buring or deep, aching pain the shooting, lancinating pain the triggered pain
The pain severity is related to the age the affected area the extent of the skin lesions
Clinical manifestations
Prodrome:
headache and fever hyperaesthesia pain in the affected area
Features of lesions
initially presents as papules and plaques of erythema
There are may only neuralgia and papuloid lesions but with no blisters.
Complications
Postherpetic neuralgia(PHN) The pain persists after the skin
lesions have healed, with the same quality as that of acute zoster pain.
The incidence of herpes zoster increases with advancing age and decline in immune function.
Other than immunosuppression and age, the factors involved in reactivation are unknown.
The tendency to have persistant pain is age dependent.
Ophthalmic Zoster
Ocular involvement is most commonly in the form of uveitis and keratitis. Less common but severe complications include glaucoma, optic neuritis, and acute retinal necrosis.
crops of clustered red papules form in a discontinuous band
evolve to clear vesicles surrounded by erythema
the eruption may have few lesions or reach total confluence in the dermatome
Pathogen and Pathogenesis
Pathogen
Varicella-Zoster virus (VZV) is characterized by neurotropism and dermatotropism.
Pathogenesis
VZV ↓ the primary infection
Herpes Zoster
Ds caused by Varicella - Zoster virus (VZV) , classically occurs unilaterally within the distribution of a sensory nerve, being characterized by clustered vesicles and considerable neuralgia.
Hyperaesthia
The skin in the affected area may be hypersensitive , normally innocuous stimuli, such as clothing touching the skin , may produce pain.
Incomplete herpes zoster
The total duration of the eruption depends on three factors: patient age severity of eruption presence of underlying
immunosuppression
Distribution
cranial or spinal sensory nerve the thoracic (55%) the cranial (20%), with the trigeminal nerve being the most common single nerve involved the lumbar (15%) the sacral (5%)
lesions may become hemorrhagic, necrotic, or bullous
the vesicles slowly become pustulars, and rupture to form crusts , which separate in two to four weeks, often with scarring the regional lymph nodes are enlarged and tender
nonimmune host ↓
varicella
↓ VZV establishes latency in sensory ganglia
↓ the decline in immune function VZV may replicate later
↓
Herpes zoster
showing neuralgia and clustered vesicles
Neuralgia
The nature of pain associated with herpes zoster varies, but three basic types of pain have been described. the constant, monotonous, usually