- Signs of the disease
- Depriving forms
- Causes
- Initial stage of the disease
- Period of rash
- Crust formation
- Diagnostics
- How to treat an infection?
- What are antiviral drugs used for?
- Possible consequences
- Is shingles contagious?
- When is shingles transmitted?
- Disease prevention
- Which doctor should I consult with this disease?
Shingles has vivid and painful symptoms. Most often, the disease is detected in older people. An unfavorable environment contributes to the development of infection in young people with weak immunity. Shingles often develops against the background of cancer, especially in people with weakened immune systems (after chemotherapy, for example).
Depriving forms
The disease can be typical or atypical.
In the atypical form, symptoms may be mild:
- In the abortive form, the rash is absent or there is a single focus;
- Bullous form - multiple blisters with clear liquid;
- Hemorrhagic form - blisters with bloody fluid, in place of which scars remain.
- The gangrenous form leaves difficult-to-heal ulcers and rough scars.
Diagnosis of pain
The diagnosis of postherpetic neuralgia is made based on the patient’s complaints, history and clinical picture. For confirmation, PCR is performed to detect the DNA of the herpes virus.
Treatment of pain with postherpetic neuralgia is carried out in the following areas:
Pain from postherpetic neuralgia exhausts patients and reduces quality of life. Long-term pain syndrome causes depression, anxiety, decreased concentration, weight loss, and limitation of physical and social activity. It is necessary not to endure pain, but to treat it promptly and effectively.
Period of rash
The type of rash depends on the severity of the disease. At the initial stage, the rashes look like small pink spots located on healthy skin.
If the process develops typically, then the next day they are replaced by bubbles with a clear liquid - grouped vesicles. After 3 days, their contents become cloudy. The rash occurs in spurts, with breaks of several days.
If a severe gangrenous form develops, the filling of the vesicles may be mixed with blood. It seems that the bubbles move to another place, located around the body.
If the form of inflammation is mild, the manifestation of the disease can only be neurological in nature, when the patient feels pain, but there is no rash. This is herpetic neuralgia.
Herpes zoster (shingles) - symptoms and treatment
There is no incubation period in the usual sense, since herpes zoster is not a primary infection. A whole life can pass, and the manifestation will still occur, although the virus is present in the body.
It is difficult to predict the development of the disease. Its onset and manifestations vary widely and depend on the severity. The disease may be preceded by stress, trauma or acute respiratory infections.
The symptoms of individual forms of herpes zoster are distinguished.
Gangliocutaneous form
This form begins with a prodrome - mild malaise, sensory disturbances, moderate pain in the areas of future rashes. This period lasts up to seven days. Then the pain becomes severe, fever appears, and a moderately severe syndrome of general infectious intoxication appears. Sometimes the pain intensifies even when the wind blows (so-called allodynic pain - from non-painful stimuli).
After 3-10 days, a vesicular rash appears in these places against a background of redness. In this case, the intensity of pain usually decreases. The rash occurs on one side, limited to the area of innervation of one sensory ganglion. Vesicles tend to cluster.
Subsequently, the contents of the vesicles become cloudy and sometimes burst open. After 4-5 days from the appearance of the rash, crusts appear. They disappear after 2-4 weeks of illness.
Rashes are allowed without a trace, but only in the absence of scratching and deep inflammatory damage. But pain phenomena can persist for a long time, sometimes up to a year. This requires timely antiviral therapy and pain relief.
In general, the pain with herpes zoster is quite pronounced and intensifies with movement or touch (even a slight one). They can be classified as acute (from prodrome to one month), subacute (1-4 months) and chronic (more than 4 months - postherpetic neuralgia - typical neuropathic pain). The nature of the pain can be different - constant and spontaneous, often burning, pressing. Sometimes the pain is compared to an electric shock. They can cause significant physical suffering to patients, disrupt sleep, and exhaust the patient.
The localization of pain and rash corresponds to the projection of the affected nerves.
Eye shape
Rashes appear on the face, nose and eyes. This is due to damage to the trigeminal nerve and gasserian ganglion. The rash spreads from the level of the eye to the parietal region, abruptly stopping along the midline of the forehead. Sometimes the process affects the eye.
Ear shape
The geniculate node is affected. In this case, the auricle and external auditory canal are captured. Paralysis of the facial nerve and facial muscles may occur - the so-called. Hunt's syndrome. Taste sensitivity is lost.
Gangrenous (necrotic) form
Deep skin damage occurs. Rough scars form, sometimes with hemorrhagic impregnation of the contents - hemorrhagic form. Most often it develops in older people with a complicated somatic history - diabetes mellitus, peptic ulcer, etc.
Meningoencephalitic form
It is more often observed when the rash is located on the head. The temperature rises, headaches, nausea and vomiting occur, which does not bring relief, meningeal syndrome, impaired consciousness, coma. The mortality rate for this condition is over 60%.
