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Herpes Simplex Virus (Cold Sores) Zoster / Shingles

Upon infection the person will develop an initial site infection – vesicle formation and local inflammation. The virus invades the sensory nerve cells where it will remain dormant. Upon reactivation, recurrences of the HSV will result.

When HSV is reactivated its presence is indicated by a burning, itching and tingling sensation prior to any vesicle formation. These vesicles may evolve into pustules. As they evolve erosion occurs and the skin layer is shed. The erosions often develop into ulcerations, either crusted or moist. The lesions may take between 2-4 weeks to fully heal and often result in post-inflammatory hypo or hyper pigmentation. The areas most likely to be affected are around the mouth, inner lips, throat, nose, fingers.

Reactivation can be caused by either:

• physical skin trauma such as sunburn, windburn or an abrasion

• systemic triggers such as fatigue, menstruation, stress or respiratory tract infections.

HERPES ZOSTER (Shingles)
This condition is an acute infection of the nerves that supply the skin. It is caused by the reactivation of the Chicken Pox (varicella zoster) virus.

After initial infection, the chicken pox virus remains dormant in the body for many years. The greater majority of cases (about 60%) occurs in adults older than 50 and only about 5% occur in children younger than 5.

The patient may have fever for days, poor appetite, fatigue and headache coupled with skin pain and tingling prior to the presentation of lesions. These lesions start as bright red papules that evolve into fluid filled vesicles. The fluid is normally clear but occasionally may be filled with blood. The lesions usually present along a nerve branch, however adjacent nerve branches may also be involved. As the condition progresses the fluid inside the vesicles turn pusy and rupture. After rupturing dry crusts form which are shed after 2-3 weeks. Temporary pinkish or hyper-pigmentation marks are left. Scaring usually does not occur.

It is an extremely painful condition and in the elderly may persist for many months or longer as successive crops of vesicles develop. Most patients experience extreme skin sensitivity and pain in the area where the lesions erupted. This sensitivity and pain usually subsides within 12 months. Recurrence is rare.

 

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