed in the Resources section for
the most current information about this disorder.
Resources
For more information on Herpes Zoster, please contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
NIH/National Institute of Allergy and Infections Diseases (NIAID)
9000 Rockville Pike
Bethesda, MD 20892
(301) 496-5717
Centers for Disease Control (CDC)
1600 Clifton Road, NE
Atlanta, GA 30333
(404) 639-3534
References
THE CLINICAL APPLICATION OF FIBROBLAST INTERFERON -- AN OVERVIEW: A.
Biliau; Med Oncol Tumor Pharmacother (1984: issue 1(2)). Pp. 87-96.
VARICELLA AND HERPES ZOSTER IN IMMUNOSUPPRESSED CHILDREN: PRELIMINARY
RESULTS OF TREATMENT WITH INTRAVENOUS IMMUNOGLOBULIN: J.M. Sullinger, et
al.; Helv Paediatr Acta (March 1984: issue 39(1)). Pp. 63-70.
INTERFERON FOR THE TREATMENT OF INFECTIONS: M. Ho; Annu Rev Med (1987:
issue 38). Pp. 51-59.
PHYSICAL TREATMENT OF HERPETIC DISEASES. REPORT OF A PILOT STUDY WITH
LOW-FREQUENCY ELECTROTHERAPY: L. Hein, et al.; Wien Klin Wochenschr (March
6, 1987: issue 99(5)). Pp. 149-153.