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Shingles is a viral infection, the cause of which is the virus also responsible for chicken pox – herpes virus. The VZV virus causes smallpox at the first contact (most often in childhood) with a non-immune person. After the infection has been extinguished, the virus is not eliminated from the patient’s body, but remains dormant in the nerve cells.
What is shingles?
Shingles is a viral skin disease characterized by unilateral vesicular and blistering lesions. The ailment is caused by the chickenpox virus – shingles. It occurs as a result of the reactivation of a latent infection (in the sensory ganglia) or as a result of contact with a person suffering from chickenpox. The incubation period of the disease is approx. 1-2 weeks. Shingles occurs in people who have had chickenpox. Most often it affects the elderly or people with impaired immunity. The lesions cover the skin of the face and torso, do not usually extend across the midline of the body, and are limited to one dermatome.
The causes of herpes zoster
The disease is caused by infection with the chickenpox virus – shingles (Herpes varicella virus – HVV). Shingles develops as a secondary infection. Infection with shingles alone from another person is rather impossible. However, exposure to mucus can lead to chickenpox in people who have not had the disease or have not been vaccinated before. The specific causes of viral reactivation are not fully known, but there are some factors that increase the risk of developing the disease:
- cancers,
- significantly weakened immunity,
- excessive stress,
- age (people over 50),
- general weakness after vaccination,
- period of serious infections,
- chemotherapy and radiotherapy,
- newborns,
- taking cortisone for a long time
- immunosuppressive therapy.
IMPORTANT: Although it is not a threat for a person who has had chickenpox to come in contact with someone with herpes zoster, it is important to cover the skin eruptions. On the other hand, people who have not yet had chickenpox should limit their contact with people with shingles.
Fig.4.17. Shingles
Shingles symptoms
In herpes zoster, the patient has typical skin eruptions – vesicles with a permanent cover filled with serous contents. These follicles can be grouped or scattered over the affected skin segment. The lesions are most often located on the patient’s face, especially in its upper part (around the optic nerve), but they can also appear on the chest. It is worth emphasizing that the herpes zoster symptoms usually appear on one side of the body, not exceeding the midline of the face or torso. Disease symptoms are often accompanied by:
- neuralgia,
- baking,
- tingle,
- itching (before skin changes, during the course of the disease, and even several months after the changes have disappeared).
In older patients, pain may persist for several months after the skin lesions have subsided. Unfortunately, they are often recurrent.
Patients with herpes zoster should see a dermatologist if pain and redness persist, as the infection can leave scarring without proper treatment.
In addition, there are specific clinical varieties of herpes zoster:
- gangrenous (zoster gangraenosus) – skin lesions break down and leave gangrenous ulcers;
- haemorrhagic (zoster haemorrhagicus) – accompanying severe disease;
- ocular (zoster ophthalmicus) – lesions occupy the cornea, which can lead to eye complications;
- generalized (zoster generalisatus) – disseminated vesicular changes that most often accompany severe diseases (lymphomas, metastatic cancers).
How to recognize shingles?
Shingles is insidious and begins with a general malaise, headache and fever. Then there is pain in the skin innervated by the nerve affected by the disease. Shingles is diagnosed on the basis of a visual examination of the skin and a medical history. If there is any doubt about the diagnosis, a section of the bladder or fluid inside is taken for further analysis. People with facial shingles must consult a doctor because this type of disease can even damage their eyesight.
A well-chosen treatment for herpes zoster helps to relieve pain and bothersome numbness and itching of the skin, which sometimes last for years.
IMPORTANT! The disease should be differentiated from other ailments, such as:
- Chickenpox,
- ordinary herpes,
- neuralgia,
- blister rose.
Treatment of herpes zoster
In all cases, shingles requires medical advice. Ideally, we should go to a specialist before the rash appears – this is a good time to start treatment with antiviral preparations. They should be administered orally (more severe cases require intravenous use). In addition, for shingles, analgesic treatment is implemented, because the pain that accompanies shingles is very troublesome. Painkillers, in addition to relieving symptoms, also shorten their duration. In some cases, the pain is so intense that the only way to relieve it is with an anesthetic injection. The combination of paracetamol with ibuprofen or naproxen gives a stronger effect. It is also recommended to use cold compresses.
Corticosteroids are medications used to reduce the swelling, but are not recommended very often as they cause the rash to spread more quickly.
In the course of the disease, the patient’s skin requires special care. First of all, it is necessary to follow the rules of hygiene so that there is no bacterial infection in the resulting vesicles. Also after bathing, drying the skin should be careful not to inadvertently damage the scabs. Rubbing the eruptions with a special lotion works well and covering them with a (non-stick) bandage helps, and you can wear looser clothing where the pain is most intense.
The prognosis for the disease is usually good. Care should be taken in the elderly and debilitated people. The serious prognosis is in specific types of herpes zoster (e.g. ocular, aural, generalized).
Shingles – complications
Shingles is a condition that usually disappears within two weeks and leaves discoloration and scarring behind. However, in some cases, shingles can cause unpleasant consequences, even several months after the disease has resolved.
The complications of the disease include:
1. Myelitis and sensory disturbances – this complication occurs when the herpes zoster virus has penetrated the spinal cord. The nerve fibers that cause drooping corners of the mouth and eyelids and limb paresis are damaged.
2. Neuralgia – it is a condition that can last for several years after shingles. Neuralgia is accompanied by skin hypersensitivity, even the slightest light touch causes pain in the patient. It happens as a result of damage to nerve fibers and tissues.
3. Hearing loss, balance disorders, hearing loss.
4. Damage to the optic nerve – a complication that leads to photophobia and (in some cases) blindness.
5. Stroke – occurs when viruses travel through the body from the trigeminal nerves to the meninges and arteries in the brain. This complication causes severe headaches and paralysis of the half of the body.
Source: A. Kaszuba, Z. Adamski “Practitioner’s guide. Dermatology”; XNUMXst edition, Czelej Publishing House