Herpes zoster, which is commonly known as shingles in English, has a more descriptive and apt Nepali name, 'janai khatira' because the skin rashes often follow the distribution of the thread around the chest and back (pictured). With the janai in mind, it should be easy for Nepali medical students to make this diagnosis when they see this kind of skin lesion in their patient.

These skin lesions caused by the herpes zoster virus are painful, and it is the same virus that causes chickenpox. A person who has had chickenpox is at risk because the virus, which lies dormant in the nerve can reactivate later in life. Although herpes zoster can occur at any age, this problem is more common among people 50 years of age or older. Usually, it starts with a painful itchy rash with blisters. It can appear on the trunk or the face and is usually on one side of the body and lasts for 2-4 weeks.

The main complication of herpes zoster is the pain that follows after the rash has subsided, called post-herpetic neuralgia. There is severe skin sensitivity described as burning and sharp pain or itchiness in the area where the rash appeared. Importantly, the pain can be so severe that it can disrupt sleep and make everyday activities difficult to perform. Sometimes shingles may also cause ear pain and vision loss.

There are oral antiviral drugs locally available in Nepal like acyclovir, which may reduce the duration of pain and accelerate the healing of the rash. Early treatment may also help avoid complications. But can this painful, common problem be prevented? Yes, but not in South Asia because of the unavailability of this expensive vaccine. In an ideal world everyone above 60 is recommended this vaccine. In Nepal we try to make a proper diagnosis and administer effective drugs. When what is ideal is not practical, what is practical has to be adequate.