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What causes herpes zoster. Herpes Zoster: Symptoms and Treatment

Herpes zoster (B02), Herpes zoster without complications (B02.9)

Dermatovenereology

general information

Short description

RUSSIAN SOCIETY OF DERMATOVENEROLOGISTS AND COSMETOLOGISTS

Moscow - 2015

Code according to the International Classification of Diseases ICD-10
B02

DEFINITION
herpes zoster ( herpesZoster, shingles) is a viral disease of the skin and nervous tissue that occurs as a result of reactivation of the herpes virus type 3 and is characterized by inflammation of the skin (with the appearance of predominantly blistering rashes against the background of erythema in the "dermatome" area) and nervous tissue (posterior roots of the spinal cord and ganglia of peripheral nerves).

Classification

B02.0 Herpes zoster with encephalitis
B02.1 Herpes zoster with meningitis
B02.2 Herpes zoster with other nervous system complications
Postherpetic(s):
- ganglionitis of the ganglion of the facial nerve
- polyneuropathy
- trigeminal neuralgia
B02.3 Herpes zoster with ocular complications
Caused by the shingles virus:
- blepharitis
- conjunctivitis
- iridocyclitis
- iritis
- keratitis
- keratoconjunctivitis
- sclerite
B02.7 Disseminated herpes zoster
B02.8 Herpes zoster with other complications
B02.9 Herpes zoster without complications

Etiology and pathogenesis

The causative agent of the disease is the human herpes virus type 3 (virus Varicella Zoster, human herpes virus, HHV-3, Varicella-zostervirus, VZV) -subfamilies Alphaherpesviridae, families herpesviridae. There is only one serotype of the causative agent of herpes zoster. Primary virus infection Varicella zoster usually manifests itself as chicken pox.

The incidence of herpes zoster (SH) in various countries of the world ranges from 0.4 to 1.6 cases per 1000 people per year in people under the age of 20 years, and from 4.5 to 11.8 cases per 1000 people per year in older age groups.

The risk of developing OH in patients with immunosuppression is more than 20 times higher than in people of the same age with normal immunity. Immunosuppressive conditions associated with a high risk of developing OH include: HIV infection, bone marrow transplantation, leukemia and lymphomas, chemotherapy, and treatment with systemic glucocorticosteroid drugs. Herpes zoster may be an early marker of HIV infection, indicating the first signs of immunodeficiency. Other factors that increase the risk of developing OH include: female sex, physical trauma to the affected dermatome, polymorphism of the interleukin gene.

In uncomplicated forms of OH, the virus can be isolated from exudative elements within seven days after the development of the rash (the period increases in patients with immunosuppression).

With uncomplicated forms of OH, the spread of the virus occurs through direct contact with rashes, with disseminated forms, transmission of infection is possible by airborne droplets.

During the course of the disease, VZV penetrates from rashes on the skin and mucous membranes to the endings of sensory nerves and reaches the sensory ganglia through their fibers - this ensures its persistence in the human body. Most often, the virus persists in the I branch of the trigeminal nerve and spinal ganglia T 1 -L 2 .

Of great importance is intrauterine contact with VZV, chickenpox, transferred before the age of 18 months, as well as immunodeficiencies associated with weakened cellular immunity (HIV infection, condition after transplantation, oncological diseases, etc.). Thus, OH affects up to 25% of HIV-infected persons, which is 8 times higher than the average incidence in persons aged 20 to 50 years. Herpes zoster affects up to 25-50% of patients in organ transplantation departments and oncology hospitals, with a mortality rate of 3-5%.
Relapses of the disease occur in less than 5% of recovered individuals.

Clinical picture

Symptoms, course

Clinical manifestations of OH are preceded by prodrome, during which pain and parasthesia appear in the area of the affected dermatome (less often - itching, "tingling", burning). Pain may be intermittent or permanent and may be accompanied by skin hyperesthesia. Pain syndrome can simulate pleurisy, myocardial infarction, duodenal ulcers, cholecystitis, renal or hepatic colic, appendicitis, intervertebral disc prolapse, early stage glaucoma, which can lead to difficulties in diagnosis and treatment.
Prodromal pain may be absent in immunocompetent patients under 30 years of age.
A feature of the rashes in herpes zoster is the location and distribution of the elements of the rash, which are observed on the one hand and are limited to the region of innervation of one sensory ganglion. The areas of innervation of the trigeminal nerve are most often affected, especially the ophthalmic branch, as well as the skin of the trunk of the T 3 -L 2 segments. Skin lesions in the chest area are observed in more than 50% of cases; least often the rash appears on the skin of the distal extremities.

The clinical picture of herpes zoster includes skin manifestations and neurological disorders. Along with this, most patients have general infectious symptoms: hyperthermia, enlargement of regional lymph nodes, changes in cerebrospinal fluid (in the form of lymphocytosis and monocytosis).

Herpes zoster eruptions have a short erythematous phase (often absent at all), after which papules quickly appear. Within 1-2 days, papules turn into vesicles that continue to appear for 3-4 days - vesicular formHerpes zoster. Elements tend to merge. If the period of appearance of new vesicles lasts more than 1 week, this indicates the possibility of the patient having an immunodeficiency state.
Pustulization of the vesicles begins a week or earlier after the onset of the primary lesions. Further, after 3-5 days, erosions appear in place of the vesicles and crusts form. The crusts usually disappear by the end of the 3rd or 4th week of illness. However, scaling, as well as hypo- or hyperpigmentation, may remain after the resolution of herpes zoster eruptions.

With a lighter abortive formHerpes zoster papules also appear in the foci of hyperemia, but the vesicles do not develop.

At hemorrhagic form diseases bubble rashes have bloody contents, the process extends deep into the dermis, the crusts become dark brown. In some cases, the bottom of the bubbles becomes necrotic and develops gangrenous form Herpes zoster leaving cicatricial changes in the skin.
The intensity of rashes in OH is varied: from diffuse forms, leaving almost no healthy skin areas on the affected side, to individual vesicles, often accompanied by pronounced pain sensations.

Generalized form characterized by the appearance of vesicular rashes over the entire skin along with rashes along the nerve trunk. Re-infection in the form of generalized rashes, as a rule, is not observed. In the presence of immune deficiency (including HIV infection), skin manifestations may appear far from the affected dermatome - disseminated form OG. The likelihood of occurrence and severity of dissemination of skin rashes increase with the age of the patient.

Defeat ophthalmic branch of the trigeminal nerve observed in 10-15% of patients with OH, while rashes can be located on the skin from the level of the eye to the parietal region, abruptly interrupted along the midline of the forehead. The defeat of the nasociliary branch, which innervates the eye, tip and sides of the nose, leads to the penetration of the virus into the structures of the organ of vision.

Defeat second and third branches of the trigeminal nerve, as well as other cranial nerves, can lead to the development of rashes on the mucous membrane of the oral cavity, pharynx, larynx and skin of the auricles and external auditory canal.

