Shingles

The Correct Answer is B

Herpes zoster, or shingles, is a common condition which results from the reactivation of varicella virus acquired during an earlier episode of chickenpox. The distribution of the characteristic rash typically follows a single dermatome and does not cross the midline. The lesions are typically painful, and postherpetic neuralgia can become a disabling chronic problem. When any branch of the ophthalmic nerve is involved, the condition is called herpes zoster ophthalmicus. Vesicles on the side or tip of the nose (Hutchinson's sign) that occur during an episode of zoster suggest involvement of the nasociliary branch, and are associated with the most serious ocular complications. Involvement of the other sensory branches of the trigeminal nerve may affect the eyelid but rarely involve the eye itself.

Treatment of uncomplicated herpes zoster ophthalmicus in an immunocompetent patient includes oral acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex). Corticosteroids can be used for acute pain but have no effect on the development of postherpetic neuralgia.

Intravenous antiviral therapy is indicated for immunosuppressed patients with extensive cutaneous disease, and those at high risk for ocular complications. Treatment is most effective when started within 48 hours of the onset of the disease.

Capsaicin cream is used in the treatment of postherpetic neuralgia, and varicella zoster immunoglobulin (VZIG) is used in high-risk immunocompromised patients to prevent varicella infection. Idoxuridine (Herplex) is indicated for herpes simplex keratitis.

Ref: Habif TP: Clinical Dermatology, ed 3. Mosby-Year Book Inc, 1996, pp 355-359.

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