Herpes Zoster (Shingles): Causes, Symptoms, Treatment & Nursing Care..

By Peter Jumba

Herpes Zoster (Shingles): Causes, Symptoms, Treatment & Nursing Care.


Understand Herpes Zoster (Shingles) causes, the painful rash symptoms, risk factors, effective antiviral treatments, and essential nursing considerations. Get vaccinated.



Herpes Zoster Infection/ Image by Peter Jumba 


Herpes Zoster: Cause, Signs And Symptoms, Risk Factors, Prevention, Treatment Options And Nursing Considerations. 


Herpes Zoster (Shingles):

Herpes Zoster (Shingles) is a viral infection that causes a painful rash. It is caused by the reactivation of the Varicella-Zoster Virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, the virus remains dormant in the nerve ganglia and can reactivate later in life, usually when the immune system is weakened.


Cause:

The sole cause of shingles is the Varicella-Zoster Virus (VZV). Shingles is a reactivation of this dormant virus in the body. It's not caused by a new exposure but by a decrease in the VZV-specific cell-mediated immunity, which allows the virus to travel along a nerve to the skin.


Signs and Symptoms:

Symptoms typically follow three phases:

1. Pre-eruptive Phase (Prodrome)

This phase occurs days or weeks before the rash appears and includes:

  • Pain, burning, tingling, itching, or numbness in the area where the rash will eventually develop (unilateral, along a dermatome).


  • Systemic symptoms like fever, headache, chills, and malaise (general feeling of being unwell).


2. Acute Eruptive Phase:

This is marked by the appearance of the characteristic rash and typically lasts for 2 to 4 weeks:

  • A Shingles that appears as a single stripe or band on one side of the body (unilateral distribution along a single dermatome).


  • The rash starts as red patches (macules/papules), then progresses to fluid-filled blisters (vesicles).


  • The blisters eventually break open, crust over, and heal, which can leave scars.


  • Excruciating, deep, burning, or shooting nerve pain is common and often severe.


3. Chronic Phase:

  • Postherpetic Neuralgia (PHN): This is the most common complication and involves persistent, debilitating nerve pain that lasts for months or even years after the rash has healed.

Vaccine

Risk Factors:

  • Anyone who has had chickenpox is at risk. Factors that increase the risk of reactivation include:


  • Age over 50 years: The risk increases sharply with age due to natural decline in immunity.


  • Weakened Immune System: Conditions like HIV/AIDS, cancer (especially leukemia/lymphoma), or undergoing organ transplantation.


  • Immunosuppressive Medications: Taking steroids or chemotherapy drugs.


  • Acute or Chronic Illnesses (e.g., diabetes, chronic kidney disease).


  • Emotional and Mental Stress: Periods of high stress may temporarily weaken the immune system.


Prevention:

The most effective way to prevent shingles and its complications is vaccination.

  • Recombinant Zoster Vaccine (RZV, Shingrix): Recommended for adults ≥50 years and for immunocompromised adults ≥19 years. It is given in a two-dose series.


  • To prevent transmission (spreading VZV to a person who has never had chickenpox), individuals with active shingles should:


  • Keep the rash covered.


  • Avoid touching the rash.


  • Wash hands frequently.


  • Avoid contact with pregnant women who haven't had chickenpox, premature infants, and immunocompromised people until the blisters have dried and crusted over.


Treatment Options:

Treatment focuses on speeding up recovery, reducing pain, and preventing complications. Treatment is most effective if started within 72 hours of the rash appearing.


Treatment Type Examples & Action:

  • Antiviral Medications Acyclovir, Valacyclovir, Famciclovir. These stop the virus from multiplying, reduce the severity/duration of the rash and pain, and decrease the risk of Postherpetic Neuralgia (PHN).


  • Pain Management Over-the-counter (OTC): Acetaminophen or Ibuprofen. Prescription: Opioids, nerve pain medications (e.g., gabapentin, pregabalin), tricyclic antidepressants (TCAs), or topical pain patches.


  • Symptom Relief Calamine lotion or cool, moist compresses to soothe the skin and relieve itching.


  • Infection Control Topical antibiotic creams for secondary bacterial infections of the blisters.


Nursing Considerations:

The core nursing goals are managing acute pain, preventing infection, and patient education.


Pain Management

  • Assess pain frequently using a pain scale and note its characteristics (burning, shooting, throbbing).


  • Administer prescribed analgesics and antiviral medications on time.


  • Apply cool, moist dressings or compresses to the lesions as ordered to soothe itching and pain.


  • Encourage wearing loose-fitting, cotton clothing to minimize irritation.


Infection Control and Skin Care:

  • Maintain strict contact isolation until the lesions are dry and crusted over.


  • Keep the rash site clean and dry to prevent secondary bacterial infection.


  • Educate the patient on the importance of hand hygiene and not scratching the lesions.


  • Monitor lesions for signs of secondary infection (increased redness, swelling, warmth, pus).


Patient Education and Emotional Support

  • Educate the patient on disease process, contagion (transmission to non-immune individuals), and the importance of adhering to antiviral therapy (especially the ≤72- hour window).


  • Teach signs and symptoms of complications, such as eye involvement (ophthalmic zoster) which is a medical emergency.


  • Acknowledge the emotional burden (isolation, depression, anxiety) due to pain and appearance, and provide compassionate support.


Consult your doctor about the Shingles vaccine today.



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