radiation for cancer, drugs taken to prevent rejection of transplanted organs, and cortisone pills or
injections taken for a long time for any reason, may also lower immunity.
The first symptom of zoster is burning pain, tingling or extreme sensitivity in one area of the skin
usually limited to one side of the body. This may be present for one to three days before a red rash
at that site. There may also be fever or headache. The rash soon turns into groups of blisters that
look a lot like chicken pox. The blisters generally last for two to three weeks. The blisters start out
clear but then pus or dark blood collects in the blisters before they crust over (scab) and begin to
dissapear. The pain may last longer. It is unusual but possible to have pain without blisters or
blisters without pain. The pain is often severe enough for the physician to prescribe painkillers.
Zoster is most common on the trunk and buttocks. But it can also appear on the face, arms or
legs if nerves in these areas are involved. Great care is needed if the blisters involve the eye
because permanent eye damage can result. Blisters on the tip of the nose signal possible eye
involvement. The dermatologist will usually refer the patienPost-herpetic neuralgia is constant pain
or periods of pain that can continue after the skin has healed. It can last for months or even years
is more common in older people. The use of medication in the early stages of the zoster may help
prevent this complication.
A bacterial infection of the blisters can occur, and can delay healing. If pain and redness
increase or reappear, you should return to the dermatologist. Antibiotic treatment may be needed.
Another complication is the spread of zoster all over the body or to internal organs. This can also
happen with chicken pox. It occurs rarely and most often in those with weakened immunity.
The diagnosis is based on the way the blisters look and a history of pain before the rash on one
side of the body. The dermatologist may scrape skin cells from a blister onto a glass slide for
examination. The glass slide is then examined under a microscope for changes characteristic of
zoster. If there is any doubt, blister fluid containing virus can be sent to the laboratory for special
testing.
The majority of people who develop zoster are otherwise healthy; however, if you have other
medical problems or could have been exposed to the AIDS virus, be sure to let your dermatologist
know. This could affect treatment. Your doctor will ask questions about your medical history and
may order tests, such as chest x-ray or blood studies, to be sure there are no other problems.
The virus that causes zoster can only be passed on to others who have not had chicken pox
and then they will develop chicken pox, not zoster. Zoster is much less contagious than chicken
pox. Persons with zoster can only transmit the virus if blisters are broken. Newborns or those with
immunity are at the highest risk for contracting chicken pox from someone who has zoster.
Patients with zoster rarely require hospitalization.
Scarring usually occurs only after more severe infections, such as in those with weakened
immune systems, elderly persons or those whose blisters become infected.
Zoster, usually clears on its own in a few weeks and seldom recurs. Pain relievers and cool
compresses are helpful in drying the blisters.
If diagnosed early, oral anti-viral drugs can be prescribed to decrease both viral shedding and the
duration of skin lesions. They are routinely prescribed for severe cases of zoster - with eye
involvement, for example - or for those with decreased immunity.
These drugs occasionally cause headache, stomach upset or lightheadedness. The earlier
treatment is started the better. These drugs do not seem to prevent post-herpetic neuralgia, but
may shorten its duration.
Corticosteroids, sometimes in combination with anti-viral drugs, also are used for severe
infection, such as in the eyes, and to reduce severe pain. Nerve blocks can also help to control
pain.
Post-herpetic neuralgia can be treated with an oral medication at night and frequent use of pain
relievers during the day. The oral medications are called anti-depressants and anti seizure
medications but are also used to treat other painful conditions. An ointment containing capsaicin,
an extract of pepper, is helpful for some people. The ointment is applied to painful areas of the skin
three to four times a day and the pain gradually eases over one to three weeks.
