Management of Skin Opening After Shingles Outbreak
Packing is not recommended for the skin opening that developed after your shingles outbreak, as there is insufficient evidence to support its use and it may cause unnecessary pain.
Understanding the Condition
- The hard nodules under the skin followed by an opening hole are likely a complication of herpes zoster (shingles) infection, which can lead to skin breakdown and secondary complications 1.
- Herpes zoster is caused by reactivation of the varicella-zoster virus that remains dormant in sensory nerve ganglia after a previous chickenpox infection 1, 2.
- Complications of herpes zoster can include bacterial superinfection of lesions, which may lead to abscess formation 3, 2.
Assessment Approach
- The skin opening should be evaluated for signs of active infection including redness, warmth, increasing pain, purulent discharge, or systemic symptoms such as fever 1.
- If there are signs of an abscess, a complete physical examination including assessment of the surrounding area is necessary 1.
- Laboratory tests may be indicated if there are signs of systemic infection, including complete blood count and inflammatory markers 1.
Management Recommendations
For Simple Skin Opening Without Signs of Abscess:
- Standard infection control precautions should be followed for all herpes zoster-related skin lesions 1.
- Simple wound care with sterile normal saline cleansing is recommended rather than packing 1.
- Application of plain petrolatum ointment and non-adherent dressings over open areas is appropriate 1.
If Abscess Is Present:
- Surgical drainage would be indicated for a confirmed abscess 1.
- Regarding wound packing after abscess drainage, current guidelines state: "No recommendation can be made regarding the use of packing after drainage of an anorectal abscess, based on the available literature" 1.
- A recent multi-center observational study found that "packing is costly and painful and does not add benefit to the healing process" 1.
Follow-up Care
- Monitor the wound for signs of healing versus progression of infection 1.
- If the lesion is from herpes zoster and still active, antiviral agents may be indicated as they have been shown to decrease viral shedding and lower the duration of herpes zoster lesions 1, 2.
- For persistent pain after shingles (postherpetic neuralgia), specific pain management may be required 2.
Important Considerations
- If the opening is large, deep, or shows signs of infection (increasing redness, warmth, pain, purulent discharge), prompt medical evaluation is necessary 1.
- Immunocompromised patients require more aggressive management and closer monitoring 1, 2.
- Unusual presentations of herpes zoster, including persistent openings, may warrant further investigation, especially in immunocompromised individuals 4, 2.
Pitfalls to Avoid
- Avoid probing or packing small openings as this may cause unnecessary pain and potentially create iatrogenic complications 1.
- Do not assume all skin openings after shingles are simple herpes zoster lesions; consider bacterial superinfection if there are concerning symptoms 3, 2.
- Avoid delaying medical attention if the wound shows signs of worsening, as early intervention for complications is essential 1, 2.