By Tedler D. Depaynos, MD
patients.”
The 53 years old lady patient comes from a mountainous barangay of a remote municipality in Benguet. She spends a lot of her time in their farm where they plant mostly carrots. She cannot understand how she got her painful skin lesions which she described in the dialect as several “bulging thin skin filled with water” which probably are skin vesicles. She attributed them initially to “ant bites” but because of the continuous pain she went to their Heath Center in the “poblacion” for consultation where she was given analgesics, medicines for neural pain and for viral infection by the Municipal MD. Obviously, she was diagnosed to have the painful viral infection which she could not remember. She has been taking the medicines for a week and since she experienced no significant relief she came over to the city to consult their family MD who is also their town mate.
The vesicular lesions started 10 days ago at her right inguinal area which spread into her right buttocks and to her vaginal opening. She was adamant that they did not start at her vaginal opening. Initially there was redness and mild swelling followed by deepening pain making her ambulation sometimes difficult specially when climbing or going down their hilly farm. When she bowed and showed her right buttocks without any inhibition, the lesions were dry, covered by the dried previously “bulging thin skin with fluid” called “crusts”.
Painful vesicular lesions which usually dry up are usually due to the Varicella Virus and are called Herpes Zoster or Shingles or zona in our old medical text books. It affects the cutaneous sensory ganglia and nerves and follows its pathway and causes vesicular skin eruption. Most common site is the thoracic area where the costal nerves along the ribs are affected. It could however affect all the other nerves like the cranial and ophthalmic nerves which may result in serious damage. Why the virus predominated in the patient’s private parts, the consulted MD could not explain. Likewise, can the patient.
The virus is the same virus that causes Chicken Pox. Herpez Zoster is rare however in childhood and more in nearly half century old individuals.
The appearance of the lesions may be preceded by malaise and fever for 2 to 4 days. Tingling pain with burning sensation may be experienced before the appearance of the rashes. They may then deepen with the appearance of the vesicles. Just like in this patient, the vesicles may dry up within a week or two but the pain may linger even up to 4 weeks. In 30% of elderly patients it may even last for 3 to 6 months or even years.
The medicines earlier given to the patient were specifically for the neural pain and for the virus but probably the patient expected immediate results. In general, viral infections are self-limiting. In most cases, anti-viral drugs may just shorten their “limits”, so that if the viral infection would last for 10 days, the drug would make it only 8 days.
In many cases even with the disappearance of the cutaneous lesions, the pain would persist. When this was explained to the patient she was worried that she might not be able to take care of their carrot farm which is near harvest time. Her MD then with a joking smile suggested that perhaps butchering a native chicken with native prayers might help. The patient went home wondering if her town mate MD also sometimes suggest the same to his other patients.
**
