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!

Herpes Treatment : Currently, there is no method to eliminate the herpes virus from its resting place in the nerve cells. Treatments are available, however, to help the infections heal faster and, if taken continually, to suppress most recurrences. OTC topical medications: Over-the-counter (OTC) topical products that state they are for herpes do absolutely nothing but make the skin tingle. These preparations have the effect of allowing the infection to heal in the same number of days as it would have done anyway. Topical anesthetics are sold that can be applied directly with a swab (often containing dyclonine or benzocaine, which are the local anesthetic agents). When large areas are affected by the herpes, a thick (viscous) preparation of the local anesthetic lidocaine is also available that can be used as a mouth rinse. However, swallowed lidocaine is hazardous because it anesthetizes (numbs) the inside of the mouth, the throat, and even the epiglottis (the cover to the windpipe). Children should probably not use such topical anesthetics for fear of aspiration (getting something they've swallowed down the wrong way into the lungs). Prescription-strength topical medications: Prescription- strength topical medicines (ones you put on the herpes sores) are not much more effective than OTC preparations. Patients who have a prodrome (a tingling or burning sensation which lets them know they are about to get a cold sore) can reduce the duration of their infection by applying acyclovir (Zovirax) ointment or one of its newer relatives, such as famciclovir (Famvir), valaciclovir (Valtrex), or penciclovir (Denavir). These medications are available only by prescription. (Their safety during pregnancy and nursing and their safety and efficacy for children under the age of 18 years have not been established.) Oral medications: Effective anti-herpes antibiotics include acyclovir (Zovirax), famciclovir (Famvir), and valaciclovir (Valtrex). (Again, the safety of these drugs during pregnancy, nursing, and in children under the age of 18 years has not been established.) All of these anti-herpes antibiotics are remarkably easy to tolerate and are generally free of side effects. When taken early, preferably during a prodrome, these drugs can limit the duration of the infection to some extent. They are also useful in helping prevent or minimize recurrences when taken for extended periods. This method is helpful for patients who experience frequent recurrences, or who have a particular event or situation (such as a wedding, honeymoon, or vacation) at which an unsightly recurrence would be especially unwelcome. Lysine supplements: Although the amino acid lysine suppresses the growth of the herpes virus in laboratory test tubes, taking lysine pills by mouth has not proved effective. What works in the lab doesn't necessarily work in a person, and that is the case with lysine. Nevertheless, some people find this over-the-counter remedy helpful.

Herpes simplex infections are common, unsightly, and embarrassing. When they appear in their most common location, around the mouth and lips, people often refer to them as "cold sores" and "fever blisters." The herpes virus has two forms called - type I and type II. In general, type I infections occur above the waist, while type II infections occur below the waist. Type II infections are associated with genital herpes. However, the distinction between types I and II herpes is not absolute. Clinically, the distinction doesn't matter a great deal since a determination between the two types plays no role in diagnosing and treating people with herpes infections in everyday practice. The most striking characteristic of herpes infections, no matter where they occur on the body, is their tendency to recur in more or less the same place. Such recurrences may happen often (for example, once a month) or only occasionally (for example, once or twice a year). The tendency of this virus to establish itself in the nerve collections (called ganglia) under the skin is responsible for the recurrences. Repeated episodes occur when the virus is reactivated by: Fever; Systemic (body-wide) infection;, Ultraviolet radiation (like a sunburn); Stress; hanges in the immune system; Trauma.

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.