Integument: Chicken Pox

What is another name for chicken pox and shingles?

-chicken pox: varicella zoster

-shingles: herpes zoster

Epidemiology Varicella Zoster

-peak onset: 5-9 years of age

-outbreak: Jan-May

-etiology: Herpes Varicella Zoster virus

-transmission: direct contact with fluid from vesicle, respiratory droplet such as coughing or sneezing, direct contact with sore from person with shingles and transplacental

-household transmission rate: 80-90%

What are the sxs. of varicella zoster?

-viral prodromal sxs: fever, HA, anorexia, malaise, myalgia, pruritic rash

What are the signs of varicella zoster?

-lymphadenopathy

-rash: 200-500 itchy blisters that appear in successive crops

>severe pruritus, scratching will cause scarring. Starts on scalp and trunk and then spreads to face, arms, and legs

What is the incubation period and infectious period for varicella zoster?

-incubation: 11-21 days

-infectious:

>start 2-4 days before rash

>end: final lesion crusted

Varicella Zoster: Viral Suppression

-acyclovir 20 mg/kg/dose up to 800 mg/dose 5x day for every 4 hours

-efficacy of acyclovir:

>shortens time of viral shedding

>most effective if started within 24 ho

>more rapid healing

Immunocompromised or pregnancy exposure < 20 weeks

-varicella zoster immunoglobulin

-acyclovir x 7 days

Varicella/Chicken Pox

-incubation: 11-21 days

-contagious: before rash until all blisters crust

-rash: macule, papule, vesicles

-itching, fever, rash x 3-5 days

-malaise, HA total 5-7 days

Formation of each sore

-a thin-walled vesicle with clear fluid forms on a red base

-the vesicle becomes cloudy and depressed in center (umbilicated) with an irregular (scalloped) border

-a crust forms in the center and eventually replaces the remaining portion of the vesicle at the periphery

Non-drug chicken pox management

-fingernails, gloves, gentle soap

Chicken Pox: Antipruritic treatment

-Colloidal oatmeal!!!!!

-sodium bicarbonate

-calamine

-topical diphenhydramine?

-local anesthetics:

>benzocaine?

>lidocaine?

>Pramoxine!!!!!

Chicken Pox Treatment: Antihistamines

-po

-diphenhydramine

-hydroxyzine

Chicken Pox Treatment: Antipyretics

-APAP

-ibuprofen

Chicken Pox Treatment: Protectant/Astringent

-calamine (ZNO and ferric oxide)

Chicken Pox Prevention

-varicella vaccine

-Varivax: 1 dose at 12-15 months and

-Varivax booster is now recommended for anyone 4-5 and old who has had one prior Varivax

>13 years-2 doses, 4-6 weeks apart

>2 doses will provide 80-90% immunity

Shingles (Herpes Zoster)

-extremely painful viral infection of the nerve roots resulting in a skin rash caused by the same virus that causes the childhood illness chickenpox

-Anyone who has had chickenpox has the risk for developing shingles later in life,

-The reactivated virus responsible for these conditions is called the Varicella Zoster virus.

-Incidence is rising, 1 in 3 Americans will experience Shingles.

-More than half of all cases occurs in in >60 yrs of age.

-FDA recommendation: Everyone age 50 or older should get vaccinated-whether they have had Shingles or not.

-Virus can lie dormant for years in the nerve roots of the spinal cord. Stress causes virus to replicate and travel down the nerve to cause Shingles.

What are the risk factors for shingles?

-Aging process. The risk for postherpetic neuralgia (PHN) is also highest in older people with Shingles and increases dramatically after age 50. PHN is persistent pain and is the most feared complication of shingles.

-Immunosuppression.

-Cancer

-Risk for Recurrence of Shingles. Shingles can recur

The Shingles Rash

-The shingles rash can appear anywhere on the body but will only be on one side of the body, the left or right. It will be in a band, a strip, or a small area. Before the rash occurs, there is usually itching, tingling, or pain in that area. The rash turns into blisters after several days. It is possible to have the shingles rash in more than one area.

Shingles

-virus

-stabbing nerve pain (Postherpetic Neuralgia)

-blistering rash clears in 3-4 weeks, but pain may remain

-may reoccur, especially if first episode lasted greater than 30 days

Shingles results in a rash that can be mildly itchy to intensely painful.

-Shingles starts with burning, tingling, or very sensitive skin. A rash of raised dots develops into painful blisters that last about two weeks. Shingles often occurs on the trunk and buttocks, but can appear anywhere. Most people recover, but pain, numbness, and itching linger for many -- and may last for months, years, or the rest of their lives

Acute Shingles Treatment

-Start antivirals as soon as possible*, preferably within 72 hours of rash onset. In most patients, use antivirals for 7-10 days

>Acyclovir: 800 mg five times daily for seven to ten days;

>Famciclovir: 500 mg three times daily for seven days;

>Valacyclovir: 1 g three times daily for seven days.

-Pain medication is often necessary as the pain level is very high in many people. The pain is often so intense that people cannot have any clothing touch the skin area with shingles. NSAIDs, APAP, codeine, & morphine around the clock for acute pain.

-A three-week course of prednisone has also been recommended: prednisone 60 mg once daily for one week, then 30 mg once daily for one week, then 15 mg once daily for one week.

-Oatmeal baths or calamine lotion may help reduce itching.

-Local anesthetics such as pramoxine may be indicated.

-Local astringents may also be useful.

Treatment of PHN

-PHN is the pain that remains in some people even after the rash goes away. Some patients do not respond to common.

-Options: narcotics, gabapentin, pregabalin, or TCAs.

Shingles Prevention

-Zostavax: same vaccine as used for Chicken Pox, 14x stronger

-$150

->60 yo, or >50 yo if they want it

-Reduces the risk of shingles by 50%.

-If shingles does occur it is mild.

-Reduces postherpetic neuralgia by 67%.

-Zostavax appears to be effective in the 60 plus age group for at least five years, although benefit decreases after about 3 yrs.

Source: https://healtheappointments.com