Herpes zoster ophthalmicus
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k5234 (Published 17 January 2019) Cite this as: BMJ 2019;364:k5234
All rapid responses
May I thank Ting, Ghosh and Ghosh for an eminently readable article? A couple of points.
1. CYANOCOBALAMIN by injection.
It was, once, reputed to be very effective in reducing the associated radicular pain.
Has it been consigned to the dustbin of history? No adverse effects were ever reported.
2. PERIOD OF INFECTIVITY.
In CHICKEN POX, - it was said that a week after the first crop of vesicles appear, the patient is non-infective. It was thought that the body inactivated the virus. If that “ thought” is correct, then I wouldlike to know how the virus hiding in the dorsal horns manages to travel down the axons to the terminals and creates pathology ( vesicles) there in the skin.
Thank you
Competing interests: No competing interests
Having had shingles in V1 I don't recommend capsaicin cream. It dried to a flaky papery texture, making my forehead look even worse, and making a message of my hair.
Gabapentin soothed my post-herpetic neuralgia but made me feel spaced out and remote; other people noticed it too. Pregabalin, recommended by NICE, was a million times better
Competing interests: No competing interests
Re: Herpes zoster ophthalmicus
Thanks to the authors for this readable and interesting article.
From a General Practice perspective I wish to raise a couple of areas which would benefit from clarity.
The authors describe Hutchinson’s sign as being rash involving the tip, side or root of the nose, however I was taught Hutchinson’s sign is vesicles on the tip of the nose - ie the distribution of nasociliary nerve.
https://patient.info/doctor/shingles-and-shingles-vaccination
https://www.college-optometrists.org/guidance/clinical-management-guidel...
The authors recommend ophthalmology referral for patients with any ocular symptoms but do not comment on whether referral required for all with Hutchinson’s sign. This information would be helpful for Primary Care and Emergency Medicine colleagues.
Competing interests: No competing interests