Pain syndrome
Pain is the main symptom of herpes zoster. It often precedes the development of a skin rash and occurs after the rash resolves (postherpetic neuralgia, PHN). Pain in herpes zoster and PHN is due to various mechanisms. In the early stages of the course of OH, anatomical and functional changes are formed that lead to the development of PHN, which explains the relationship between the severity of primary pain and the subsequent development of PHN, as well as the reasons for the failure of antiviral therapy in the prevention of PHN.

The pain syndrome associated with OH has three phases: acute, subacute And chronic(PGN). Acute phase pain syndrome occurs in the prodromal period and lasts for 30 days. Subacute phase pain syndrome follows the acute phase and lasts no more than 120 days. Pain lasting more than 120 days is defined as postherpetic neuralgia. PHN can last for several months or years, causing physical suffering and significantly reducing the quality of life of patients.

The immediate cause of prodromal pain is subclinical reactivation and replication of VZV in neural tissue. Damage to peripheral nerves and neurons in the ganglia is a trigger factor for afferent pain signals. In a number of patients, the pain syndrome is accompanied by general systemic inflammatory manifestations: fever, malaise, myalgia, and headache.

In the majority of immunocompetent patients (60-90%), severe acute pain accompanies the appearance of a skin rash. A significant release of excitatory amino acids and neuropeptides caused by blockade of the afferent impulse in the prodromal period and the acute stage of OH can cause toxic damage and death of inhibitory interneurons of the dorsal horns of the spinal cord. The severity of acute pain syndrome increases with age. Excessive nociceptor activity and the generation of ectopic impulses can lead to an increase and prolongation of central responses to ordinary stimuli - allodynia(pain and/or discomfort caused by stimuli that do not normally cause pain, such as the touch of clothing).

Predisposing factors to development PGN, are: age over 50 years, female gender, the presence of a prodrome, massive skin rashes, localization of rashes in the area of innervation of the trigeminal nerve or brachial plexus, severe acute pain, the presence of immunodeficiency.

With PHN, it is possible to distinguish three types of pain:
- constant, deep, dull, pressing or burning pain;
- spontaneous, periodic, stabbing, shooting, similar to an electric shock;
- allodynia.
Pain syndrome, as a rule, is accompanied by sleep disorders, loss of appetite and weight loss, chronic fatigue, depression, which leads to social exclusion of patients.

Complications of herpes zoster
Herpes zoster complications include: acute and chronic encephalitis, myelitis, retinitis, rapidly progressive herpetic retinal necrosis, leading to blindness in 75-80% of cases, ophthalmic herpes (Herpes ophthalmicus) with contralateral hemiparesis in the long run, and lesions of the gastrointestinal tract and cardiovascular system and etc.

Ophthalmic herpes is a herpetic lesion of any branch of the optic nerve. In this case, the cornea is often affected, leading to the appearance keratitis. In addition, other parts of the eyeball are affected with the development episcleritis, iridocyclitis, inflammation of the iris. The retina is rarely involved in the pathological process (in the form of hemorrhages, embolisms), the optic nerve is more often affected, which leads to optic neuritis with an outcome in atrophy (possibly due to the transition of the meningeal process to the optic nerve). In herpes zoster involving the eyes, the rash extends from the level of the eyes to the top of the head, but does not cross the midline. Vesicles localized on the wings or tip of the nose ( Hutchinson's sign) are associated with the most serious complications.

Gangliolith of the geniculate ganglion is manifested by Hunt's syndrome. This affects the sensory and motor areas of the cranial nerve ( paralysis of the facial nerve), which is accompanied by vestibulo-cochlear disorders. Rashes appear in the area of distribution of its peripheral nerves on the mucous membranes and on the skin: vesicles are localized on the tympanic membrane, external auditory opening of the auricle, external ear and on the lateral surfaces of the tongue. One-sided loss of taste is possible on 2/3 of the back of the tongue.

Exhaust gas rashes can be located in the coccyx area. At the same time, a picture of a neurogenic bladder develops with urination disorders and urinary retention (due to virus migration to adjacent autonomic nerves); may be associated with OG of sacral dermatomes S 2 , S 3 or S 4 .

Shingles in children
There are isolated reports of the disease of children with herpes zoster. Risk factors for OH in children include maternal chickenpox during pregnancy or primary VZV infection in the 1st year of life. The risk of OH disease is increased in children who have had chickenpox before the age of 1 year.
Herpes zoster in children is not as severe as in older patients, with less pain; postherpetic neuralgia also rarely develops.

Shingles in patients with HIV infection
The risk of developing OH in patients with HIV infection is higher, and they are more likely to develop relapses of the disease. Additional symptoms may appear due to the involvement of motor nerves (in 5-15% of cases). The course of OH is longer, gangrenous and disseminated forms often develop (25-50%), while 10% of patients in this category have severe lesions of internal organs (lungs, liver, brain). In HIV infection, frequent recurrences of OH are noted both within one and several adjacent dermatomes.

Herpes zoster in pregnancy
The disease in pregnant women can be complicated by the development of pneumonia, encephalitis. VZV infection in the first trimester of pregnancy leads to primary placental insufficiency and is usually accompanied by abortion.
The presence of infection should serve as a basis for intensive prevention of the consequences of hemodynamic disorders (placental insufficiency, intrauterine hypoxia, intrauterine growth retardation).

Diagnostics

Diagnosis of OH is based on characteristic complaints (manifestations of neurological symptoms), the course of the disease (prodromal period and manifestation on the skin) and the features of clinical manifestations on the skin.

If necessary, to verify the diagnosis, nucleic acid amplification methods (PCR) are used to identify the Varicella zoster virus contained in the material from the lesions of the GO on the skin and / or mucous membranes.

Differential Diagnosis

It is necessary to differentiate the manifestations of OH with the zosteriform variety of herpes simplex, contact dermatitis (after insect bites, photodermatitis), cystic dermatosis (Duhring's herpetiform dermatitis, bullous pemphigoid, pemphigus).

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Treatment

Treatment Goals

Relief of clinical symptoms of the disease;
- prevention of complications.

General notes on therapy
The presence of lesions in peripheral ganglia and nervous tissue, the organ of vision in OH determines the need to involve specialists of the appropriate profile in the treatment: the treatment of postherpetic neuralgia and ophthalmic herpes is carried out in conjunction with neurologists and ophthalmologists.
To effectively influence the course of a viral infection caused by VZV, it is necessary to use antiviral drugs. With the severity of the pain syndrome, analgesic drugs are prescribed. External treatment is aimed at accelerating the regression of skin rashes, reducing signs of inflammation and preventing bacterial superinfection.
The need for anti-inflammatory treatment is determined by the occurrence of herpetic neuralgia, accompanied by pain, if indicated, it should be selected individually.
It is necessary to avoid the use of occlusive dressings and glucocorticosteroid drugs. External treatment of OH with antiviral and painkillers is ineffective!

