HERPES ZOSTER

drg. Zaiviani Juniani K, Mkes

DEFINITION

 HerpesZoster or shingles is an acute

inflammatory viral disease

Etiology
 The causative organism is Varicella-Zoster
virus (human herpesvirus 3)
HERPES ZOSTER (SHINGLES)
 Caused by reactivation of a latent varicella
zoster virus infection
 Can occur years or decades after illness with
chickenpox
 Generally associated with normal aging and
with anything that causes reduced
immunocompetence
 Lifetime risk of 32% in the United States
 Estimated 1 million cases zoster diagnosed
annually in the U.S.
CLINICAL FEATURES

 Thethoracic, cervical, trigeminal, and

lumbosacral dermatomes are the most
frequently affected.

 OralLesions occur if the second and third

branches of the trigeminal nerve are
involved.
ORAL LESIONS

 Itching sensation and pain, which may simulate

pulpitis.
 Ulcers heal in 2-3 weeks

 Unilateral cluster of vesicles which rupture in 2-

3 days, leaving painful ulcers surrounded by a
red zone
 Post-herpetic trigeminal neuralgia and
osteomyelitis of the jaw bone are the most
common complication
SKIN LESIONS

 Intense pain associated with pruritus, tingling,

and tenderness
 Painful eruption of vesicles or erythematous
bases which develop along a sensory
dermatome
 Rash typically involves a single dermatome and
does not cross the midline but may involve
multiple dermatomes
 Postherpenic neuralgia in 10-15% of cases
COSTITUTIONAL SYMPTOMS

• Fever
• Malaise
• Headache
DIAGNOSIS

• The diagnosis is usually made clinically

but may be aided by culture. Direct
fluorescent antibody test, serology, PCR.
DIFFERENTIAL DIAGNOSIS

 Herpetic gingivostomatitis
 Necrotizing Ulcerative Gingivitis

 Varicella

 Erythema multiforme
TREATMENT

 Patientsshould be isolated and stay

on the bed for 1 week
 The diagnosis should be made and
treatment begun as early as possible
 Immunocompromised patients must
be hospitalized.
SUGGESTED THERAPIES
 Antivirals :
Valacyclovir 1 g three times dailty for 7 days and
famciclovir 500 mg three times daily for 7 days are
the drugs of the choice bcause of the more
convenient does regimens than acyclovir
Traditionally, oral acyclovir 800mg 5times daily for
7 – 1 day has been used in treatment of herpes
zoster. High-dose acyclovir (30mg/kg per day)
for at least 7 days is recommended for the
treatment of herpes zoster for
immunocompromised patients
 Analgesics, transquilizers, tricyclic anti-
depressant, anti-epileptics (carbamazepine,
gabapentin) has been used as a pain relief
 Corticosteroids : Early used of prednisone
20 -30 mg/ day for 7 - 10 days tapered to 10
mg/day
for 1 week has been used to reduce incidence
of postherpetic neuralgia in elder patients.
Corticosteroids must be avoided in
immunocompromised patients
VERICELLA
HERPES ZOSTER