$Unique_ID{BRK03818} $Pretitle{} $Title{Herpes Zoster} $Subject{Herpes Zoster Shingles Zona Acute Posterior Ganglionitis Geniculate Zoster, also known as Ramsay Hunt Syndrome Ophthalmic Herpes Zoster Bell's Palsy Chickenpox Herpes Simplex (Cold Sores) Trigeminal Neuralgia (Tic Douloureux) } $Volume{} $Log{} Copyright (C) 1987, 1988, 1989, 1991 National Organization for Rare Disorders, Inc. 457: Herpes Zoster ** IMPORTANT ** It is possible the main title of the article (Herpes Zoster) is not the name you expected. Please check the SYNONYMS listing on the next page to find alternate names, disorder subdivisions, and related disorders covered by this article. Synonyms Shingles Zona Acute Posterior Ganglionitis DISORDER SUBDIVISIONS Geniculate Zoster, also known as Ramsay Hunt Syndrome Ophthalmic Herpes Zoster Information on the following disorders may be found in the Related Disorders section of this report: Bell's Palsy Chickenpox Herpes Simplex (Cold Sores) Trigeminal Neuralgia (Tic Douloureux) General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Herpes Zoster is a common central nervous system infection caused by the varicella-zoster virus. This is the same virus that causes chickenpox. The disorder is characterized by eruption of blisters, nerve pain, and severe itching of the skin. Symptoms Preliminary symptoms of Herpes Zoster include chills, fever, and a feeling of discomfort three or four days before distinctive features of the disease develop. Pain may or may not occur along the site of the future skin eruption. On the 4th or 5th day, characteristic crops of blisters appear on a red base, distributed on skin areas that are served by one or more posterior root nerve centers (ganglia) along the spine. The involved skin area is usually hypersensitive, and the associated pain may be severe. The eruptions occur most often in the chest area and may spread only on one side of the body. They begin to dry and form scabs about the 5th day after their appearance. Herpes Zoster rarely becomes generalized. If it spreads or if the lesions persist beyond two weeks, additional special medical evaluation may be necessary. One attack of Herpes Zoster usually gives the patient immunity from subsequent attacks. Most patients recover without any after effects except for occasional scarring of the skin. However, in a minority of cases, nerve pain (neuralgia) may persist for months or years, most frequently in elderly persons. Geniculate Zoster (Herpes Zoster Oticus or Ramsay Hunt Syndrome) involves part of the facial nerve near the internal ear (geniculate ganglion). Pain in the ear and facial paralysis (rarely permanent) may occur on the affected side. Blisters may erupt in the external ear canal, the outer ear, the soft palate, and the top part of the throat. Ophthalmic Herpes Zoster involves Herpes Zoster affecting the ganglion of the fifth cranial nerve (trigeminal or gasserian ganglion). Pain and an eruption of blisters in the distribution of the branch of the 5th nerve serving the eye occur. A 3rd nerve paralysis may be present. Blisters on the tip of the nose indicate that the branch of the 5th nerve serving the nose, eyes, eyebrows (nasociliary branch) and the cornea are involved. Development of corneal ulcerations and clouding may also occur. Causes Herpes Zoster is caused by the varicella-zoster virus, the same virus that causes chickenpox. This virus may be activated by local lesions involving the posterior root nerve ganglia, by diseases involving a decreased immune system (particularly Hodgkin's disease), or by immunosuppressive drugs. Affected Population Herpes Zoster is a common viral infection which may occur at any age. However, it is most common after age 50. It affects males and females in equal numbers. While the disorder is common for the elderly population, long-term complications of Herpes Zoster are rare, and in rare cases, children or young adults may be affected. Related Disorders Symptoms of the following disorders may be similar to those of Herpes Zoster. Comparisons may be useful for a differential diagnosis: Bell's Palsy is a one-sided facial paralysis of sudden onset resulting from inflammation and/or compression of the facial nerve (cranial nerve VII). It is nonprogressive, benign, and