Indications for hospitalization
Complicated course of herpes zoster

Therapy regimens
1. Antiviral therapy
The appointment of antiviral drugs is most effective in the first 72 hours of the development of clinical manifestations of the disease:
- aciclovir (A) 800 mg orally 5 times a day for 7 days

Famciclovir (A) 500 mg orally 3 times a day for 7 days
or
- valaciclovir (A) 1000 mg orally 3 times a day for 7 days.
The reduced sensitivity of VZV to acyclovir compared to HSV, as well as a high level of antiviral activity, determine the preferred appointment for the treatment of OH famciclovir or valaciclovir (A) .

2. Anti-inflammatory therapy.
Perhaps the appointment of non-steroidal anti-inflammatory drugs.
In the absence of the effect of analgesic therapy, drugs with a central analgesic effect and neural blocks (sympathetic and epidural) can be used, as determined by the consultation of a neurologist (A) .

3. Interferons of systemic action:
- interferon gamma 500,000 IU 1 time per day subcutaneously every other day, for a course of 5 injections (B).

4. External treatment
To provide a local anti-inflammatory effect and prevent bacterial superinfection, alcohol 1-2% solutions of aniline dyes (methylene blue, brilliant green), fucorcin (D) are prescribed.
In the presence of bullous rashes, the blisters are opened (incision with sterile scissors) and extinguished with aniline dyes or antiseptic solutions (0.5% solution of chlorhexidine bigluconate, etc.) (D) .

Special situations
In the treatment of OH patients with impaired immunity(persons with malignant lymphoproliferative neoplasms, recipients of transplanted internal organs, patients receiving systemic corticosteroid therapy, and patients with AIDS), the therapy of choice is intravenous acyclovir:
- acyclovir (B) 10 mg per kg of body weight (or 500 ml / m 2) intravenously 3 times a day.
Upon reaching the morbistatic effect, treatment can be continued with oral forms of acyclovir, famciclovir or valaciclovir according to the method proposed for patients with normal immunity:
- aciclovir (A) 800 mg orally 5 times a day for 7 days

Famciclovir (A) 500 mg orally 3 times a day for 7 days
or
- valaciclovir (A) 1000 mg orally 3 times a day for 7 days.

Treatment of children:
- acyclovir (B) 20 mg per kg of body weight orally 4 times a day for 5 days.

Requirements for treatment outcomes
- clinical recovery;
- relief of pain syndrome.

PREVENTION
In the Russian Federation, at the time of the creation of these recommendations, vaccination against OH is not carried out.

Information

Sources and literature

Clinical recommendations of the Russian Society of Dermatovenerologists and Cosmetologists
1. 1. McDonald E.M., Kock J., Ram F. Antivirals for management of herpes zoster including ophthalmicus: a systematic review of high-quality randomized controlled trials. Antiviral Ther 2012; 17:255-264. 2. Whitley R. J., Volpi A., McKendrick M. et. al. Management of herpes zoster and post-herpetic neuralgia now and in the future. J Clin Virol 2010; 48: (Suppl. 1): S20–S28. 3. Chen N., Yang M., He L. et al. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database Syst Rev 2010; (12): CD005582. 4. Fashner J., Bell A.L. Herpes zoster and postherpetic neuralgia: prevention and management. Am Fam Physician 2011; 83(12): 1432–1437. 5. Li Q., Chen N., Yang J. et al. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev 2009; 2: CD006866. 6. Watson P. Postherpetic neuralgia (updated). Clean Evid (Online). October 8, 2010. http://clinicalevidence.bmj.com/ceweb/conditions/ind/0905/0905. (date of access: 07/14/2013). 7. Torigo S., Ihara T., Kamiya H. IL-12, IFN-gamma, and TNF-alpha released from mononuclear cells inhibit the spread of varicella-zoster virus at an early stage of varicella. microbiol. Immunol. 2000; 44(12): 1027-1031. 8. Desloges N, Rahaus M, Wolff MH. Role of the protein kinase PKR in the inhibition of varicella-zoster virus replication by beta interferon and gamma interferon. J Gen Virol. 2005 Jan;86(Pt 1):1-6. 9. Balachandra K, Thawaranantha D, Ayuthaya PI, Bhumisawasdi J, Shiraki K, Yamanishi K. Effects of human alpha, beta and gamma interferons on varicella zoster virus in vitro. Southeast Asian J Trop Med Public Health. 1994 Jun;25(2):252-7. 10. Usuki K, Kitamura K, Urabe A, Takaku F. Herpes zoster, postherpetic neuralgia, and interferon-gamma. Ann Intern Med. 1988 Apr;108(4):643-4. 11. Gainanova E.G., Skorokhodkina O.V. Evaluation of the effectiveness of the use of gamma-intcrferon (ingaron) in patients with varicella-zoster herpesvirus infection // Russian Allergological Journal. - St. Petersburg. - 2010. - No. 5, Issue. 1 - S. 73-74. 12. Gainanova E.G., Skorokhodkina O.V. Clinical and immunotropic activity of the domestic drug gamma-interferon ingaron in patients with varicella-zoster herpesvirus infection. Clinical pharmacology and therapy. - 2010. - No. 6. - P. 118-121. 13. Kiselev O.I., Ershov F.I., Deeva E.G. Interferon-gamma: a new cytokine in clinical practice. Ingaron-M., St. Petersburg: Dimitreid Graph Group, 2007. - 348 p. 14. Rakhmatulina M.R., Maleev V.V., Shmelev V.A. Modern approaches to the treatment of herpes zoster. infectious diseases. - 2007. - V.5. - No. 3. - P.28-32. 15. Dubensky V.V., Garmonov A.A. External therapy of dermatoses: a guide for physicians. - Tver: IP Shitova, 2008. - 220 p.

Information

The personal composition of the working group for the preparation of federal clinical guidelines for the profile "Dermatovenereology", section "Herpes zoster":
1. Dubensky Valery Viktorovich - Head of the Department of Dermatovenereology, Tver State Medical Academy of the Ministry of Health of Russia, Doctor of Medical Sciences, Professor, Tver.
2. Dubensky Vladislav Valerievich - Associate Professor of the Department of Dermatovenereology, Tver State Medical Academy of the Ministry of Health of Russia, Candidate of Medical Sciences, Tver.

METHODOLOGY

Methods used to collect/select evidence:
search in electronic databases.

Description of the methods used to collect/select evidence:
The evidence base for the recommendations is the publications included in the Cochrane Library, the EMBASE and MEDLINE databases.

Methods used to assess the quality and strength of evidence:
· Consensus of experts;
· Evaluation of significance in accordance with the rating scheme (the scheme is attached).

Levels of Evidence	Description
1++	High quality meta-analyses, systematic reviews of randomized controlled trials (RCTs), or RCTs with a very low risk of bias
1+	Well-conducted meta-analyses, systematic, or RCTs with low risk of bias
1-	Meta-analyses, systematic, or RCTs with a high risk of bias
2++	High-quality systematic reviews of case-control or cohort studies. High-quality reviews of case-control or cohort studies with very low risk of confounding effects or bias and moderate likelihood of causation
2+	Well-conducted case-control or cohort studies with moderate risk of confounding effects or bias and moderate likelihood of causation
2-	Case-control or cohort studies with a high risk of confounding effects or biases and an average likelihood of causation
3	Non-analytic studies (eg: case reports, case series)
4	Expert opinion

Methods used to analyze the evidence:
· Reviews of published meta-analyses;
· Systematic reviews with tables of evidence.

