From the Guidelines
Shingles can present bilaterally, although this is extremely rare and often associated with immunocompromised individuals. This rare presentation is typically seen in patients with compromised immune systems, such as those with HIV/AIDS, cancer, or those on immunosuppressive medications 1. The varicella-zoster virus, which causes shingles, usually reactivates in a single sensory nerve ganglion and follows the distribution of that nerve on one side of the body. However, in cases of disseminated zoster, where lesions appear in more than three dermatomes, the presentation can be bilateral 1. Key points to consider in the presentation of shingles include:
- Unilateral presentation is the most common form of the disease
- Bilateral presentation is rare and often associated with immunocompromised individuals
- Disseminated zoster can present with lesions in multiple dermatomes, including bilateral lesions
- Treatment with antiviral medications, such as acyclovir, valacyclovir, or famciclovir, should be started within 72 hours of rash onset, along with pain management. When a patient presents with what appears to be bilateral shingles, healthcare providers should consider alternative diagnoses or investigate for underlying immunodeficiency, as the bilateral presentation can be a sign of a compromised immune system 1.
From the Research
Presentation of Shingles
- Shingles, also known as herpes zoster, is a viral infection that typically presents with a painful rash, usually on one side of the body 2, 3.
- The rash is typically unilateral, confined to a single dermatome, and usually resolves within 7-10 days 2, 3.
- However, there is no direct evidence in the provided studies to suggest that shingles can present bilaterally, meaning on both sides of the body.
Characteristics of Shingles
- Shingles is caused by the reactivation of the varicella-zoster virus, which is the same virus that causes chickenpox 2, 3.
- The risk of developing shingles increases with age, with most cases occurring in people over 50 years old 4, 2.
- Shingles can be treated with antiviral medications, such as acyclovir, valacyclovir, and famciclovir, which can help reduce the severity and duration of the rash and pain 4, 2, 5, 6.
Complications of Shingles
- Postherpetic neuralgia (PHN) is a common complication of shingles, characterized by persistent pain in the affected area after the rash has resolved 4, 2, 3, 6.
- PHN can be severe and difficult to manage, and may require treatment with pain medications, such as opioids, tricyclic antidepressants, and antiseizure drugs 2, 3, 6.