may be partial or complete. The affected muscles usually regain their function after one or two months, although in cases of extensive nerve damage, all or part of the paralysis may be permanent. (For more information on this disorder, choose "Bell's Palsy" as your search term in the Rare Disease Database.) Chickenpox is an acute children's disease which is caused by the same Herpes Zoster virus. It usually begins with mild constitutional symptoms such as a mild headache, moderate fever and discomfort followed by an eruption appearing in itchy crops of flat or elevated spots and blisters, which form crusts. It is highly contagious. Herpes Simplex (Fever Blister; Cold Sore) is a recurrent infection by the relatively large herpes simplex virus. It is characterized by the appearance on the skin or mucous membranes of clusters of small blisters, filled with clear fluid on slightly raised inflamed bases. There are two types of Herpes Simplex. Type 1 causes infections around the lips and in the cornea. Type 2 usually affects the genital areas and is transmitted primarily by direct contact with lesions, most often during sexual intercourse. Trigeminal Neuralgia (Tic Douloureux) is a nerve disorder characterized by attacks of acute pain at the side of the mouth and nose, along the distribution of the trigeminal nerve. (For more information on this disorder, choose "Trigeminal" as your search term in the Rare Disease Database.) Therapies: Standard There is no specific therapy for Herpes Zoster. However, corticosteroids (if given early), may relieve pain in severe cases. Locally applied wet compresses may be soothing. Aspirin, alone or with codeine, may relieve pain. Immunosuppressed patients with Herpes Zoster may benefit from treatment with the antiviral drug adenine arabinoside (vidarabine), or intravenous immunoglobulin. Immunoglobulin can also be beneficial for prevention of Herpes Zoster infection in immune suppressed patients. The drug Zovirax (aciclovir) is now listed as standard therapy for Herpes Zoster. It is manufactured by Burroughs-Wellcome. Therapies: Investigational Transfer factor from a Herpes Zoster patient during the healing phase is being tested as treatment for immunosuppressed patients. Postherpetic neuralgia (intractable pain following shingles) has been observed in rare cases. Zostrix (capsaicin), a new drug for treating this pain, was introduced into the United States and Canada in 1987. For more information, physicians can contact: GenDerm Corporation 425 Huehl Road Northbrook, IL 60062 (312) 382-7404 Skin eruptions may heal faster with fibroblast interferon infused into the abdominal cavity. Low-frequency electrotherapy has also been used successfully. However, more research with these forms of treatment is needed to establish their safety and effectiveness. Injection of anesthetics into the painful nerves (nerve block) has been found beneficial for severe cases of postherpetic neuralgia. Clinical trials are being conducted on the experimental drug Arabinosyl adenine (ARA-A) for treatment of Herpes Zoster (shingles). For additional information, physicians can contact: Ives Laboratories Professional Service P.O. Box 8299 Philadelphia, PA 19101 This disease entry is based upon medical information available through September 1989. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Herpes Zoster, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 NIH/National Institute of Allergy and Infections Diseases (NIAID) 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5717 Centers for Disease Control (CDC) 1600 Clifton Road, NE Atlanta, GA 30333 (404) 639-3534 References THE CLINICAL APPLICATION OF FIBROBLAST INTERFERON -- AN OVERVIEW: A. Biliau; Med Oncol Tumor Pharmacother (1984: issue 1(2)). Pp. 87-96. VARICELLA AND HERPES ZOSTER IN IMMUNOSUPPRESSED CHILDREN: PRELIMINARY RESULTS OF TREATMENT WITH INTRAVENOUS IMMUNOGLOBULIN: J.M. Sullinger, et al.; Helv Paediatr Acta (March 1984: issue 39(1)). Pp. 63-70. INTERFERON FOR THE TREATMENT OF INFECTIONS: M. Ho; Annu Rev Med (1987: issue 38). Pp. 51-59. PHYSICAL TREATMENT OF HERPETIC DISEASES. REPORT OF A PILOT STUDY WITH LOW-FREQUENCY ELECTROTHERAPY: L. Hein, et al.; Wien Klin Wochenschr (March 6, 1987: issue 99(5)). Pp. 149-153.