Methods used to formulate recommendations:
Expert consensus.

Force	Description
A	At least one meta-analysis, systematic review, or RCT rated 1++ that is directly applicable to the target population and demonstrates robustness or a body of evidence that includes results from studies rated as 1+ that are directly applicable to the target population and demonstrate overall consistency of results
IN	A body of evidence that includes results from studies rated as 2++ that are directly applicable to the target population and demonstrate overall consistency of results or extrapolated evidence from studies rated 1++ or 1+
WITH	A body of evidence that includes results from studies rated as 2+ that are directly applicable to the target population and demonstrate overall consistency of results; or extrapolated evidence from studies rated 2++
D	Level 3 or 4 evidence; or extrapolated evidence from studies rated 2+

Good practice indicators (Good practice points - GPPs):
The recommended good practice is based on the clinical experience of the members of the Guideline Development Working Group.

Economic analysis:
Cost analysis was not performed and publications on pharmacoeconomics were not analyzed.

is a disease caused by the herpes virus. It affects not only the skin, but also the nervous system. Herpes zoster and chickenpox share the same etiology and pathogenesis. Modern medicine classifies herpes zoster as an infectious disease that is highly contagious, as it is provoked by the herpes virus. The disease is characterized by the classic triad:

Symptoms similar to infectious diseases;

Skin manifestations characteristic of a herpetic infection;

Manifestations from the nervous system, both peripheral and central.

Available statistics indicate that shingles will occur in one in four people who have a history of chickenpox. Moreover, the disease will enter the active stage after a person reaches 50 years of age. It is in this age group that shingles is most often diagnosed. There is no gender difference between patients.

In addition, cases of herpes zoster at a young and mature age have recently become more frequent. Scientists explain this fact by the unfavorable environmental situation in cities, the weakening of the immune system of people, and the high susceptibility to infectious and viral diseases. Shingles often accompanies patients with oncology, the number of which is steadily growing. It is especially common in people who have undergone radiation or chemotherapy.

It is known that most people had chicken pox in childhood, which means that the herpes virus that provokes shingles exists in their body. In this regard, the risk of its reactivation for each inhabitant of the planet is about 10%.

Shingles Symptoms

The symptoms of shingles are hard to miss. The clinical picture is characterized by an acute onset, with severe pain and severe burning at the site of injury.

The disease affects the area of the human body most often on one side.

Zones of localization of herpes zoster can be:

Genitals;

lower and upper limbs;

Intercostal areas;

Face (its part along the trigeminal nerve);

Lower jaw;

If shingles affects the front part, then the rash will be located along the ternary, or facial nerve. If a part of the body is affected, then the rash will be located along the course of the spinal nerves. This fact is explained by the high accumulation of the virus in the nerve nodes, in 11 pairs of cranial nerves, in the posterior horns in each of the halves of the spinal cord. Therefore, skin manifestations are localized along the involved nerve.

Specialists distinguish three periods, each of which has its own symptoms of shingles:

The onset of the disease

This period is called the prodrome. It is accompanied by general malaise, psychovegetative (neurological) pains, which can have different intensity. The duration of the initial period can be from 48 hours to 4 days.

In parallel, the patient experiences the following symptoms:

feeling of weakness;

Headache;

An increase in body temperature to subfebrile marks (fever is extremely rare, but it does occur);

Violations of the functioning of the digestive tract and associated dyspeptic disorders;

Pain, burning, itching, severe tingling in the area of that part of the body or face where rashes will subsequently appear;

As the symptoms increase, the lymph nodes swell and become painful and hard to the touch;

Violations of the process of emptying the bladder is observed in the severe course of the disease.

When the body temperature drops, the symptoms of intoxication caused by it are significantly weakened.

The next stage of the disease is characterized by the appearance of rashes on the skin. Their intensity and number depends on the severity of herpes zoster. Rashes look like small spots, the size of which does not exceed 0.5 mm. They are located in foci, have a pink color. Between them are areas of intact skin.

If the disease has a classic clinical course, then vesicles will appear at the site of the foci that have arisen after a day. They will be filled with serous contents: colorless and transparent. After 1 day, the liquid that is inside the bubbles will become cloudy.

If shingles is severe, then inside the vesicles you can see a liquid mixed with blood, and they themselves will be black. The rash characteristic of shingles is similar in undulating course to the rashes that appear with chicken pox. That is, with a period of several days, new vesicles will appear first in one place, then in another. Rashes gradually encircle the body, hence the name of the disease.

If the lichen proceeds in a mild form, then only skin nodules may appear without the subsequent formation of pustules. Or a person can only experience pain along the nerves at all, but there will be no rashes.

Due to the blurring of the clinical manifestations of the disease, it is so important to make the correct diagnosis by differentiating shingles in a mild form from intercostal neuralgia, osteochondrosis and pain in the heart.

Crust formation period

After two weeks (maximum 1.5 weeks), in the place where the rash was previously, crusts form from yellow to brown. The places where the vesicles were located lose their rich color. Gradually, the crusts disappear from them, after which patches of pigmentation remain on the skin.

Pain in shingles

A person always suffers from severe pains that arise from even a slight touch to the skin. This is due to the fact that the virus is localized in nerve cells, disrupting their work and many times increasing the sensitivity of nerve endings. The pain that a person experiences can be compared to burn pain. They are especially aggravated when water enters the affected areas. In this regard, scientists have not yet come to a single decision - is it worth taking a bath with shingles.

Some doctors are of the opinion that it is better to avoid water procedures, others believe that baths with the addition of sea salt to them help well, and still others recommend taking only a shower, after which the body will simply get wet.

Describing the nature of the pain, patients indicate that they can be dull, burning or boring, some people compare them to the passage of an electric current through the affected area. The pain tends to increase after a slight mechanical or thermal impact. They can continue to bother a person even after the rash has completely subsided. This happens to about 15% of all those who recover from shingles.

The reason for the residual pain is that the viruses have destroyed the tissues of the nerves, and it will take some time for them to recover. Most often, postherpetic neuralgia in the elderly can persist for several months, and in young people it disappears after a maximum of 10 days after the disappearance of the rash.

Causes of shingles

Shingles is known to be caused by the varicella zoster virus, which also causes chicken pox. However, these two diseases are radically different from each other in terms of symptoms and the course of inflammation.

Once having had chickenpox in childhood, one should not assume that the virus was completely defeated by the immune system. It simply goes into a latent state and exists in the body in a dormant state. The place of its localization is the cranial nerves and nerve nodes. The virus can be suppressed for many years, as long as the human immunity controls its reproduction and produces antibodies against it in the required volume.

When a certain part of the immune system fails, the zoster virus is activated again, but it no longer causes chicken pox, but shingles. Therefore, the opinion that, having had chickenpox once, you will never encounter this disease again is erroneous. Re-infection cannot occur, since the virus is already in the body, but the disease can worsen with a high degree of probability, only it will proceed like shingles.

