Herpes Zoster (Shingles)
A 23-year-old female came to the clinic complaining of fatigue and a burning, tingling sensation down the back of her left leg. She stated that it feels like "pins and needles going up and down my leg," followed 2 days later by an eruption of a red bumpy rash which originated on the posterior left thigh. The red bumps became more pronounced and raised over the next couple of days. On examination, the rash had developed into multiple clusters of grouped vesicular lesions and spread from the top of her posterior left thigh, following dermatome S2, and ending at mid-calf. The patient reported having a low-grade fever for the past 2 days, but there were no other signs of infection. The patient complained of intense sharp, stabbing pain and mild itching. She stated that she tried applying a topical anti-itch cooling gel to the rash with no relief for the pain or the pruritis. She denied any exposure to harsh or irritating substances or allergens, such as poison ivy or poison oak.
Patient denies prior hospitalizations, surgeries, or accidents. The patient does have a history of exercise induced asthma. During the exam the patient stated that she had had chickenpox when she was a child.
Herpes zoster (HZ) or shingles, is an acute inflammatory eruption of incredibly painful vesicles that occur along a band-like unilateral pattern along the course of the peripheral nerves or dermatomes, and does not cross the midline of the body. Shingles results when the herpes varicella-zoster virus or chickenpox reactivates, for unknown reasons, after lying dormant in the dorsal root ganglia. Tingling, itching, and pain along the affected dermatome usually proceeds the eruption of vesicular lesions by 2 or 3 days. After several days, the vesicles evolve through stages of postulation, crusting, and then develop a scab. The duration of shingles is usually 10 days to 5 weeks, from onset to recovery. The skin overlying the thoracic dermatomes are the sites most commonly affected, but any area of the body may be affected. If the ophthalmic nerves are involved, severe and permanent damage to the eye can occur. Shingles can affect all age groups, but those older than 55 are more frequently affected.(Frazier & Drzymkowski, 2009)
A diagnosis of shingles was made based on the classic presentation of unilateral extremely painful, red, swollen vesicular lesions involving a single dermatome forming a band-like pattern on one side of the body. A culture from the vesicle scrapings confirmed that the herpes varicella-zoster virus was present. Further laboratory investigation revealed the presence of the varicella-zoster antibodies in the patient’s blood sample.
The goal of treatment for shingles is directed at making the patient comfortable. For palliative treatment, I prescribed an analgesic and prednisone to control pain. I also prescribed an antiviral, Acyclovir, to help prevent the formation of more vesicles. I warned the patient of the potential of infection if she were to scratch at the lesions. I informed the patient that cool compresses, and oatmeal baths might be soothing to help relieve some of her discomfort.
After 15 days the red vesicular lesions dried up, changed to scabs and dropped off. At the same time, the patient’s pain alleviated.

Reference

Frazier, M. S., & Drzymkowski, J. W. (2009). Essentials of Human Diseases and Conditions Fourth Edition. St Louis: Saunders Elsevier.