Herpes Zoster, which is commonly known as shingles in English, has a more descriptive and apt Nepali name, “JanaiKhatira”. “Janai” is the sacred thread worn by Brahmins and Chettris and the skin rashes ( “khatira”) often follow the distribution of the thread around the chest and back (picture).
In many instances regarding diseases, Nepali names are very apt. For example, Nepalis call typhoid fever “myadhejoro” because the fever without antibiotics usually lasts for 3 weeks. This time frame can also help doctors distinguish typhoid fever from other illnesses. But back to JanaiKathira--With the “Janai” in mind, it should be easy for Nepali medical students to make this diagnosis when they see this kind of skin lesion in their patient. In medical examination, these lesions in patients are shown and you have to make a “spot” diagnosis. This can always be challenging under the glare of the strict examiner, but this “khatira” is so common that it is important to make the diagnosis so that we can then help the patient properly. “JanaiKhatira” should not be mixed up with “JanaiPurnima” the annual Vedic festival of the sacred thread when among other celebrations, Nepalis rapidly climb up to Gosainkudna for a holy dip in the lake at 4300 m and risk altitude sickness .Clearly both, the “Purnima” and “Khatira”, have to be taken seriously. Today we will deal with the “Khatira”.
These in lesions caused by the herpes zoster virus are painful, and it is the same virus that causes chickenpox. A person who has had chickenpox is at risk because the virus which lies dormant in the nerve can reactivate later in life. Although herpes zoster can occur at any age, this problem is more common among people 50 years of age or older. Usually it starts with painful itchy rash with blisters. It can appear on the trunk or the face and is usually on one side of the body and lasts for 2 to 4 weeks. Many times before the rash is seen, there is intense pain at the site where the lesions will show up, but before the lesions show up there will be a period of confusion as to what is going on. So proper examination is required and a proper history taking skills are important in the diagnosis of JanaiKhatira.
The main complication of herpes zoster is the pain that follows after the rash has subsided. The pain is called post herpetic neuralgia. There is severe skin sensitivity described as burning and sharp pain or itchiness in the area where the rash appeared. Importantly the pain can be so severe that it can disrupt sleep and make everyday activities difficult to perform. Sometimes shingles may also cause ear pain and vision loss.
There are oral antiviral drugs locally available in Nepal like acyclovir, which may reduce the duration of pain and accelerate the healing of the rash. Early treatment may also help avoid complications. But can this painful, common problem be prevented?
Yes, but not in South Asia because of the unavailability of this expensive vaccine. In an“ideal”worldeveryone > 60 years is recommended this vaccine. In Nepal we try to make a proper diagnosis and administer effective drugs. When what is ideal is not practical, what is practical has to be adequate.