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Friday, June 6, 2008

Some aspects of Herpes Zoster infection ( shingles) with homoeopathic mode of treatment-

This infection usually represents the re-emergence of varicella zoster virus (VZV) from posterior nerve roots in the spinal cord or cranial nerves into the skin, the original infection having been acquired in an attack of chicken pox many years previously usually in the childhood. VZV is a DNA virus that infects only humans and produces two distinct diseases in man- varicella ( chicken pox) and herpes zoster ( shingles) among which chicken pox is the primary infection occurring usually in the childhood. Chicken pox is the primary infection in the non-immune host. It almost never occurs twice in the same individual. The virus then remains latent in the dorsal root and cranial nerve ganglia for the rest of the life. If immunity is impaired which occurs in elderly persons, the virus replicates and migrates along the sensory nerves to the skin or eye causing the lesions of zoster. Shingles is never the direct result of a primary infection. Patients with chicken pox or shingles are infective, the virus being spread from fresh skin lesions by direct contact or airborne transmission and causing chicken pox in susceptible individuals.The disease affects individuals in their middle years or old age. Factors causing re-emergence of the virus are often ill understood and probably may represent changes in the immune state of the host.
In the cranial nerves herpes zoster has a predilection for the fifth and seventh nerve.

Age- Old age, being common after the age of fifty years.

Incubation Period- About two weeks.

Clinical Features- It produces an identical skin lesion to chicken pox, although classically it is unilateral and restricted to a sensory nerve (dermatomal) distribution, thus respecting the midline. But inflammatory oedema may cross the midline, giving the erroneous impression of bilaterality. General symptoms include fever, malaise, swelling of lymph nodes etc, which may precede the development of pain. The first specific symptom is pain in the segmental distribution of the nerves involved and is burning or shooting or cutting in character associated with hyperaesthesia or hyperalgesia over the affected cutaneous segments. Within a few days this is followed by appearance of erythema initially and later on vesicles containing clear fluid and papules or bullous lesions. These eruptions are distributed over the cutaneous segments of the affected nerves. The vesicular eruption is accompanied with much swelling and tenderness. The lesions vary in distribution, density and severity. They may be small, discrete and scattered or large, confluent and deep with haemorrhagic bullae. In course of time the vesicles are dried up leaving behind permanent scars on the skin. Unusual site of involvement such as sacral nerve disease may give rise to visceral changes which may lead to, for example, bladder dysfunction.

Clinical variants-
(1) Zoster of the limbs and trunk-This is the usual type where the posterior root ganglia of the spinal nerves are involved.
(2) Geniculate zoster- This is herpes zoster of the geniculate ganglion causing facial palsy identical to Bell’s palsy with herpetic vesicles on the external auditory meatus, pinna and sometimes on the soft palate. Deafness may also be there.
(3) Ophthalmic zoster- This involves the ophthalmic division of the fifth cranial nerve. There may be keratitis, anterior uveitis, conjunctivitis, scleritis, episcleritis, acute retinal necrosis. There may be cranial nerve palsies of which third nerve palsy is the most common but palsies of fourth, sixth and seventh cranial nerves, though uncommon, may occur.
(4) Generalised zoster- In rare cases there may be scattered eruptions all over the body.

Complications- These are secondary infection, very rarely purpura and necrosis in the affected segment and postherpetic neuralgia.
Postherpetic neuralgia - Postherpetic neuralgia is intractable pain in the zone of the previous eruption after the subsidence of the vesicles. It occurs in some 10% of patients who are often elderly. It is a burning, continuous pain responding poorly to any treatment and depression is almost always associated with.

Treatment-
There are lots of medicines for herpes zoster. A few of them are described below-
Dolich ( Dolichos puriens ) may be used in case of intense itching. It is particularly useful in postherpetic neuralgia. Croton tig (Croton tiglium) 6 or 30 potency is useful especially in pustular eruptions on face where there is intense itching but scratching is painful. It is also useful in herpes with eye symptoms. Semperv.t (Sempervivum Tectorum) is also recommended for herpes zoster. But Cantharis 6 may be recommended as the drug of choice if there is burning sensation with or without itching. And in general Rhus.tox ( Rhus Toxicodendron) 30 should be used. Locally cantharis ointment or lotion may be used.
Labels-Croton tig (Croton tiglium), Dolich ( Dolichos puriens ), Keratitis, Postherpetic neuralgia, Purpura, Rhus.tox ( Rhus Toxicodendron), Semperv.t (Sempervivum Tectorum), Cantharis, Ointment, Lotion, Conjunctivitis, Scleritis, Episcleritis, Retinal necrosis, Uveitis, Geniculate ganglion, External auditory meatus, Pinna, Soft palate, Segment, Facial palsy, Purpura, Hyperaesthesia, Hyperalgesia .

IN SHORT- Herpes Zoster is a viral disease usually occurring in old man due to the re-emergence of varicella zoster virus (VZV) from posterior nerve roots in the spinal cord or cranial nerves into the skin. It usually occurs in persons who had chicken pox several years earlier. General symptoms include fever, malaise, swelling of lymph nodes etc followed by pain burning or shooting or cutting in character restricted to a sensory nerve (dermatomal) distribution and associated with hyperaesthesia or hyperalgesia over the affected cutaneous segments. Within a few days this is followed by appearance of skin eruptions which are usually unilateral and confined to the area supplied by a single sensory ganglion. The commonest sites are the areas innervated by spinal cord segments from third thoracic to second lumber and the trigeminal nerve, particularly its ophthalmic branch. The eruptions heal in about two weeks but pain and paresthesia of the affected area may persist for weeks or months. Of the complications, postherpetic neuralgia is very important. Treatment is as mentioned.

But in every case a doctor should be consulted. Signs including swelling of the eyelid, conjunctivitis or blistering at the site of the nose should seek the attention of an ophthalmologist.

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