Presentation - History
Giles Winterbourne is a 48 year old plumber whom you have not seen before. He phones you today complaining that he has had a pain in his chest and now has noticed that he has come out in a rash.
You ask him to send you a picture from his smartphone and tell him that you will get back to him.
Have a look at the photograph he sends you and then type in the most likely diagnosis.
picture of rash on chest
Presentation - Consultation
Presentation - Management
What would be the most appropriate treatment at this stage?
Can shingles be prevented and if so how?
The Department of Health introduced the national shingles immunisation programme in adults aged 70 years with a catch-up programme for people in their late 70s, to help protect the age groups most at risk from shingles and its complications.
The vaccine is a live attenuated vaccine which needs to be administered only once. Because it is a live vaccine it is contraindicated in severely immunocompromised people, pregnant women and children.
Presentation - Follow up
Post herpetic neuralgia is best treated with a tricyclic anti-depressant such as amitriptyline at an initial dose of 25mg nocte (10mg in the elderly) titrated for effect and avoidance of side effects.
Anti-neuropathic drugs such as Gabapentin can also be used
Strong pain relief in the form of Oxycodone, for example, could be used and Capsaicin, a topical treatment made from chilli peppers can be applied to the affected several times per day.
End - Thank you for taking part in this learning package
End - Acknowledgements
NHS online patient information - for use of images