Real-Life Challenge: Shingles
A 57-year-old woman has severe pain in the left occipital region, in the left side of her neck, and in the left scapular region. The onset was approximately 36 hours ago. She describes the pain as intermittent, sharp, shooting, and severe. She has been taking ibuprofen for the pain with little relief. She noticed small blisters forming along the painful areas in the last few hours. She is afebrile and appears quite uncomfortable. On examination, small blister-like eruptions are noted along the left side of the neck, left anterior shoulder, and clavicular area. Some eruptions also appear at the base of the skull just in the hairline. These eruptions do not cross the midline on either the front or back of the body. The patient is diagnosed with shingles, along the C-2, C-3, and C-4 peripheral nerve or dermatome area. On questioning, the patient confirms having chickenpox in childhood at about 8 years of age. Medications prescribed include famciclovir (Famvir) 500 mg TID for 7 days. Acyclovir (Zovirax) cream also was prescribed for topical application to the affected areas and hydrocodone bitartrate with acetaminophen (Vicodin) for pain.
1. What is the significance of the previous occurrence of chickenpox?
2. What is the causative agent of chickenpox? Of shingles?
3. Why is the fact that the eruptions do not cross the midline important?
4. Identify other medications that may be prescribed for shingles.
5. What might the patient expect as an outcome of this condition?
6. What is meant by postherpetic neuralgia (PHN)?