Experts identify the following causes of shingles:

Elderly age. Having crossed the line of 50-60 years, a person has a 7-fold increased risk of developing the disease compared to young people. With complaints about the symptoms of herpes zoster, about 5% of pensioners turn to doctors. The explanation for this fact is very simple, because in old age there is a natural decrease in immunity, the level of endorphins drops, the process of assimilation of vitamins and microelements worsens. The peak of appeals falls on autumn and spring.

At a young age, shingles develops due to a malfunction in the immune system.

These include:

Diseases of the blood and blood-forming organs;

Autoimmune pathologies, lack of immunity;

Due to the fact that in most people the zoster virus is in a dormant state in the body, everyone is at risk of developing shingles.

The disease is contagious until new blisters appear on the patient's body. When they open and crust over, the virus does not pose a threat in terms of infection.

How long can pain persist after herpes zoster? The virus that causes shingles disrupts the functioning of nerve cells. They become more sensitive to any external influences and respond in the human brain with severe pain, similar to burns.

According to available data, up to 14% of people after a visible recovery, continue to experience pain in those parts of the body that were affected. These sensations do not indicate that the infection continues to progress. They only indicate that the work of nerve fibers was disrupted due to their defeat by the virus. Doctors call this condition postherpetic neuralgia or neuropathy.

Pain does not always occur after tactile contact or after interaction with water, they can appear on their own.

It was found that at a younger age, shingles after the extinction of inflammation can remind of itself with pain for several weeks. They rarely last more than a month. When the disease affects a person over the age of 50, the pain can persist for up to several months. If a person has had shingles after the age of 70, then neuralgia can haunt him for a year or more.

Can I bathe with shingles? You can wash during illness, but you should not do it too often. The best option is to take a shower, after which you should not rub your body with a towel. The skin will be enough to get wet.

Can shingles recur? Yes, the disease can recur.

How dangerous is shingles during pregnancy? The virus that causes shingles can cross the placenta. This is another way of contracting the disease. It is known that during the bearing of a child, the immunity of a woman suffers. A drop in protective forces can cause the activation of the Zoster virus, which was in the body in a suppressed state, or the risk of primary infection increases.

It is especially dangerous when the activation of the virus goes unnoticed by the woman herself, since there may be no specific symptoms.

At this time, the virus crosses the placenta and can cause the following harm to the health of the fetus:

The death of a child inside the womb of a woman and subsequent stillbirth, spontaneous abortion.

The defeat of the nervous system of the child, his brain. All this causes disability, can lead to loss of hearing, vision, cerebral palsy.

If a woman has not had chickenpox before conception, then she does not have antibodies to this disease, which means she will not pass them on to the fetus. Infection of a baby in early childhood threatens the development of meningeal disorders.

In connection with such serious threats to the health of the child, it is necessary to limit the contact of a pregnant woman with people suffering from shingles or chicken pox. In addition, the most favorable conditions should be created for the immune system of the pregnant woman to function properly.

If shingles does not cause any health problems, then it does not make sense to treat it. The disease in a mild form resolves on its own in an average of two weeks.

However, the older a person is, or the worse his immune system functions, the higher the risk of developing complications. Such people need to undergo specialized treatment with antiviral drugs. If therapy is abandoned, serious health problems may develop.

Regardless of the age of the patient, a visit to the doctor in the presence of symptoms of herpes zoster is mandatory. He may recommend taking drugs such as: Acyclovir, Valaciclovir, Famciclovir, which have antiherpetic activity. They are taken either orally or by injection. They contribute to the speedy restoration of the skin and the rapid relief of the symptoms of the disease. It is not well established whether antiviral therapy has any effect on the occurrence of pain after shingles.

The duration of the course will be determined by the doctor, most often it lasts from a week to 10 days.

Pain relief at the start of treatment

Severe pain can occur even in the prodromal period of the disease, they should not be tolerated, it is necessary to seek medical help. The doctor may recommend means to fight the virus, or analgesic drugs.

It has been established that attempts to endure pain without taking medications lead to an increase in the threshold of pain sensitivity in humans. In addition, chronic pain may occur that will haunt a person not just for months, but even for years.

Therefore, at the appointment with a specialist, it is necessary to be as open as possible and tell in detail about where the pain occurs and what it feels like. Only thanks to complete information about the patient, the doctor will be able to provide really high-quality care.

So, if the pain is not too pronounced, then it may be suggested to take weak painkillers, such as: Paracetamol, Ibuprofen, Aspirin, Ledocaine gel, Naproxen.

If the pain is severe, then drugs such as Oxycodone, Gabapentin and others will be required. They are taken in combination with an antiviral drug.

Treatment of pain left after shingles

There are cases when, after a complete recovery, a person continues to be haunted by severe pain. Attempts to endure them only lead to the fact that it will be increasingly difficult to cope with them later. In addition, persistent pain can cause health problems.

Therefore, in the presence of residual pain, it is necessary to contact a neurologist. The doctor will assess the patient's condition and prescribe the appropriate treatment for him.

Modern drugs that are used at this point in time are as follows:

Gabapentin.

Pregabalin.

Drugs from the group of tricyclic antidepressants (amitriptyline).

Complementary Pain Therapies

As an auxiliary way to deal with the disease, a specialist may recommend the following methods:

Performing blockades that allow you to get rid of even the most intense pain. This requires injecting painkillers into the tissues adjacent to the affected nerves.

Performing electrical stimulation of nerve endings through the skin. This procedure is aimed at normalizing the functioning of damaged nerve tissues.

Shingles treatment at home

Treatment of herpes zoster is in the competence of a specialist. The doctor examines the patient and if the disease does not pose a threat to human life, he may recommend therapy at home.

Advice on how to act in case of illness and what not to do will be given by a specialist as follows:

Hands should be washed with soap after each contact with the affected area of the skin.

Areas of localization of rashes should not be combed, scratched or otherwise injured. Any mechanical damage increases the risk of secondary infection and can cause suppuration or bacterial infection. When itching becomes unbearable, you need to consult a doctor about taking the drug. Suprastin can act as such a tool.

Do not apply pressure to the affected area of the skin, do not rub it with clothes.

Artificial piercing or rupture of vesicles with serous contents is unacceptable. They should resolve naturally.

Until the moment when bubbles with liquid remain on the skin, you can alleviate your own condition by applying a sterile gauze to them. It should first be soaked in cool water.

When the blisters are resolved and crusted, it is necessary that moisture does not get on them. Areas with crusts should remain dry, so compresses are excluded, water procedures are minimized.

Any ointments with antibacterial components are prohibited, except for those recommended by the doctor.

Adhesive plaster is prohibited, it will only prolong the process of healing and tissue repair.

If suppuration of sores occurs, then an appeal to a specialist is mandatory.

It is known that symptoms similar to those of shingles can occur due to other diseases that also pose a threat to health. Therefore, if any rashes appear on the skin, you should visit a therapist, dermatologist, or infectious disease specialist.

