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Shingles or Herpes Zoster is a viral infection caused by the Chicken Pox Virus. It causes pain and skin lesions in a characteristic and diagnostic distribution in a single dermatome on precisely one side of the body.

It is important to make this diagnosis as early as possible as anti-viral medication can limit the extent of the skin lesions and also reduce the incidence of the post herpetic neuralgia or chronic pain that can persist for months after the skin lesions have resolved.

Usually, at least 1 or 2 lesions have to declare themselves to enable a diagnosis but there should be a very high index of suspicion for unusual pains or irritation along dermatomes. Often the pain is present for days before the lesions. If the dermatome includes the eye, there can be unexplained tearing before the skin erupts. If the ocular branch of the trigeminal nerve is involved (eye) an ophthalmologist should examine the eye with a slit lamp to determine if the virus has invaded the cornea.

In general the anti-viral medication should be started as quickly as possible and continued for 10 to 14 days. Topical corticosteroid creams are definitely contra-indicated and topical antibiotics are ineffective. Lesions on the trunk are best managed by wearing and changing a clean white T -shirt.

The lesions usually resolve with little or no scar. Often strong pain medication may be used to help sleep during the worst period.

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