Management of Shingles (Kayap)

 

 

1. What is shingles?

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• infection of the skin caused by herpes zoster virus
• painful, itchy vesicular rash, that follow dermatomes distribution
• mostly unilateral side
• commonly affected immunocompromised people such as in:
• AIDS
• diabetic patient
• cancer patient on treatment
• elderly 
• long term steroid use

2. How to diagnose shingle?

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• it is diagnosed clinically, based on signs and symptoms

3. How to treat shingle?

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• general measures
• keep the skin dry
• avoid peeling the crust
• trim nail short
• antivirals
• start early within 72 hours to prevent complications
• immunocompetent : Tab acyclovir 500mg 5 times a day, for 7 to 10 days
• immunocompromised : IV acyclovir 10mg/kg 8 hourly for 7 days
• symptomatic treatment
• Vaseline cream / calamine lotion
• LMS cream / lignocaine gel
• paracetamol
• gabapentin 300mg ON/BD
• antipruritic
• refer urgently to ophthalmologist or ENT if lesion involving the eye / near the eye

What are the complications of shingles?

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• post herpetic neuralgia
• may last > 3 months
• zoster ophthalmicus (infection involving the eyes)
• Ramsay Hunt syndrome
• aka herpes zoster oticus (ear)
• disseminated herpes zoster
• usually in immunocompromised patient
• zoster-associated encephalitis

Cover image from BruceBlaus, CC BY-SA 4.0, via Wikimedia Commons