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Herpes Zoster

 

Herpes Zoster Introduction

Herpes zoster is a viral infection that appears as red blisters or vesicles on the skin and manifests with associated nerve pain. The outbreak usually follows a dermatome or an area of skin that correlates with a particular nerve root. It is caused by the varicella zoster virus, the same virus that causes chickenpox.

Individuals who had chickenpox can get herpes zoster if the virus becomes active, otherwise the virus remains dormant (inactive). The virus can become active due to stress, immunocompromise, severe illness, or extreme temperature exposure. Not all who had chickenpox will get shingles.

Herpes zoster affects men and women equally. It is most common in children, people over the age of 60, and immunocompromised individuals. [1]

Herpes Zoster Shingles

The initial symptom of shingles is pain in the affected area. About 2-3 days after onset of pain, a rash will develop. The pain and rash usually follow one or more dermatomes. Usually only one side of the body is affected. The trunk and back are the most common areas affected, though anywhere on the body can be affected because of nerve involvement.

The rash consists of small vesicles on a erythematous (red) base. The vesicles will break open and ooze a honey colored liquid then crust over. The vesicles will continue to form for 3- 5 days, then resolve on their own.

The pain that is associated with shingles can take much longer to resolve. It is usually described as burning and can become very intense. In some cases, individuals may have pain for months to years after the skin eruption has resolved. This diagnosis is called post-herpetic neuralgia.

Very few patients will have a reoccurrence of the shingles. This is a distinguishing fact from herpes simplex virus. Complications can occur if the virus infects nerve roots that innervate the eye, internal organs, or the inner ear. [2]

Herpes Zoster Statistics

  • Herpes zoster will affect 10% of adults some point during their lifetime.
  • 20% of individuals who had chickenpox will be diagnosed with herpes zoster.
  • There are over 600,000 cases of herpes zoster each year.
  • The risk of occurrence is 10 times greater if one is over 60 years old or under 10 years old. [3]

Herpes Zoster (Shingles) Treatment

Treatment of herpes zoster is focused on the treatment of pain-related symptoms. The rash itself, is self-resolving, usually over 5-7 days and requires no formal treatment. Conventional treatments for the pain and possible post-herpetic neuralgia includes analgesic medications, and in severe cases, anti-depressants. Individuals with severe immunocompromise (HIV/AIDS, cancer) will usually be given IV acyclovir, or a similar anti-viral to prevent complications and reoccurrence. [4]

Alternative therapy has several options for treating the pain associated with herpes zoster. Because an outbreak of shingles is not precipitated by any one event, there is little information on preventing an outbreak.

Supplements helpful for Herpes Zoster (Shingles)

Glycyrrhizin

Glycyrrhizin is a component of Glycyrrhiza glabra, or licorice. It is a root that yields certain anti-inflammatory properties. Interestingly, licorice root has been shown to exhibit certain anti-viral activity against the varicella zoster virus in vitro (Petri dish). This anti-viral activity is believed to be effective in vivo (in the body) as well, though no studies have been performed. [5] One study found that the topical application of glycyrrhizin decreased the intensity of pain in patients with herpes zoster. It was compared to acyclovir and placebo and found to be as effective as acyclovir, and was faster acting. [6]

Capsaicin cream

Capsaicin cream is a well-documented treatment for the pain associated with shingles. It is effective for long-term use in the case of post-herpetic neuralgia as well. Capsaicin is believed to stimulate specific fibers of nerve cells that cause a release of Substance P. Substance P is responsible for pain sensation. This continued stimulation from capsaicin results in a depletion of Substance P and therefore an end to the pain. [7] In one study, application of 0.025% capsaicin cream for 8 weeks resulted in improvement of pain intensity in more than 48% of patients. A significant effect was achieved after only 2 weeks of treatment in another study. [8] The only side effect reported was mild discomfort at the beginning of treatment, which usually subsided after several days.

Peppermint oil

Peppermint oil (10% menthol) has been reported in a case study to decrease pain in post herpetic neuralgia. The individual in study was an elderly woman whose symptoms were resistant to standard treatment. Relief persisted 4-6 hours after application of the oil to the affected area. [9]

Vitamin E

Vitamin E has also been used as a topical application for post-herpetic neuralgia. There is conflicting evidence in the literature, and its effectiveness in shingles treatment remains unclear.

References

[1] Beers M, Berkow R. The Merck Manual, 17th Ed. 1999. Herpes Zoster: 1294-1295.

[2] Beers M, Berkow R. The Merck Manual, 17th Ed. 1999. Herpes Zoster: 1294-1295.

[3] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml The National Institute of Neurological Disorders and Stroke. December 2004.

[4] Beers M, Berkow R. The Merck Manual, 17th Ed. 1999. Herpes Zoster: 1294-1295.

[5] Baba M, Shigeta S. Antiviral activity of glycyrrhizin against varicella zoster virus in vitro. Antiviral Res. 1987 Feb; 7(2): 99-107.

[6] Aikawa Y, Yoshiike T, Ogawa H. Effect of glycyrrhizin on pain and HLA-DR antigen expression on CD8 positive cells in peripheral blood of herpes zoster patients in comparison with other antiviral agents. Skin Pharmacol. 1990; 3(4): 268-271.

[7] Rains C, Bryson HM. Topical capsaicin: a review of its pharmacological properties and therapeutic potential in post-herpetic neuralgia, diabetic neuropathy, and osteoarthritis. Drugs Aging. 1995 Oct; 7(4): 317-328.

[8] Peikert A, Hentrich M, Ochs G. Topical 0.025% capsaicin in chronic post-herpetic neuralgia: efficacy predictors of response, and long-term course. J Neurol. 1991 Dec; 238(8): 452-456.

[9] Davies SJ, Harding LM, Baranowski AP. A novel treatment of post-herpetic neuralgia using peppermint oil. Clin J Pain. 2002 May-Jun; 18(3): 200-202.