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14 Cards in this Set

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What are the 3 most common causes of vesicles?
1. herpes zoster reactivating as shingles
2. herpes simplex infection
3. contact dermatitis
How do I tell shingles from herpes simplex?
Shingles (aka zoster) is reactivation of dormant varicella zoster virus (the virus that causes chickenpox. It has a dermatomal distribution, which typically does not cross the midline, clinches the diagnosis.
What are the symptoms of shingles?
Symptoms usually begin with painful burning along a single dermatome, followed by an outbreak of vesicles on a erythematous base in the same dermatome.
In what populations does shingles occur most often?
Shingles occurs much more frequently in patients who are elderly or immunocompromised, and is especially common in patients with HIV.
When herpes simplex affects the fingers with weepy ulcerations, what is it called?
herpes whitlow
How do you confirm a diagnosis of herpes simplex?
Obtain a sample of cells for a viral culture from the base of an unroofed vesicle (rub firmly for an adequate sample).
What is post-herpetic neuralgia?
Post-herpetic neuralgia (PHN) is pain occuring after shingles resolves. It may last from a few weeks to a year or two in severe cases. The incidence and duration of PHN increases with age.
How do I treat herpes zoster and post-herpetic neuralgia?
Treat with 7 days of acyclovir (800 mg 5x/day). Famciclovir (500 mg tid) and valacyclovir (1 gm tid) are equally effective, but much more costly.
T or F: Acyclovir, famciclovir and valacyclovir shorten both the time to healing and duration of PHN, but they do not affect the incidence of PHN.
T
When should prednisone be used in herpes zoster?
Prednisone should only be sued when the acute rash is severe. It may decrease the acute pain, but has little to no effect on PHN.
Patients with active zoster should avoid who?
Pregnant women and those who do not have a history of chicken pox or varicella vaccination.
When should patients with zoster have an urgent ophthalmologic evaluation?
Patients who have lesions on the forehead, the nose, or around the eye, or those who have ocular symptoms should have urgent ophthalmologic evaluation to rule-out corneal involvement.
Post-herpetic neuralgia may respond to what type of drugs?
1. Tricyclic antidepressants
2. Topical capsaicin cream
3. Gabapentin
How do I treat herpes simplex?
Outbreaks are self-limited, but may be shortened by 7 days of acyclovir (400 mg tid). Patients with frequent severe attacks can be given prophylactic acyclovir (400 mg bid). Lessen the risk of transmission by avoiding intimate contact with the involved area during outbreaks.