Brief Answer:
PHN & IED:Amitriptyline, Gabapentin & oral steroid

Detailed Answer:
Hello,

Welcome and thanks for posting your query to the forum. I can understand your concern for pain and related condition after herpes zoster (shingles) along with itching and eczematous lesions over other sites.

After analyzing yor condition with diligence it seems that you have developed "Post herpetic neuralgia" (PHN) and " infectious eczematoid dermatitis" (IED).

For "Post herpetic neuralgia": It is condition where pain persists after herpes zoster and induces moderate to severe discomfort of variable nature at the affected site. This is very much annoying and the person has repeated tendency to touch the area or scratch the area. This can be an inducing factor for the debilitating pain as well eczema like lesions.

Lesions or plaque present at one site can induce further more itching all over body with eczema like areas called as " infectious eczematoid dermatitis".

I suggest you to meet a dermatologist to get yourself examined completely and therefore a proper course of treatment could be given to you.

In my patients I generally prescribe "Amitriptyline" and Gabapentin for the treatment of Post herpetic neuralgia. These are the main drugs for the treatment for this condition and are prescription drugs to be taken under medical guidance according to the severity of the condition.

For infectious eczematoid dermatitis: I generally prescribe oral steroid according to body weight and then taper off or reduce the dose according to improvement.

Additionally I generally prescribe Loratadine (Claritin) as antihistamine to be taken in day time. It can be taken for 3-4 times in case of intense itching and 2 times if the itching is moderate. I prefer this over other of antihistamine as is non-sedating one than cetrizine as well quite low dose than fexofenadine ( 5 mg over 180 mg).

For the further betterment kindly follow the suggestion below:

- Keep your self away from hot and humid climate.

- Take two times bath.

- Wear cotton clothes and cotton undergarments to be changed two times a day. Do not wear any synthetic or tight garments.

- Do cold compression or warm water compresses according to the weather condition.

- Do not sit continuously for long hours.

-Don't try to scratch or rub the area as can lead to further aggravation of the problem.

- Reduce your weight if it is on higher side.

I additionally suggest you the most important part to not to scratch the area. It is the sole most important factor in causing more aggravation of problem.
I hope these informations will help you in treating and managing the condition better. If you have further queries I will be happy to help.

"Wish you good health and early recovery from the problem"

Regards,
Dr Sanjay Kumar Kanodia
MD (Dermatology)

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Brief Answer:
Go for "culture and sensitivity” of pus.

Detailed Answer:
Hello,

Welcome again and thanks a lot for posting details with pictures.

I can get that the areas are quite badly infected. This is one of the causes of infection and itching spreading to rest of the body. To treat the area better let me explain certain more things:


The reason for the inflammation and infection of the area is due to the fact that our body harbor multiple types of bacteria on the skin which are known as “Normal flora” of the skin. As soon as there is some break in the skin or trivially also due to bit ups and downs in immunity or any other infection, the bacteria gets access into the skin and causes the aforesaid process of inflammation and infection.

When it is superficial it heals without any problem, but when it is deep it causes lot of pain, itching and swelling around the area. In general these persist for few weeks and heal without any problem. After a period of time our immunity prevents the further formation and inflammation. The main concern is when it is present for long period of time.

In my patients I generally go for "culture and sensitivity” of pus or the exudate or the discharge to know the exact bacteria and its sensitive antibiotic. Additionally complete blood examination along with blood sugar or otehr of the investigations are also quite important.

A proper full course of sensitive antibiotic treats the condition fully. For fever and pain you can take pain killer tablet such as Ibuprofen or paracetamol by mouth for reducing the intensity of pain and redness. You can discuss the same with your treating doctor.

A course of steroid along with antibiotics is also very helpful. Steroid course is also to be given in tapering dose.

A proper cleaning of the area is very much helpful. Though you must be doing it regularly but if you are doing once or twice then you must do it for 3-4 times.

Eat healthy and nutritious food to improve your immunity at its best because is the most important factor in reducing and eliminating any infection from the body.

Hope I have answered your query. If you have any further questions, I will be happy to help.

Wish you good health.

Regards,

Dr Sanjay Kumar Kanodia
MD- Dermatology

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