ZOSTER

Synonyms: Zona; Herpes zoster; Ignis sacer; Shingles.

Zoster is an acute, self limited, probably specific infectious disease of the nervous system. An acute hemorrhagic inflammation attacks one or more ganglia of the sensory roots of the cranial or spinal nerves. There are often prodromal symptoms, anorexia, slight fever, and neuralgic pains along the course of the diseased nerve. On the third or fourth day the rash appears as groups of vesicles upon an erythematous base, situated in the skin region supplied by the affected nerve. The neuralgia sometimes subsides with the outbreak, though often it persists for several days. As the nerve distribution is unilateral, so the rash is confined to one side of the body, though lesions situated near the median line may encroach a little upon the opposite side. When two nerves are affected at the same time, which is not very unusual, they nearly always supply adjacent areas. In very rare instances the rash has a bilateral distribution. There may be only one or as many as twenty groups, each composed of few or many vesicles. They appear simultaneously or usually all within forty-eight hours, though occasionally new crops of blisters continue to erupt for a week or longer. The vesicles reach their maturity in three or four days, when they are about pea size, hemispherical, clear, tense and thick walled; they seldom rupture spontaneously. Later their contents become turbid, rarely puriform, but occasionally hemorrhagic in one or two vesicles. They finally dry

to thin yellowish or brownish crusts which fall off
in a few days and leave temporarily hyperemic or
lightly pigmented spots. In debilitated individuals
the lesions sometimes become pustular or even gan-
grenous, and leave groups of pit-like scars when they
heal. The severity of the subjective sensations and
of the local disturbance seems to increase with the
age of the patient. It is usually in those past middle
life that the neuralgic pains may persist long after
the rash has disappeared, for months or even years.
The most common localization of zoster is the re-
gion of distribution of the intercostal nerves, over
an area as wide as 1—3 intercostal spaces, and ex-
tending halfway around the trunk from the posterior
to the anterior median line. The most serious com-
plication may arise when the disease affects the first
division of the trigeminus. Lesions upon the con-
junctiva and cornea may cause ophthalmia or ulcer-
tive keratitis with resulting impairment or loss of
sight. One attack of zoster seems to confer an
immunity. DIAGNOSIS: Herpes simplex, unlike
zoster, is very prone to recur, its outbreak is not
preceded or accompanied by neuralgia, and the le-
sions which are usually located near a mucous ori-
fice are often situated well to both sides of the
median line. TREATMENT: Local treatment aims
to prevent rupture of the vesicles. This can best
be done by keeping them powdered and covered with
a soft pad of cotton. It may be necessary to give
analgesics to allay the pain.

127

HST. 00 0001.061