Recurrent Herpes : By far the most common manifestation of herpes infections -- what people usually mean when they speak of "herpes" or "cold sores" -- is a recurrence of the virus when it is reactivated from its latent sleep in the nerves below the skin. What this looks like depends on where the virus has been hibernating: Labial herpes: This is the familiar cold sore that appears on the lip margins (labial refers to the lip). When labial herpes reappears, it usually occurs at most a few millimeters away from its previous location(s). Herpetic whitlow: Sometimes, the herpes virus shows up on the fingertip. This is especially common in dental and medical workers who have to put their fingers inside people's mouths, despite the use of gloves. Wrestlers' herpes: This has the picturesque name, "herpes gladiatorum." Gladiators, or nowadays just plain wrestlers, can contract herpes from an opponent who is shedding the virus. This form of herpes can appear all over the body. Wrestlers differ from most other patients with herpes who only develop recurrences in one spot. The reason for this is that although the antibodies in the bloodstream do not prevent the herpes from returning, they do make it hard for the virus to get a foothold anywhere else on the body.

Shingles : Herpes zoster: Also called shingles, zona, and zoster. The culprit is the varicella-zoster virus. Primary infection with this virus causes chickenpox (varicella). At this time the virus infects nerves (namely, the dorsal root ganglia) where it remains latent (lies low) for years. It can then be reactivated to cause shingles with blisters over the distribution of the affected nerve accompanied by often intense pain and itching. Shingles is a skin rash caused by the same virus that causes chickenpox. The virus responsible for these conditions is called Varicella zoster. After an individual has chickenpox, this virus lives in the nerves and is never fully cleared from the body. Under certain circumstances, such as emotional stress, immune deficiency (from AIDS or chemotherapy) or with cancer, the virus re- activates causing shingles. In most cases, however, a cause for the reactivation of the virus is never found. The herpes virus that causes shingles and chicken pox is not the same as the herpes virus that causes genital herpes (which can be sexually transmitted) and herpes mouth sores. Shingles is medically termed Herpes zoster. Before a rash is visible, the patient may notice several days to a week of burning pain and sensitive skin. Shingles start as small blisters on a red base, with new blisters continuing to form for 3-5 days. The blisters follow the path of individual nerves that comes out of the spinal cord (called dermatomal pattern). The entire path of the nerve may be involved or there may be areas with blisters and areas without blisters. Generally, only one nerve level is involved. In a rare case, more than one nerve will be involved. Eventually, the blisters pop and the area starts to ooze. The area will then crust over and heal. The whole process may take 3-4 weeks from start to finish. On occasion, the pain will be present but the blisters may never appear. This can be a very confusing cause of local pain!

Primary Herpes : The first time someone is exposed to herpes, the virus often infects the body without causing any noticeable problem. This process generates an antibody response in which the immune system produces specific proteins that are directed against the herpes virus. The antibody response usually makes recurrences mild. Sometimes, however, the first attack of herpes causes people to become very sick. It may cause fever, swollen glands, and bleeding gums, together with painful sore(s) around the mouth (gingivostomatitis). These signs and symptoms may last several days. Difficulty in eating and drinking may lead to dehydration. The viral infection typically lasts 10 to 14 days. The herpes blisters themselves may last anywhere from 2 to 6 weeks before they scab over and go away, usually without scarring. Primary herpes is typically contracted during childhood.

Treatment for Shingles : There are several effective treatments for shingles. Drugs that fight viruses (antivirals), such as acyclovir (Zovirax) or famciclovir (Famvir) can reduce the duration of the rash if started early (within 48 hours of the appearance of the rash). The addition of steroids may also limit the length of time that a patient has pain with shingles. However, the benefit of both of these drugs is limited. In addition to antiviral medication, pain medications may be needed for symptom control. The affected area should be kept covered and dry. However, bathing is permitted and the area can be cleansed with soap and water. An aluminum acetate solution (Burows or Domeboro's solution, available at your pharmacy) can be used to help dry up the blisters and oozing.