Herpes zoster: symptoms and treatment

Herpes zoster, or shingles, is an infectious disease caused by a virus from the Herpesvirus family. Its main manifestations are the defeat of the skin and peripheral nerves. In some cases, the infection can be generalized, which can cause encephalitis or myelitis. Clinical manifestations of the disease are quite specific, on which the diagnosis is based. In the treatment, specific anti-herpetic drugs of the Acyclovir group are used, which block the multiplication of the virus. From this article you can learn about the signs and methods of treatment of herpes zoster.

The word "herpes" in many people is associated with eruptions on the lips that appear with a cold. Herpes zoster to eruptions on the lips has nothing to do. The causative agents are different, they are united only by the origin of viruses from one family, and nothing more.

The cause of herpes zoster

Only a person who has had chicken pox (chickenpox) can get herpes zoster. "Previously" means ever in life, even 50-60 years ago. This is possible because the causative agent of chicken pox and shingles is the same.

The causative agent of both diseases is the herpes simplex virus type 3 (and there are 8 of them known so far) called Varicella zoster (note - colds on the lips cause the first and second types of herpes viruses). This virus at the first meeting with the human body generates chicken pox. Most often this occurs in childhood. Clinical recovery from chickenpox is not accompanied by a 100% elimination of the virus from the body. Its amount in the body falls under the action of antibodies, but, so to speak, the remains "hide" in the neurons of the horns spinal cord, ganglions of the cranial nerves, ganglia of the autonomic nervous system, less often in the cells of the neuroglia. And they remain there persist throughout their life, because with such localization they become inaccessible to the action of antibodies that circulate in the blood.

Throughout life, under the influence of provoking factors, the virus can reactivate and leave its "shelter". At the same time, it moves along the peripheral nerves towards the skin, where it manifests itself as an itchy rash. The provoking factors are:

• supercooling (including drafts);
• acute respiratory viral infections (especially against a background of decreased immunity);
• taking corticosteroids or chemotherapy (because they themselves reduce the immune forces of the body);
• injuries;
• stress;
• exacerbation of chronic somatic diseases (especially with regard to blood diseases);
• elderly age.

All provoking factors, in principle, become a source of reduced immunity. And now, with a decrease in protective forces, the herpesvirus of type 3 emerges from its neurological "refuge". And then there is shingles.

Postponed herpes zoster does not leave permanent immunity, as the virus again hides in the nerve ganglia. If the immunity decreases again, it can reactivate again and cause the disease. This can happen a myriad of times.

The virus itself is highly contagious (contagious). This means that even a little contact with a sick person can cause chicken pox. That is, if in the family the adult person becomes ill with shingles, and there is a child who did not suffer from chickenpox, then almost 100% that he will catch chickenpox. For other adults, contact with the shingles is not so dangerous, but only under the condition of normal immunity.

Although the virus is very contagious, it is very unstable in the external environment. It quickly dies when heated, exposed to sunlight, treated with disinfectants. But low temperatures only contribute to its preservation.

Symptoms of herpes zoster

Eruptions on the skin are usually preceded by a rise in body temperature and a general malaise.

Most often the disease begins with prodromal symptoms: there is a general malaise, weakness, fatigue, weakness, headache, fever (insignificant), aching muscles, chills. There may also be a slight itch and tingling at the site of future rashes. These symptoms can last only a few hours, or maybe several days.

Then intoxication sharply increases, which is accompanied by a stronger temperature increase, an aching all over the body, chills. Against the background of these phenomena on the skin appear rashes. What does the rash look like with herpes zoster? First, the skin appears red-pink spots 2-5 mm in size. After a day, the spots turn into vesicles, located on a wide base, with a tendency to merge. The skin around the blisters is swollen, hyperemic (red). The contents of the bubbles are transparent, but it quickly becomes turbid. Within a few days, new and new bubbles appear (next to the previous ones). After about 6-8 days, the vesicles dry out, and yellowish crusts form in their place. When the crusts fall away, there remains pigmentation of the skin, which can persist for a long time (several months).

The appearance of a rash is associated with painful sensations in the place of its location. The pain is associated with the defeat of the nerve processes responsible for the pain, and local skin changes. In most cases, patients characterize their sensations as pronounced itching, which makes rest and sleep impossible. Pain can be a drilling, burning, shooting along the course of the affected nerve. Painful sensations are permanent, intensified at night. Patients spare the affected area, since even a breeze blow, not just a touch, can aggravate pain.

Very specific is the nature of the rashes, which serves as a criterion for diagnosis. Spots and vesicles are located along the peripheral nerves: on the trunk in the form of transverse bands (and often only on one side), on the face in the zone of location of individual branches of the trigeminal nerve, in the region of the auricle (with damage to the ganglion of the facial nerve), along the limb of the extremities. Most often, rashes with herpes zoster are localized along the intercostal nerves either on the left or on the right, less often - around the entire trunk. Hence the name of the disease "shingles", because the rash resembles a trace from the belt that surrounds the trunk.

The fever lasts for several days, usually until new elements of the rash appear, and then gradually normalizes. Also, signs of intoxication gradually disappear. On average, the total duration of the disease is about 3 weeks. Pain usually decreases with the disappearance of the rash, but sometimes it remains durable. In the latter case, the so-called postherpetic neuralgia is formed. About that, in what cases there is postherpetic neuralgia, than it is shown and as it is treated, you can learn from the following article.

