Zoster (shingles) is due to a virus indistinguishable from that causing chicken-pox which results in an inflammation of one or more posterior root ganglia. It usually occurs spontaneously but sometimes it seems to be precipitated by injury to the spine, by the reticuloses or chronic arsenical poisoning. The disease produced is variable in severity and can range from pain without cutaneous involvement to severe cutaneous gangrene—with intermediate grades of erythema only, or erythema with groups of tense vesicles which pass through stages of pustulation, crusting and scarring. This natural variability makes it impossible to assess the results of early treatment in individual cases and it is unlikely that any of the recommended means of aborting attacks—such as injections of pitressin or of thiamine—have any significant effect. The objects of treatment are to relieve pain (which can be extremely severe), to protect the affected skin from friction, to prevent secondary infection and—if the eye is involved—to prescribe mydriatics and seek the help of an ophthalmologist as soon as possible. The pain is best treated by keeping the patient warm in bed, by painting the skin with flexible collodion B.P., and thereafter powdering it with zinc, starch and talc dusting powder B.P.C., by protecting it from friction by a thick layer of cotton-wool and by giving oral analgesics. The local or systemic use of antibiotics is indicated only in severe attacks or if the eye is involved.
Post-tier fetic pain can be a grievous problem and is liable to occur in elderly patients. Analgesics (aspirin or paracetamol) are used and their effect can be enhanced by giving promazine hydrochloride. Vibration therapy (the Pifco vibrator is commonly used) is worthy of trial. There is a tendency for improvement to occur up to six months after the attack. In the intractable case the problems are similar to those found in the management of trigeminal neuralgia and may require to be reviewed by a neurosurgeon.
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