After examination, the doctor will clarify the diagnosis and prescribe treatment.

Be sure to visit a doctor in the following situations:

The presence of symptoms of the disease in a young child, or in an infant.

The presence of signs of illness in an elderly person.

If signs of shingles appeared in a pregnant woman.

If a person has cancer or is being treated for cancer.

If a person takes drugs that affect the functioning of the immune system. It can be: Azathioprine, Methotrexate, Mercaptopurine, etc.

If a person with shingles symptoms has had an internal organ transplant and is taking medication to reduce the risk of rejection.

Ate, the symptoms of the disease developed against the background of an existing chronic infection.

Seeking emergency medical care is necessary if, against the background of shingles:

There are severe headaches;

There was vomiting and nausea;

There is tension in the occipital muscles;

There is a high body temperature, chills;

The patient loses consciousness;

The patient experiences violations of taste, smell, his hearing is reduced;

If there is confusion;

Convulsions appear;

There is dizziness;

Education: Diploma of the Russian State Medical University N. I. Pirogov, specialty "Medicine" (2004). Residency at the Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).

Vaccination is the creation of sustainable immunity against infection. However, it is possible to vaccinate a patient with herpes zoster only if the period without exacerbations is at least two months. Therefore, if a person has fairly frequent exacerbations, then with the help of immunomodulatory drugs it is necessary to bring the patient's state of health to such a level that the remission period is at least two months.

However, it should be noted that all patients suffering from herpes virus infection are prescribed blood donation to determine the immune status. Subsequently, in accordance with the changes that are in the immune system of a given person, on the basis of individual changes, immunocorrective therapy is selected, which is included in all complex methods for the treatment of herpes virus infection.

Vitamin therapy and diet

Also, with shingles, to strengthen the immune system, it is recommended to take the following vitamins:

Vitamin A;
Vitamin E;
Vitamin C.

B group vitamins.

It should also be borne in mind that during treatment, a sparing diet rich in nutrients, vitamins and trace elements is recommended for a patient with herpes zoster. Food is recommended to boil or steam, and you should also reduce the intake of salty, fatty and fried foods.

dairy ( milk, kefir, butter, cottage cheese);
vegetables ( beets, broccoli, carrots, eggplant, zucchini, pumpkin, tomatoes, peppers, onions);
white meat;
seafood ( salmon, pike perch, herring);
nuts ( peanuts, pistachios, almonds, walnuts, cashews);
fruits ( grapes, apricots, apples, kiwi, plums, citrus fruits);
cereals ( oatmeal, wheat, barley groats);
legumes ( peas, beans);
green tea, rosehip or raspberry tea.

Prevention of herpes zoster

There are the following measures to prevent herpes zoster:

vaccination;
boosting immunity.

Vaccination

The purpose of this vaccine is to provide artificial active immunity against the Varicella-zoster virus. This vaccine contains live cultures, but with reduced virulence ( the ability of a microorganism to infect).

Currently, there is so far the only preventive vaccine against herpes zoster - the Zostavax vaccine. This vaccine is administered once, intradermally. The duration of action of the prophylactic drug, on average, is from three to five years.

This vaccine is indicated:

for the prevention of relapse in persons already suffering from herpes zoster;
adults who have not had chickenpox;
people suffering from postherpetic neuralgia.

There are the following contraindications for vaccination:

the presence of allergic reactions to the components of the vaccine;
with colds ( if the body temperature is 37.5 degrees and above);
the presence of HIV infection or AIDS;
during pregnancy.

Symptoms of an allergic reaction after a vaccine is given include:

weakness;
pallor of the skin;
dizziness;
swelling of the throat;
heartbeat;
labored breathing;
wheezing.

Note:

people who have contact with a patient with herpes zoster;
people with reduced immunity;
newborn if the mother had chickenpox during pregnancy.

Immunity Boost

To improve immunity, the following recommendations should be followed:

daily walks in the fresh air;
hardening of the body;
moderate daily physical activity;
rejection of bad habits ( alcohol, smoking);
nutrition should be balanced proportionate intake of fats, proteins and carbohydrates);
periodic visits to the sauna or bath;
avoidance of stress.

Answers to frequently asked questions

Can you get herpes zoster again?

chicken pox

In ten percent of people, a recurrence of herpes zoster is observed in the presence of the following pathologies:

HIV infection;
AIDS;
oncological diseases;
diabetes;

The purpose of the introduction of the vaccine is to create artificial active immunity against the Varicella-zoster virus.

Is herpes zoster contagious?

It should be noted that herpes zoster is contagious during herpetic eruptions. During the healing period and the formation of crusts, this disease ceases to be dangerous.

In medical practice, there are many diseases associated with a weakened immune system. Some of them pose a real danger to people. Among such viral diseases, herpes zoster is especially distinguished. In medical circles, it is often referred to as shingles due to its specific location on the human body. The disease is provoked by the same virus as chicken pox, which many people get sick in childhood. The latent stage is long, and the first manifestations of the disease occur when a favorable situation is created for the development of infection. The latest methods of modern medicine are used in the diagnosis and treatment of this disease.

Scientists have discovered several types of HSV, one of which is herpes zoster. It belongs to the 3rd type. The infection causes chickenpox in children and shingles in adults. A feature of the virus is its localization in the nerve cells of the body after recovery. Therefore, a person who has had an infection is considered to be its carrier all his life.

The main manifestations of the disease are specific rashes on human skin and damage to the central nervous system. The causative agent of infection - Varicella zoster - is very sensitive to external factors and dies 10 minutes after heat treatment or exposure to UV rays. But lowering the temperature contributes to the progression, and the lower the temperature, the more active the virus.

The mechanism of infection with herpes zoster

By airborne droplets, the pathogen enters the human respiratory system, from there with the blood flow to the lymph nodes and adversely affects the nervous system. It spreads through nerve cells to the skin and mucous membranes. Ultimately, inflammation appears on the human body. The risk group includes older people who have passed chicken pox in childhood. But there are cases of re-infection, since the body does not develop stable immunity to this type of virus.

Interestingly, a child who has not had chickenpox, in contact with a carrier of herpes zoster, will become ill with an infection with a high degree of probability. The manifestation of the first signs can be observed after 14-20 days. In this case, the disease will proceed like chicken pox.

After the child is ill, the virus is localized in the nerve endings of the spinal cord, in its posterior roots. With favorable factors, it is activated again and already looks like shingles.

Factors provoking re-infection with the virus

Favorable factors for the development of the virus include:

weakening of the immune system;
constant unrest and prolonged depression;
severe injuries;
long-term presence of the body in conditions of low temperature;
frequent viral infections;
the presence of HIV or AIDS in the body;
forced chemotherapy treatment.

By studying the ways the virus enters the body and understanding its nature of occurrence, it is possible to alleviate the patient's condition in case of repeated infections.

Causes of herpes zoster

The virus hidden in the cells of the spinal cord can be activated at any moment and manifest itself stronger than before under special conditions.

