Video transcript :-

Herpes zoster, also known as shingles, is viral infection that occurs with reactivation of the varicella-zoster virus, which causes chickenpox.
The condition is characterized by a painful but self-limited dermatomal rash.

The initial infection, chickenpox, is a contagious and usually benign febrile illness.

After this infection is resolved, viral particles remain in the dorsal root or other sensory ganglia, where they may lay dormant for years to decades.
In this latent period, host immunologic mechanisms suppress replication of the virus, but varicella zoster virus reactivates when the host immune mechanisms are compromised.
The clinical course of shingles can be divided into 3 phases.
Pre-eruptive phase,
Acute eruptive phase,
And chronic phase, also known as post herpetic neuralgia.
Features during the pre-eruptive phase include the following.
Sensory symptoms such as pain, paresthesia, and itching, which last for about 1 to 10 days.
Pain may simulate headache, pleurisy, brachial neuritis, iritis, cardiac pain, appendicitis or other intra-abdominal disease, or sciatica.
Additional symptoms in this phase include myalgias, malaise and lethargy, photophobia, and less commonly, fever.
During the acute eruptive phase, the patient develops grouped herpetiform vesicles on an erythematous base.
The vesicular eruption is confined to a particular dermatome.
This eruption causes the development of severe pain, which significantly impairs the patient's daily activities and the quality of life.
Vesicles are initially clear, but they become cloudy with time.
Eventually they rupture, leaving crusts on the affected region.
Sometimes, scarring can occur due to secondary bacterial infection or excoriation.
Regional lymphadenopathy may also be seen.
Symptoms in this phase tend to resolve over 10-15 days.
However, complete healing of lesions may require up to a month.
Post herpetic neuralgia is characterized by persistent or recurring pain lasting more than 30 days after all the lesions have crusted.
The pain is typically severe and incapacitating, confined only to the affected dermatome.
Sometime, the pain can persist for months to years.

Herpes zoster can involve various other structures as well.
Including the eyes, cranial nerves, and visceral organs such as the bladder, bronchi, pleural space, and the gastrointestinal tract.
The diagnosis of herpes zoster infection is primarily clinical.
Treatment includes both topical agents and systemic agents.

Topical treatments include acyclovir 5% cream, lidocaine, and capsaicin.
Additionally, wet-to-dry dressings with sterile saline solution or Burow solution, which should be applied to the affected area for 30 to 60 minutes 4 to 6 times a day is beneficial.
Calamine lotion can be used as an anti-pruritic agent.

Oral pain control agents such as oxycodone and gabapentin may also be required.
Corticosteroids such as prednisolone, and antiviral agents have also been shown to reduce pain and other symptoms when given in combination with other pain controlling agents.
Common antiviral agents used to treat herpes zoster include acyclovir, valacyclovir, and famciclovir.

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