Derm: Shingles: Free MSRA Podcast

🎧 MSRA Deep Dive: Shingles – High-Yield Revision EssentialsGet exam-ready with this concise breakdown of shingles (herpes zoster) – covering pathophysiology, risk factors, red flags, and NICE-aligned management. Perfect for MSRA prep! 🧠🧠 Core Learning Points📌 Definition• Reactivation of latent Varicella-Zoster Virus (VZV)• Causes painful, unilateral, vesicular rash in a dermatomal pattern• Commonly affects thoracic dermatomes or cranial nerves📌 Pathophysiology• After chickenpox, VZV lies dormant in sensory dorsal root ganglia• Reactivation → virus travels along nerve → dermatomal rash• Triggered by immunosuppression, age, stress🧠 Mnemonic: “VIRUS” – VZV Reactivation In Unilateral Segment📌 Risk Factors• Age >50• HIV (15x increased risk)• Chemotherapy, immunosuppressants, long-term steroids• Bone marrow transplant, lymphoma• Stress• Hx of chickenpox is a prerequisite📌 Clinical FeaturesProdrome (2–3 days):– Burning/tingling pain– Fever, malaise, local lymphadenopathyEruptive Phase:– Red → vesicular → crusting rash in one dermatome– Does not cross midline– Lasts 2–4 weeks– Ophthalmic zoster: affects eye – URGENT referralPostherpetic Neuralgia (PHN):– Pain lasting ≥30 days after rash resolves– Risk ↑ with age📌 Differentials• HSV• Contact dermatitis• Eczema herpeticum• Impetigo• Insect bites• Migraine/angina (if prodrome only)📌 Infectivity & Transmission• Shingles = not contagious as shingles• VZV from blister fluid can cause chickenpox in non-immune individuals• Avoid contact with:– Pregnant women without immunity 🤰– Neonates 👶– Immunocompromised 💉📌 Investigations• Clinical diagnosis is usually sufficient• Consider PCR of vesicle fluid if:– Atypical features– Immunocompromised patient– Disseminated or severe disease• IgM, Tzanck smear (older method) rarely used• Eye involvement → urgent ophthalmology assessment📌 Management (NICE/CKS aligned)💊 Antivirals (start within 72h ideally):• Aciclovir, valaciclovir, famciclovir• Give to:– Adults >50– Immunocompromised– Severe pain or non-truncal involvement🕒 Start even after 72h if high-risk or ongoing vesicle formation💥 Pain Relief• 1st line: Paracetamol ± NSAIDs• 2nd line: Amitriptyline, gabapentin, pregabalin, duloxetine• Topical lidocaine patches may help• Corticosteroids: reserved for severe acute pain (selected adults)👁️ Referral Needed If:• Ophthalmic zoster• Immunocompromised• Disseminated rash or complications• Neurological signs (e.g., meningitis)• Pregnant women• PHN – consider pain clinic📌 Complications• PHN – burning nerve pain (up to 30% in older adults)• Ophthalmic zoster – uveitis, keratitis, vision loss• Ramsey Hunt syndrome – facial paralysis, ear pain, hearing loss• Skin scarring, pigmentation• Secondary infection• Neurological – meningitis, encephalitis, myelitis• Disseminated zoster – esp. in immunocompromised📌 Prognosis• Most recover in 2–4 weeks• PHN may persist for months/years• Early antiviral treatment = ↓ PHN risk• Mortality rare – mainly in immunocompromised📌 Vaccination• Shingles vaccine (Shingrix) offered to older adults to reduce risk• Chickenpox vaccine not routine in UK (due to theoretical effects on herd immunity)📎 More Free MSRA Shingles Resources📝 Revision Noteshttps://www.passthemsra.com/topic/shingles-revision-notes/🧠 Flashcardshttps://www.passthemsra.com/topic/shingles-flashcards/💬 Accordion Q&A Noteshttps://www.passthemsra.com/topic/shingles-accordion-qa-notes/🚀 Rapid Quizhttps://www.passthemsra.com/topic/shingles-rapid-quiz/🧪 Topic Quizhttps://www.passthemsra.com/quizzes/shingles/🎓 Dermatology Coursehttps://www.passthemsra.com/courses/dermatology-for-the-msra/🔖 Hashtags#MSRA #Shingles #DermatologyMSRA #MSRARevision #MSRAFlashcards #MSRAQuiz #VZV #HerpesZoster #PostherpeticNeuralgia