HERPES

Both shingles (herpes zoster) and cold sores (herpes simplex) occur with increased frequency in patients with malignancy, especially those who are immuno-suppressed during or after chemotherapy. Shingles is also more common in the elderly due to a natural decline in cell-mediated immunity. Shingles causes a painful eruption of vesicles in one dermatome (a section of skin supplied by one cutaneous nerve).

Persisting pain in the skin after the rash has healed (post-herpetic neuralgia) is more common in the elderly. It occurs in about 10% of patients under 60 and about 40% of those over 60. In about half of these it lasts over a year. It is a nerve pain (burning, stabbing pain which fluctuates in severity and which can be worsened by emotional tension). About 2% of shingles affects the eye. The nasociliary nerve (supplying the tip of the nose and the cornea) is affected. Keratitis and uveitis can occur and can cause loss of vision.

Oral acyclovir in high dosage (800mg 5 times a day for 5 days), started within 48 hours of the rash appearing, can reduce the severity and pain of the rash and will reduce the severity of eye complications. It does not reduce the likelihood of post-herpetic neuralgia. Acyclovir has few side effects because it is activated by an enzyme specific to the herpes virus.

There is no firm evidence that steroids (commonly used) or amantadine (occasionally used) at the time of the rash reduces the incidence or severity of neuralgia.

Post-herpetic neuralgia is difficult to treat and may require a combined approach. (see Nerve Pain)

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