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Herpes zoster

The herpes zoster is a disease that affects peripheral nerves and skin, causing small blisters in a circle around a dermatome , or area of skin innervated by a ganglion.

It is produced when the varicella- zoster virus (VVC) is reactivated , which can remain latent in the body for many years after having had chickenpox.

Colloquially, it is also known as shingles. In some Mediterranean countries (Spain, Malta, Italy), it is called “Saint Anthony’s fire”.

Zoster can appear in any age group. The development of this ailment is more likely in people older than 60 years, and in those who suffered from chickenpox before reaching 1 year of age. Patients who have depressed immune systems due to medical treatments or illness are also prone.

Causes of shingles

Herpes zoster belongs to the herpesvirus family (human herpes virus HHV-3), and has a single serotype. It is also the cause of varicella zoster (VZV), a characteristic skin disease of childhood.

Once the chickenpox has subsided, the virus is not completely eliminated, but remains in a latent state, settled in the ganglia of the spinal cord, the trigeminal, or others of the head. It is believed that it can remain in these locations for life.

The virus in an inactive state does not cause damage and does not multiply, although it can be reactivated in case of immunodeficiency . Due to this, it shows a higher incidence in the elderly and patients treated with immunosuppressive drugs.

Clinical picture

Initial symptoms of shingles include fever , headaches, and malaise, lasting several days. This is followed by itching and burning pain, which can be intense. The skin rash will appear in the area of ​​the affected nerve, in the form of sharp outbreaks. The patient may also have hyperesthesia and photosensitivity in the dermatome.

Some patients present with these symptoms, with the exception of a skin rash, known as “zoster sine herpete,” and it can complicate the diagnosis.

The later phase appears at 12-24 hours and includes the development of the skin rash. The initial lesions are erythematous spots that develop into vesicles along the dermatomes, with a common belt-like pattern.

Evolution of herpes zoster

The most common areas are the middle region of the thorax and the ophthalmic area of ​​the face, where it can cause alterations in vision.

On the third day, the vesicles turn into blisters with serous liquid content, usually painful and accompanied by a flu-like picture that includes fever, fatigue, and generalized pain. Once they dry they remain crusted for 2 or 3 weeks. Sometimes they can burst within 7 to 10 days, leaving a scar with hyperpigmentation.

If shingles involves the ophthalmic area of the trigeminal nerve , the rash appears on one side of the head, from the eye area to the crown of the head.

If the virus affects the nasociliary branch of this same nerve, it presents with blisters on the tip and sides of the nose, and can cause damage to the cornea. In case of affecting other divisions of the trigeminal or another cranial nerve, the lesions occur in the mouth, pharynx, larynx and ears.

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Herpes zoster is spread by direct contact with the blisters, usually in the first week, so it is not communicable through coughing, breathing, or casual contact. If a person contracts zoster without ever having been in contact with the virus, the condition they develop is chickenpox.

Herpes zoster complications

Shingles can cause a variety of complications, depending on which nerves are affected. Among the main diseases, the following stand out:

  • Respiratory insufficiency.
  • Ramsay Huntm syndrome, if the nerves of the face or ear are affected.
  • Bacterial skin infections.
  • Blindness (if the virus affects the eyes).
  • Deafness.
  • Encephalitis and sepsis in people with depressed immune systems.

Postherpetic neuralgia (PHN ), a sensation of chronic pain in the affected dermatome, due to damage to sensory neurons. This sequel can last between weeks and years.

Shingles treatment

There is no known cure for shingles, nor can the virus be eliminated from the body. However, there are palliative treatments for the symptoms, which can decrease the duration of the process. The main ones are listed below:

Analgesics

If there is mild to moderate pain, patients can be treated with common pain relievers. In severe pain, an opioid medication, such as morphine, may be necessary.

Calamine-based topical lotions can be applied to the rash. Once scabs have formed, creams containing capsaicin are indicated. Topical use of lidocaine can also decrease pain.

The combined administration of antivirals and gabapentin can alleviate the discomfort of postherpetic neuralgia.

Antivirals

The aciclovi acts r inhibiting replication of viral DNA, and is used as a treatment and preventative.

Other antivirals used are valaciclovir and famciclovir . As both are precursors of acyclovir, lower doses can be used to obtain higher concentrations in the body, with a longer effect.

The brivudine is another inhibitor of DNA polymerases drug, which prevents the virus can replicate. It is a more energetic antiviral than acyclovir, which has a greater reduction in the incidence of postherpetic neuralgia.

Ophthalmic herpes zoster is treated with valaciclovir, since its effectiveness is similar to that of acyclovir, but adds the advantage of requiring three doses a day, instead of the five of acyclovir.

Prophylaxis

The only vaccine currently available against shingles is called Zostavax. It is an attenuated vaccine, which contains live viruses devoid of their pathogenicity. These multiply normally in the host’s organism, causing an immune response similar to that caused by a natural infection, but without producing a pathological state. In this way, the specific immunity to VZV is strengthened in the vaccinated person.

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Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of ​​Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.

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