The medical name is herpes zoster and it is caused by the re-activation of the chickenpox virus (varicella zoster). This crazy virus lays dormant in the nerves and something causes it to flare up years or decades later.This patient noticed a small rash behind her right ear and thought it was insect bites after a camping trip. She had some tingling (a common sign) and swollen and tender lymph nodes. Two days later when I saw her, the rash had spread down her neck and shoulder and she definitely had lymph node swelling at the neck and above the clavicle (nuchal and supraclavicular nodes). She had no fever but felt a little down.
Most shingles occurs in older people but it is not uncommon in younger folks too, like this patient. The rash takes about a week to develop and can last about 2 weeks with varying degrees of pain and annoying tingling. Some patients have pain that lasts in the nerves long after the rash has resolved.
We treat shingles with antiviral medication (valcyclovir ) and pain control.
People over the age of 60 are recommended to get Zostavax vaccine to help prevent an outbreak. It reduces the chances of shingles by 51% and even higher reduction of post-herpetic neuralgia pain.No special tests are needed to make the diagnosis. This is another reason everyone should have a primary care physician who can make the diagnosis and get the patient started on treatment.
This post originally appeared at Everything Health. Toni Brayer, MD, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.
