Lightning Learning: Shingles
STOP!
Shingles is a painful rash caused by the reactivation of the Varicella-Zoster virus – the same virus that causes chickenpox.
Reactivation often occurs in immunocompromised individuals who have previously had chickenpox.
50% of those who live to 85 years old will have at least one episode.
While normally self-limiting, it does have some rare complications such as:
- Post-herpetic neuralgia
- Aseptic meningitis
- Encephalitis
- Ramsay Hunt syndrome
- Herpes zoster ophthalmicus
LOOK
The rash is unilateral and limited to a dermatomal distribution. In some cases the pain may start BEFORE the rash appears.
It begins with erythematous papules and progresses on to vesicles and papules.
Have symptoms started <72 hours ago OR >72 hours ago (but new lesions are still appearing)? Antiviral treatment is recommended to help reduce the pain and shorten duration of symptoms.
Hutchinson’s Sign: lesions to the tip of the nose indicate possible herpes zoster ophthalmicus – possibly leading to serious eye complications. Prompt treatment and ophthalmology review is advised.
LEARN
- Recognise shingles and prescribe antivirals (if within 72 hours of onset) to reduce pain and duration of symptoms.
- Reassure patients. Shingles can be very painful but is usually a self-limiting condition.
- Contagious until the last blister scabs over! Individuals who have never had chickenpox could catch it during that window. Vulnerable people who have never had chickenpox should be avoided.
