2017 HCHB_digital

Shingles
Shingles (herpes zoster) is a reactivation of the varicella zoster virus – also called
herpesvirus 3, the same virus that causes chickenpox (see Childhood Diseases
and Immunisation).
Chickenpox generally occurs in children and young people. However, once an
episode of chickenpox has resolved, the virus is not eliminated from the body
but lies dormant in nerve cells close to the spinal cord. Many years later it can
reactivate to cause shingles, an infection with symptoms vastly different from the
original chickenpox infection. Exactly how the virus remains latent in the body,
and subsequently reactivates, is not understood.
Shingles occurs only in people who have had chickenpox, and people whose
immune systems are impaired due to ill health, medications, or diseases that
lower the immunity (eg, cancer, HIV) are most at risk. Occasionally, trauma (eg, a
surgical scar) may trigger shingles at the site of the injury. Contact with somebody
who currently has varicella or herpes zoster may also cause reactivation. Shingles
can occur at any age but is more common in adults aged over 60. Rarely, shingles
may occur in young children who were either born with chickenpox or had it soon
after birth. Most people get shingles only once in their lifetime.
Symptoms of shingles
Early symptoms may include non-specific complaints, such as headache, fever
and malaise, which may be easily misdiagnosed. After a couple of days, itching,
tingling, numbness or burning, and/or a stabbing pain may develop in the
affected dermatome (an area of skin supplied by one spinal nerve). Usually, after
one or two days (but sometimes as long as three weeks), the initial phase is
followed by the appearance of the characteristic skin rash.
The pain and rash most commonly occur on the areas of skin supplied by
the thoracic (chest), cervical (neck), ophthalmic (forehead), and lumbar (torso)
nerves. The rash usually starts as a crop of red papules and may look like hives
but, since the virus spreads along certain nerves located off the spinal cord, it
typically has a stripe-like and usually unilateral presentation, unlike hives which
are usually widespread. Within a few days, the papules form small, painful,
exudate-filled blisters, which may persist for up to seven to 10 days before they
crust over and heal.
Once the blisters have appeared, and until the rash has developed crusts, a
person is extremely contagious and transmission of the virus can occur to people
without immunity to the virus. These people may then develop chickenpox but
will not immediately develop shingles.
Shingles may be associated with serious complications including postherpetic
neuralgia, bacterial superinfection, infection of internal organs, visual
impairment, hearing loss and death. Sometimes after severe blistering, scarring
and discoloured skin may remain.
Initial assessment
Avoid close contact with somebody with suspected shingles if you have never
TREATMENT OPTIONS
Category Examples Comments
Oral analgesics
Topical pain relievers
Varicella vaccine
Natural / herbal products /
supplements
[GENERAL SALE]
eg, paracetamol (Panadol, Paracare), ibuprofen
up to 25s (Advil, Nurofen)
[PHARMACY ONLY MEDICINE]
eg, paracetamol – greater than 20 tablets,
suspension (Pamol All Ages, Paracare, Panadol),
ibuprofen >25s (Advil, Nurofen), ibuprofen +
paracetamol (Maxigesic, Nuromol)
[GENERAL SALE]
eg, capsaicin cream (Zostrix HP*), lignocaine
preparations (Soov cream/spray)
[PHARMACY ONLY MEDICINE]
eg, lignocaine/prilocaine (Emla), aspirin (