The main causes of herpes zoster are:

contact with an infected person;
changes in the immune system;
systematic stress;
the presence of various chronic diseases;
diabetes;
malignant tumors;
taking medications that weaken the immune system;
having bad habits.

Attention! Increased moral and physical stress interferes with proper rest, disrupts diet and sleep. Therefore, the weakening of the body's immune forces leads to the activation of a dangerous virus.

Symptoms of herpes zoster

In England, herpesvirus infection affects 250 thousand people annually, almost half of them suffer from postherpetic neuralgia. It manifests itself in the form of inflammation of the trigeminal nerve and intercostal neuralgia. In this regard, the first rashes are observed on the face and trunk, and later spread to the lower limbs, buttocks and genitals.

Stages of development of the disease

The course of an infectious disease is always a complex step-by-step process of manifestation of specific signs that require special care and treatment. The development of herpes infection occurs in several stages:

prodromal period. It is characterized by a rash on the skin, accompanied by itching. Later, the itching intensifies to a burning sensation, which sometimes cannot be overcome. Inflammation at this stage affects the nerve located next to the affected area of the skin, so pain appears along the nerve. The general condition of the patient becomes noticeably worse: the temperature rises, weakness, nervousness, dizziness, and sleep disturbance appear. The duration of the prodromal stage is from 2 to 5 days.
Eruption period. Along the way the nerve is located, specific skin rashes are observed, resembling blisters with transparent internal contents. Their size is mostly small, but there are also large foci. Above the skin, they rise by 0.3-0.5 cm. Blisters create a feeling of skin tension until they burst. At this stage, sleep disturbance occurs due to severe itching and pain. A rare person refrains from combing. This time is considered the most dangerous for others, when the infection is actively spreading.
erosion stage. A burst blister leaves an open wound in its place. It almost immediately becomes covered with a fragile crust that can crack from the slightest friction. This results in pain. These troubles help to survive modern medicines in the form of gels and ointments for quick healing.
Healing period. During this time, the patient is actively recovering, but he still needs patience, as this process lasts from one to two weeks. The speed of recovery depends entirely on the accuracy of compliance with medical recommendations.

Atypical manifestations of herpes zoster

Herpesvirus infection can manifest itself quite atypically for itself. This rarely happens, but the symptoms of the manifestation differ from the usual type of disease. Medicine knows several forms:

Ophthalmic - the focus is localized in the region of the trigeminal nerve and affects the eye sockets. There is a high probability of damage to the cornea of the eye.
Ear - rashes are observed on the outer ear, the facial nerve is affected, it becomes impossible to close the eye from the affected side.
Necrotic - the virus penetrates into the deep layers of the skin, after the rash, traces remain for a long time.
Bullous - multiple rashes merge with each other and form extensive lesions. The blisters become large.
Hemorrhagic - this form of manifestation of infection is characterized by bloody content in the vesicles.
Generalized - with weak immunity, rashes occur over the entire surface of the body, mucous membranes.
Abortive is one of the mild types of an atypical course of the disease, when papules form, and no blisters are observed. It always proceeds without complications.

Any manifestation of herpes zoster requires complex treatment.

Treatment of herpes infection

Timely treatment of shingles is the key to the absence of complications after recovery. With normal immunity, herpes can go away on its own in 14 days. But this is possible only in young and relatively healthy people. Doctors do not recommend risking your health.

It would be more correct to start measures to combat the viral disease at its first manifestations. Dermatologists, ophthalmologists and neuropathologists can help in this case. It is desirable to involve immunologists for treatment.

Taking antiviral drugs is considered part of effective treatment: Bonafton, Acyclovir, Cycloferon and others. Doctors pay special attention to immunoglobulin, which significantly speeds up recovery and reduces the risk of complications. Its use is also effective in preventing re-infection with the virus.

Immunomodulating, antipyretic, anti-inflammatory drugs are added to the treatment, and the patient is prescribed vitamin therapy and a certain diet. For external use, doctors recommend lotions with antiseptics. Most often, brilliant green is used, which is applied to erosion at least twice a day. A 1% solution of methylene blue is used to relieve pain.

Vitamin therapy consists in taking vitamins of group B, as well as A, E, C.

Comprehensive treatment includes a blood test for immune status, when the degree of changes in the immune system is determined. It is carried out periodically to monitor the dynamics of the patient's condition and adjust the treatment.

The diet for herpesvirus infection should consist of fish dishes, cereals, dairy products, greens, nuts.

Only an integrated approach to treatment helps to achieve real results.

Prevention of shingles

Herpes zoster, like all diseases, is easier to prevent than to cure. According to the International Classification of Diseases, shingles is classified as a dangerous disease that requires special control.

For effective prevention, doctors recommend vaccination. It develops strong immunity against shingles. But its introduction is possible only in the absence of an exacerbation of the disease for a period of at least two months. Contraindications to the injection of the vaccine are:

allergy to the composition of the solution;
the presence of SARS or fever in the patient;
HIV infection and AIDS stage;
pregnancy.

There are no complications after vaccination. It is very rare to observe a rash and swelling of the skin, but this is a natural reaction of the body that is not allergic. The duration of the vaccine is from 3 to 5 years.

Immunoglobulin injections are also included in the complex of preventive measures. The dosage of the drug depends on the weight of the patient.

Maintaining a healthy lifestyle, systematic exposure to fresh air, playing sports, hardening, and avoiding stress also contribute to an increase in immunity.

Care measures as a preventive measure for herpes

Among the preventive measures to combat herpes zoster, the importance of proper care for a sick person is noted. This will prevent the spread of the disease. When caring for a patient, it is recommended:

regular wet cleaning of the premises;
frequent airing of the room, at least five times a day and at least 10 minutes;
storage of underwear and bed linen for the patient should be separate from the general;
careful ironing of linen after washing;
choose loose clothes for the patient to prevent discomfort from contact with the tissue, as well as for better blood circulation, which will accelerate wound healing;
avoid walking during daylight hours to protect the skin from the sun.

Update: October 2018

Autumn and spring are the most dangerous periods of the year for people with chronic diseases, because at this time their exacerbations occur more often, and some viruses or infections that are in a latent state can be reactivated.

Such insidious diseases include shingles, the symptoms of which are quite bright and painful. Both men and women are equally often ill with it, and most often it appears in older people after 50 years.

However, with the general unfavorable environmental situation among urban residents, cases of this disease have become more frequent among young people, whose immune system is weakened for various reasons and cannot cope with viral and infectious diseases. And the increased incidence of cancer leads to the fact that shingles is a frequent companion of cancer patients, especially those who receive radiation or chemotherapy that destroys the immune system.

It is known that most people had chickenpox in childhood, therefore, under favorable conditions for the virus, a secondary exacerbation of herpes zoster develops in the form of herpes zoster and during the life of each person the risk of such reactivation is 15-20%.

Symptoms of the disease

The symptoms of this disease begin quite acutely, while at first, at the site of the localization of the virus, a person experiences a strong burning sensation, pain in a certain area.

