From the Guidelines
Bilateral shingles is extremely rare, and its exact prevalence is not well-established in the provided evidence, but it is generally considered to occur in less than 1% of all shingles cases. Shingles (herpes zoster) typically affects only one side of the body along a single dermatome, which is an area of skin supplied by a specific spinal nerve. When shingles appears on both sides of the body simultaneously, it often indicates a compromised immune system. This bilateral presentation is more common in immunocompromised individuals, such as those with HIV/AIDS, cancer patients undergoing chemotherapy, organ transplant recipients on immunosuppressive medications, or elderly people with naturally declining immune function.
Some key points to consider about shingles and its management include:
- The varicella-zoster virus typically reactivates from a single dorsal root ganglion where it has remained dormant since the initial chickenpox infection, making the simultaneous reactivation in multiple ganglia on opposite sides of the body an uncommon occurrence 1.
- Herpes zoster occurs most frequently during the first year following chemotherapy treatment, or following receipt of an HSCT or a SOT, with a significant risk of developing dissemination without prompt and effective antiviral therapy 1.
- High-dose IV acyclovir remains the treatment of choice for VZV infections in compromised hosts, while oral acyclovir, famciclovir, and valacyclovir are beneficial for VZV infections in otherwise healthy hosts 1.
- The most effective strategy to prevent varicella, HZ, and its related complications is by vaccination, as highlighted in recent recommendations 1.
If bilateral shingles is suspected, immediate medical attention is necessary as it may require more aggressive antiviral treatment (typically valacyclovir 1000mg three times daily, famciclovir 500mg three times daily, or acyclovir 800mg five times daily for 7-10 days) and further investigation of potential underlying immune disorders. The rarity of bilateral shingles and its association with immunocompromised states underscore the importance of prompt recognition and management to prevent complications and improve outcomes.
From the Research
Bilateral Shingles Prevalence
- The provided studies do not directly address the prevalence of bilateral shingles 2, 3, 4, 5, 6.
- However, it is mentioned that herpes zoster is typically characterized by a unilateral, dermatomal distribution of the rash 2.
- There is no specific data or discussion on the frequency or commonality of bilateral shingles in the given studies.
- The studies primarily focus on the treatment, prevention, and management of herpes zoster, as well as its complications, such as postherpetic neuralgia 2, 3, 4, 5, 6.