Disseminated form
Occurs with AIDS. The rash spreads throughout the entire skin. Often this affects internal organs - lungs, brain, liver, kidneys. The prognosis is unfavorable.
Ganglioneuralgic form
There are no characteristic rashes, but there is obvious pain. Diagnosis is extremely difficult. Due to the very late diagnosis, treatment is limited to pain relief only. The use of antiviral drugs in the delayed period clearly does not affect the process.
Herpes zoster during pregnancy
In pregnant women, herpes zoster (in the absence of HIV) usually does not have any differences. It does not affect the course of pregnancy and does not cause damage to the fetus/child[2][3][6][8][10].
What are antiviral drugs used for?
The goal is to exclude the development of complications. Antiherpetic treatment helps the ulcers heal quickly and improves the patient's condition.
The course of treatment and dosage of medications is determined by the doctor taking into account the general condition of the patient. On average, treatment time does not exceed 10 days.
If a gangrenous form with a bacterial infection develops, antibiotics, immunomodulators, physiotherapeutic procedures and vitamins are prescribed.
When it comes to treating rashes, there are different opinions regarding the use of drying agents. In any case, they should be used with caution so as not to worsen the condition of the skin by burning.
Hormonal medications should not be used as they suppress the immune system.
Treatment of the disease in elderly patients is not always successful, since antiviral drugs are not justified.
How is shingles transmitted?
Herpes zoster (syn. - herpes zoster) is a secondary infection that develops only in people who have previously had chickenpox. Activation of the virus usually occurs against the background of a weakening of the cellular component of immunity and exposure to unfavorable factors, such as:
- Hypovitaminosis
- Taking hormonal medications
- Radiation or chemotherapy
- Blood diseases, diabetes, oncology
Women are more susceptible to relapses of herpes zoster, as well as carriers of the interleukin gene mutation and older people - for example, among adults aged 85 years, 50% of people have suffered at least one episode of the disease. And in patients with immunodeficiencies, in particular with HIV, the risk of reactivation of herpes type 3 increases 20 times compared to people with normal immune status.
Which doctor should I consult with this disease?
You should first contact a therapist, then an infectious disease specialist or dermatologist. If the form of herpes is severe, the help of a neurologist is necessary; if the eyes are affected, the help of an ophthalmologist is necessary.
We recommend making an appointment at the neurological department of the RAS clinic (Moscow). The best doctors will examine you, study the signs of the disease, identify the causative agent of the infection, make a diagnosis, conduct a consultation, issue clinical recommendations and prescribe effective treatment.
Don't put off visiting a specialist! Specialists from the neurological department of the Central Clinical Hospital of the Russian Academy of Sciences in Moscow remind you: any symptoms that worry you are a reason to consult a neurologist. In this case, the doctor will be able to recognize and treat the disease at an early stage, before the situation worsens and becomes irreversible. You can make an appointment with a neurologist by calling the clinic or using the form on the website.
Description and causes of postherpetic pain
Postherpetic pain (or postherpetic neuralgia) occurs as a result of a previous shingles infection caused by the Herpes Zoster virus.
When the virus enters the body for the first time, it causes chickenpox, but after recovery it does not disappear, but circulates in the body for life and can be reactivated when the immune system is weakened (HIV infection, taking immunosuppressants, aging of the body). The virus affects the spinal ganglia and cranial nerves. Clinically, the disease manifests itself as pain along the affected dermatome (an area of skin innervated by an infected nerve), impaired sensitivity, and blistering rashes on an erythematous background. Most often, the pain goes away after the disease subsides, but in some cases it remains persistent.
The pain can be of different types:
- constant, unabating, burning, pulling, pressing,
- "shooting"
- a burning sensation that occurs when you touch the affected area.
Atypical forms of the disease
In some cases, the course of herpes zoster differs from the classical pattern, which makes timely diagnosis difficult. There are several forms of Herpes zoster:
1. Abortive. It has minimal clinical manifestations: malaise, weakness, redness and swelling of the skin without rashes. The duration of the illness does not exceed several days.
2. Bullous. Skin symptoms include flaccid blisters the size of a pea or larger, which are filled with clear fluid. This type of herpes zoster is accompanied by severe intoxication.
3. Hemorrhagic. Develops in patients with a suppressed immune system. In this case, the lesion affects the deep layers of the skin: the blisters are filled with bloody contents, and dark brown crusts appear.
4. Gangrenous. Another variant of Herpes zoster, typical for elderly and weakened patients. Skin inflammations do not heal for a long time, turning into ulcers that leave behind rough scars.
5. Generalized. It is characterized by the spread of a herpetic rash over a large area of skin beyond the zone of innervation of one nerve. This form is observed in immunocompromised patients.