English

Abstract

OBJECTIVES: 1. To find out the incidence of zoster in patients attending the dermatology and venereology clinic. 2. To determine the distribution of herpes zoster in relation to age, sex, religion, season, socio-economic status and rural urban background. 3. To study the various clinical features like site of occurrence, initial presentation and course of the disease. MATERIALS AND METHODS: A total of 100 patients of herpes zoster attending outpatient Department of Dermatology and Venereology were included in the study. Detailed history, thorough physical examination and relevant investigations were done. RESULTS: No seasonal variation was found. Out of the 100 patients of herpes zoster majority of the patients belonged to the age group 21-40 years (42%). The male to female ratio was 1.8:1. Most of the patients were from low socio-economic group. 65 patients were literate and 35 patients were illiterate. Prodromal symptoms occurred in 61% of patients. Post-herpetic neuralgia was common in elderly and immunosuppressed patients. Commonest segment involved was the thoracic segment (46%). Majority of patients had single dermatomal involvement (87%). Multidermatomal involvement was seen in 13 patients (13%), out of which majority had immunosuppression like HIV and Diabetes Mellitus. INTRODUCTION: `Herpes zoster' is a localized disease characterized by unilateral radicular pain and a vesicular eruption that is generally limited to the dermatome innervated by a single spinal or cranial sensory ganglion.1 the words are derived from Greek Herpes - Meaning to creep or to spread and 'Zoster' meaning 'Girdle' or 'Zone'. 2 Zoster is characterized by a prodromal stage characterized by fever, headache, burning pain, followed by an acute stage, with appearance of crops of vesicles on an erythematous base in a dermatomal pattern and an intractable neuropathic pain in chronic stage. Zoster is a common infection among the elderly. Chicken pox and herpes zoster (Shingles) are usually benign but are associated with morbidity and mortality especially in immuno compromised hosts. The distinction between the natural history and manifestation of these clinical syndromes caused by VZV is essential for understanding the potential value of antiviral therapy. zoster usually involves one or more dermatomes and occurs at one particular site. 3 many complications like cutaneous, visceral, ocular and neurologic can occur. Post herpetic neuralgia (PHN) is the most feared and debilitating complication of zoster. The risk for PHN is increased in patients over 60 years of age. Recurrent herpes zoster is listed as one of the AIDS defining illness. In HIV infected there are many atypical manifestations like ulceration, necrosis, ecthymatic lesions, hyperkeratotic papules and many neurological, cutaneous, ophthalmic complications. The thoracic dermatomes are the most commonly affected (56%) followed by cervical (17%), lumbar (10%), sacral (5%) and the trigeminal nerve was infected in 12%.4 the management of PHN remains a challenge, with various modalities of treatment having a modest success. Laboratory studies for herpes zoster includes, serological tests, PCR, Tzanck smear, biopsy and viral tissue culture. The drugs used for the treatment of herpes zoster are Acyclovir, Valacyclovir and Famcyclovir, Desiclovir, Penciclovir and Foscarnet.