HERPES ZOSTER
INTRODUCTION:
Herpes zoster is also known as shingles or zona. It is an acute infectious viral disease of an extremely painful and incapacitating nature. The viral infection affects sensory nerves with trigeminal nerve most frequently involved and other sensory nerves involved are C3, T5, Ll and L2.
ETIOLOGY:
Virus causing infection is “varicella zoster” virus.
CLINICAL FEATURES:
l. The disease is most common in adult life and affects both the sexes equally.
2. Initially adult patient exhibits fever, a general malaise, pain and tenderness along the course of involvedsensory nerves, usually unilaterally. Often the trunk is affected.
3. Within few days, the patient has a linear papular or vesicular eruption of the skin or mucosa supplied by the affected nerves. It is typically unilateral and dermatomic in distribution.
4. The dorsal root ganglion is also inflamed with vesicular eruptions unilaterally along the sensory nerve path, over the skin or mucosa.
5. Triggering factors for infections are: Malignancy, trauma, radiations, etc.
ORAL MANIFESTATIONS:
l. Lesions of oral mucosa are fairly common and extremely painful vesicles may be found on the buccalmucosa, tongue, uvula, pharynx and larynx. They generally rupture to leave the areas of erosion.
2. One of the characteristic clinical features of the disease involving the face or oral cavity is the unilaterality of the lesions. Typically when large the lesions will extend up to midline and stop abruptly.
JAMES RAMSAY HUNT SYNDROME:
l. A special form of zoster infection of the geniculate ganglion with the involvement of external ear and oral mucosa, has been termed as James Ramsay Hunt syndrome.
2. The clinical manifestations include facial paralysis, pain in external auditory meatus and pinna of the ear. In addition, vesicles occur in the oral cavity and oropharynx with hoarseness, tinnitus, vertigo and other disturbances.
DIAGNOSIS:
l. Characteristic distribution of lesions
2. Cytological smears
3. Fluorescent antibody staining techniques
4. Viral culture and serologic diagnosis.
TREATMENT:
l. Antiviral drugs such as acyclovir.
2. For the treatment of post-herpetic neuralgia: Intralesional corticosteroids.
3. Topical application of capsaicin.
4. The newer antiviral drugs are under intensive clinical testing for potential effectiveness in treatment of herpes zoster.
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