Most often, these are unilateral areas innervated by one nerve - where the trigeminal nerves are located on the face, upper, lower jaw, forehead, back of the head, neck, intercostal nerves and nerves of the extremities, as well as on the chest, shoulders, back, buttocks, in the genital area.

On the body, these are the so-called dermatomes supplied by the spinal nerves; on the face, there are areas of damage to the trigeminal or facial nerves. This is due to the fact that the main accumulation of the virus is in the nerve nodes (ganglia), the posterior horns of the spinal cord or cranial nerves, and the rashes go along the nerve.

Initial period

Prodromal, characterized by general malaise, neuralgic pains of varying intensity, this lasts an average of 2-4 days:

Headache
Subfebrile body temperature, rarely fever up to 39C
Chills, weakness
Dyspeptic disorders, disruption of the gastrointestinal tract
Pain, itching, burning, tingling in the area of peripheral nerves in the area where there will be rashes later.
Most often, in an acute process, the regional lymph nodes become painful and enlarge.
In severe cases of the disease, urinary retention and other disorders of some systems and organs may occur.

After lowering the temperature, other general intoxication disorders also subside.

Eruption period

The time when the rashes characteristic of shingles appear. The symptoms and nature of the rash depend on the severity of the inflammatory process. At first, the rashes look like foci of pink spots 2-5 mm in size, between which areas of healthy skin remain.

In a typical form of the disease, the next day, small, closely grouped vesicles, vesicles with transparent serous contents, which become cloudy after 3-4 days, form in their place.
In severe gangrenous herpes, the contents of the vesicles may be mixed with blood, black. Herpetic eruptions have an undulating course, as with chickenpox, that is, fresh rashes with vesicular elements appear at intervals of several days. Bubbles, as it were, crawl from one place to another, encircling the body, hence the name of this disease.
In mild forms of the inflammatory process, the transformation of skin nodules into pustules does not form and their ulceration does not occur, and it is also possible that herpes is only of a neurological nature - pain without a rash, otherwise it is also called herpetic neuralgia and is often mistaken for manifestations of intercostal neuralgia, osteochondrosis or heart pains. And therefore, inadequate treatment may be prescribed.

Period of crusting

Usually after 14-20 days, crusts form at the site of the rash. The entire erythematous background, that is, the places where the vesicles were located, gradually become pale, dry out, and the yellowish-brown crusts disappear, leaving a slight pigmentation or depigmentation.

Pain in shingles

The symptoms of this disease are caused by a disruption in the functioning of nerve cells in the zone of localization of the virus, therefore, in the process of its active reproduction, the nerve endings become overly sensitive, even a light touch causes significant pain to the patient as if burned, especially when in contact with water. Therefore, the question of whether it is possible to wash with herpes zoster is not decided unambiguously. There are several opposing opinions, one is that it is contraindicated to wash with shingles, the other is that it is necessary to bathe and baths with sea salt help very well, the third is that it is better to take only a shower, after which you should not dry off, but gently blot the body with a towel.

Many patients describe the pain in herpes zoster as burning, dull, boring, or as the passage of an electric current, aggravated by the slightest thermal or mechanical impact. Skin pain also accompanies the period of the disease, and persists in 15% of those who have been ill after the healing of herpetic eruptions.

This is not due to the progression of the disease, but to the fact that with a viral infection, disturbances occurred in the nervous tissues, the recovery of which takes time. This period is called postherpetic neuropathy, which in young people can last no more than a month, but in older people in 70% of cases it lasts several months. In patients older than 70 years, neuralgia can last even more than a year.

How to treat herpes zoster?

Treatment of this disease in young people who do not have serious chronic diseases and health problems is not required. Herpes zoster in such cases leads to a complete recovery after 2 to 3 weeks. However, in any case, when the symptoms of the disease described above appear, you should definitely seek the advice of a doctor. Which doctor treats shingles, herpes? To begin with, you should contact a therapist, then a dermatologist or an infectious disease specialist, and in case of a severe course of the disease, you may need to consult a neurologist or, in case of an ocular form of herpes, an ophthalmologist.

To relieve pain and discomfort, the doctor may prescribe painkillers such as Naproxen or Lidocaine gel. If the pain is more intense, then such strong painkillers as Gabapentin and Oxycodone will be prescribed along with antiviral agents. It is also possible to use non-steroidal anti-inflammatory drugs (see list of all NSAIDs).

The doctor may prescribe specific antiherpetic drugs, in injections, tablets, in the form of creams or ointments:

Acyclovir preparations - Acyclovir, zovirax, viroleks.
Valaciclovir preparations - Valciclovir, Valtrex. Ether of acyclovir, which is transformed after absorption into acyclovir.
Penciclovir preparations - in the form of triphosphate, penciclovir also blocks the synthesis of viral deoxyribonucleic acid.
Famciclovir preparations. Prodrug that is converted to penciclovir in liver cells

Antiviral therapy is necessary, because without adequate treatment, shingles can cause complications, in addition, antiherpetic treatment promotes rapid healing of ulcers, reduces pain and improves the general condition. Both the dosage and the course of therapy are determined by a specialist, taking into account the individual course of the inflammatory process, concomitant diseases, and on average is no more than 10 days.

To date, the antiviral cream Epigen, which includes glycyrrhizic acid, is considered to be a fairly effective drug for the treatment of herpes. It has a local anti-inflammatory, antiviral, immunomodulatory, antipruritic effect.

In the gangrenous form, when a bacterial infection joins, broad-spectrum antibiotics are prescribed. Also, if necessary, immunomodulators, such as Cycloferon, Genferon, physiotherapy and vitamin therapy, can be prescribed by a specialist.

For the treatment of rashes, there are also several opposing opinions. One thing is that you can use brilliant green - a solution of brilliant green, boric acid - Castellani liquid, fukortsin, a strong solution of potassium permanganate. All of these products have a drying effect and should be used with care to avoid the formation of burns, which worsens the condition of the skin. Another opinion is that you should not treat rashes with these agents, but it is better to use antiviral, antiherpetic creams, ointments, sprays.

Do not use corticosteroid drugs, either by mouth or in the form of creams and ointments, as this only worsens the situation. Hormonal agents have a suppressive effect on the immune system, which must cope with viral agents on its own.

Treatment of postherpetic neuralgia with chronic pain in the elderly is not always successful, since antiviral drugs are powerless. Neurologists can prescribe plasmapheresis, physiotherapy, Pregabalin, Gabapentin.

Consequences

In severe cases of the disease, there may be facial paralysis or other paralysis due to damage to the motor nerves.
It is also possible violations of the internal organs, such as pneumonia, diseases of the genitourinary system, duodenum.
With eye damage, visual acuity can occur and significantly decrease.
With a very dangerous encephalitic form of herpes zoster, a complication is meningoencephalitis - a serious disease, most often leading to disability.
When a bacterial infection is attached, purulent processes aggravate the patient's condition, the recovery process after the disease is delayed for months.

The prognosis for mild forms of the disease is favorable, usually there are no relapses and serious consequences of herpes zoster. However, in weakened people after a severe inflammatory process, exacerbations are possible in the future.