There are several separate forms of herpes zoster:

• eye shape, in which the first branch of the trigeminal nerve is affected. In this case, the rashes are located in the area of ​​the orbit, including the eyeball. In this case, herpetic keratitis (corneal damage) can develop, which is fraught with complications from the organ of vision;
• ear form (Ramsay-Hunt syndrome). In this case, rashes are associated with damage to the ganglion of the facial nerve. In addition to rashes and pains, peripheral paresis of facial muscles can develop, with face twisting, pouring of food from the mouth and getting it into the nose, and the inability to close eyelids on the affected side;
• necrotic form, in which deep layers of the skin are damaged. At the same time, almost always collapses a secondary bacterial infection, the disease proceeds quite heavily, and after recovery, scars remain on the skin of the affected area. This form develops in persons with a sharp decrease in immunity (for example, with HIV infection);
• bladder (bullous) form. It occurs if small bubbles merge into large ones;
• hemorrhagic form. It is diagnosed if the contents of the blisters are bloody;
• generalized, or disseminated form, in which the rash spreads throughout the body and even the mucous membranes. This form also develops in persons with a marked decrease in immunity;
• abortive form. It is characterized only by the appearance of spots along the nerve trunks, bubbles are not formed. This is a fairly easy form, which is not accompanied by symptoms of intoxication and can even pass unnoticed for the patient.

In a number of cases, infection can be transferred to the central nervous system. In this case, meningitis, encephalitis, meningoencephalitis, myelitis develop with the corresponding symptomatology. Such forms can even have a fatal outcome.

Diagnosis of herpes zoster

The diagnosis is made based on a typical clinical picture, that is, the presence of a characteristic rash with a specific location (along the course of peripheral nerves) against the background of common infectious symptoms. Sometimes there are difficulties in diagnosing in the first few days of the disease, when there is no rash yet, or in those cases, when the patient does not know if he had previously suffered from chickenpox, and the rash is located throughout the body (generalized form).

Laboratory diagnostic methods are rarely used, in difficult-to-recognize cases. It is used to detect the virus under a microscope, immunofluorescent or serological methods.

Treatment of herpes zoster

All methods of treatment with herpes zoster can be divided into three groups:

• etiotropic (directed directly at the cause of the disease);
• pathogenetic (affect the mechanisms of the development of the disease);
• symptomatic (help to cope with individual symptoms).

Etiotropic treatment

It is, to date, in the application of specific anti-herpetic drugs. These include drugs Acyclovir (Zovirax, Virolex, Gerpevir), Valtrex, Ganciclovir, Famciclovir. The drugs have such a mechanism of action that they block the multiplication of the herpes virus. They prevent the appearance of new elements of the rash (which means that the lesion area becomes much less than without treatment), accelerate the formation of crusts, prevent the generalization of infection. There are various forms of preparations in the form of powder for the preparation of injections, tablets, capsules, syrup, ointments and creams for external use. Usually, intravenous use is combined with external use.

Scheme of application includes the use of Acyclovir 5 mg / kg intravenously drip 3 times a day for 5-10 days. An alternative to intravenous administration is the use of Acyclovir in 800 mg tablets 5 times a day for 5-10 days. Simultaneously, the affected skin is applied cream or ointment 5 times a day for 5-10 days. Sometimes, along with Acyclovir, other immunomodulating agents are used: Viferon, Cycloferon, Tyloron (Amiksin, Lavomax), Isoprinazine and others.

In severe cases, the use of Acyclovir is combined with the use of human immunoglobulin. If a bacterial infection joins, antibiotics should be prescribed.

Pathogenetic treatment

This group of methods includes means to combat intoxication. To do this, use intravenous solutions of glucose, Ringer, rheosorbylact and others. In some cases, their administration is combined with diuretics (Furosemide, Lasix). The use of B vitamins is shown, in connection with their selective and even analgesic effect on the nervous system. Antihistamines (Eryus, Suprastin, Zodak and others) can be used to reduce edema and increase the action of analgesics. The choice of means depends on the form and severity of the disease in a particular case.

Symptomatic treatment

As the means of symptomatic therapy use:

• antipyretics (Paracetamol, Ibuprofen and others);
• analgesics (combined preparations based on non-steroidal anti-inflammatory drugs, narcotic analgesics such as tramadol);
• blockade with anesthetics (with severe pain syndrome);
• sleeping pills (if the pain prevents the patient from fully resting).

From the means of physiotherapy, UVA (ultraviolet irradiation) on the rash zone, UHF, laser therapy and quartz are effective.

In some cases, it is justified to lubricate the rashes with solutions of brilliant green ("green"), methylene blue, which contribute to the drying of bubbles, while providing a disinfectant effect. Only it should be remembered that it is necessary to apply these substances extremely accurately and point-by-point, because generosity in this case can do much harm.

Another important point in the treatment of herpes zoster: the affected area should be kept open, that is, so that there is air access. So the bubbles have a lower risk of stratification of secondary bacterial infection and dry up more quickly.

Thus, herpes zoster is the unpleasant consequences of the reactivation of the herpes simplex virus type 3, which occur against the background of a decrease in immunity in general. The main manifestations of the disease are a specific rash in the form of vesicles and pain in this area due to the lesion of nerve trunks. In most cases, the disease has a favorable prognosis and ends with recovery within 3 weeks. However, it is possible to develop complicated forms that may require longer treatment. Modern achievements in the field of medicine have a fairly wide arsenal of effective means of fighting the virus and allow you to defeat the infection.

European clinic "Siena-honey", video on "Treatment of shingles. Clinic and diagnosis of shingles »:

Shingles. Treatment of herpes zoster. Clinic and diagnosis of herpes zoster.

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TVC channel, TV program "Doctor I", theme "Herpes zoster":

Doctor I - Herpes zoster. 20 August 2014

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