Thread by @shakiratgold

#dermatologyteaching
Have you ever heard of the condition called herpes zoster?

This condition is caused by a virus called Varicella zoster virus. It is infact a reactivation of the virus in the dorsal root ganglion (within some nerves) after it finds a way to hide there after an initial chicken pox infection probably decades earlier.

This means that after a person has had chicken pox, your virus hides in that place in the body and becomes reactivated later. This reactivation does not occur in everyone. Often occurs due to immune suppression of some sort.

Immune suppression can be due to old age, pregnancy, uncontrolled diabetes, cancer, HIV/AIDs, longterm use of steroids amongst others. In some cases,a cause of immune suppression might not be discovered. Tends to follow dermatomes.

This is an area of the skin that represents where sensory nerves that carry sensation are derived from) and that's why you'll see the sharp demarcation corresponding to the dermatome affected. Usually affects one dermatome at a time; however multiple dermatomes may be affected

Usually starts with some pain in the affected area with itching before the rapid eruption of these vesicles in a grouped manner within a few days. There may be fever and malaise.
The most worrisome complication after it has resolved is called post herpetic neuralgia.

This refers to continuous pain in the area that was affected. This pain can be extremely debilitating for those affected. Herpes zoster affecting the region of the eyes or ears (ophthalmicus and oticus) are medical emergencies as blindness/deafness can follow.

Myths about herpes zoster
1) It is as a result of attacks from your village people - Not true.
2) Everyone that develops has HIV -Not true
3) You need to scrub and rupture all the vesicles - So not true!!!

Management involves relieving pain, medications for the itching, gentle cleaning and dressing with a topical antibiotic if it ruptures on it's own and management of complications like post herpetic neuralgia when it occurs. HZ oticus and opthalmicus are medical emergencies.

Secondary bacterial infection can occur especially when it ruptures and herbal concoctions are applied. The secondary bacterial infection must also be taken care of.

Herpes zoster. Around T4 dermatome.

Secondary bacterial infection can follow in this type especially when things that are not supposed to be applied are put on the surface.

Very gory picture I know.

Please REFER immediately to ophthalmology emergency.
Herpes zoster opthalmicus.

All pictures from google images.

Any comments or questions?
I'd be happy to answer them on the thread. If you have further questions and you're a doctor, please send a DM.