Shingles: recognition, treatment and prevention
Pain, burning or tingling in a band on one side of the body, appearing days before any rash. Then grouped vesicles on an erythematous base, following a single dermatome and stopping at the midline. The unilateral distribution that respects the midline is the diagnosis. Antiviral treatment works best when started within seventy-two hours of the rash appearing. This is why a client describing unexplained band-like pain is assessed promptly rather than reassured. Two situations that must be escalated the same day: involvement of the eye or the tip of the nose, which threatens vision, and involvement of the ear with facial weakness or hearing change. Transmission: the fluid in the vesicles carries the virus. A person who has never had chickenpox or been vaccinated can catch chickenpox from it, not shingles. Cover the lesions, apply contact precautions until they are crusted, and keep the client away from pregnant people, newborns and immunosuppressed people. Pain is the main problem and is often undertreated. Post-herpetic neuralgia can persist for months, and it is treated with agents for neuropathic pain rather than with ordinary analgesics alone. Prevention: the vaccine is recommended for the age groups covered by the immunization schedule, including for those who have already had an episode.