Shingles: Symptoms and Treatment
Herpes zoster, also defined as herpes zoster or herpes zoster, is a disease in which the skin is exposed to lesions, a lesion that is more pronounced and massive than the traditional herpes variant of the lips. Shingles, the symptoms of which can be observed in both men and women, are especially common in persons over the age of fifty, although this does not exclude the possibility of its occurrence in young people.
Herpes zoster is a sporadic disease and is manifested due to the activation of the human varicella virus in a person in a latent (that is, temporarily latent) state. With this type of herpes, the back roots of the spinal cord and intervertebral ganglia are inflammatory, which is also accompanied by symptoms in the form of general intoxication, fever and a specific type of exanthema formed along the course of the sensory nerves involved in this process.
Based on the above feature, we note that shingles occur in those individuals who had previously suffered varicella. The causative agent of both diseases is one virus, Herpesviridae. It is noteworthy that he is unstable with regard to the impact on him of environmental conditions, and therefore quickly dies as a result of heating, the use of disinfectants and ultraviolet rays in his address. Meanwhile, it also has the ability to remain viable for a long time in low-temperature conditions, while maintaining, in addition, repeated freezing.
Quite often, shingles appear in patients exposed to various types of effects that affect immunity. These include leukemia, neoplasms, chemotherapy procedures, prolonged use of immunosuppressants and corticosteroids.
In particular, the development of this infection is often observed in people with HIV. As for the elderly who are most susceptible to shingles, here, as in the conditions previously listed, it is also important to reduce immunity, which is the most suitable basis for the disease.
In herpes zoster, as we have already noted, the smallpox virus is activated in a latent form, and the virus can survive for several decades, therefore, without manifesting itself in any way with regard to any symptoms. It is noteworthy that the vegetative ganglia may be involved in the inflammatory process, meningoencephalitis may develop. In addition, internal organs can also be affected.
Shingles: the main forms of the disease
Clinical forms of herpes zoster may be as follows:
- ganglionic skin form
- eye and ear forms;
- necrotic form (gangrenous)
- Shingles form when they defeat vegetative ganglia
- meningoencephalic form
- disseminated form
- The form is abortive.
All these forms of herpes zoster and the symptoms peculiar to their course will be considered below, but first consider the main type of course of this disease.
The duration of the incubation period, determined for this disease, is the period from the moment of transferring the primary infection to the patient to the moment of its activation, which, in turn, can last for many years.
For the initial period of the course of herpes zoster, the presence of so-called prodromal signs is characteristic, which manifests itself in the form of headache and general malaise, fever to subfebrile indices (up to 38 degrees), dyspeptic disorders (digestive disorders).
Simultaneously with these manifestations also there is burning, pain and itching combined with pronounced tingling and paresthesia (numb sensation), centered along the course of nerve peripheral trunks in the area where the rashes subsequently appear. As for the intensity of these symptoms, it is individual in each case.
The duration of the initial period of shingles can be from 1 to 4 days, while in adults it is noted more often compared with its appearance and course in children.
In the vast majority of clinical cases, shingles start acutely. This implies an increase in body temperature of about 39 degrees, which is accompanied by the addition of general toxic reactions (in the form of chills, general malaise and headache). Simultaneously, the innervation zone of the spinal ganglia (one or more of them) is covered by characteristic skin eruptions, whose appearance is also accompanied by certain sensations (pain, numbness, etc.).
Initially appeared exanthema looks like limited spots of pink hue, their value is about 2-5 mm. Meanwhile, on the day of appearance or the next day after that, vesicles of small sizes appear already against their background, closely grouped with each other, they contain transparent contents. Often the appearance of exanthema is accompanied by soreness and an increase in lymph nodes.
The localization of the exanthema is determined on the basis of the projection of the corresponding sensory nerve. Predominantly, this lesion is one-sided, focusing along the course of the intercostal nerves, along the branches of the trigeminal nerve located on the face, and also, which is not so often observed, along the course of the nerves concentrated in the extremities. In addition, some cases of the disease in practice indicate the possibility of skin lesions of the genital organs.
The course of the shingles can be accompanied by the formation of new spots, which occurs at intervals of several days, against which the vesicular structures subsequently develop. A few days after the appearance of these formations, the blanching of the erythematous background, which acts as the basis for the location of the vesicles, is noted, the content of the vesicles themselves becomes turbid.
Later, they begin to dry out gradually, which is accompanied by the formation of crusts, they, in turn, begin to disappear by the end of the third week of the disease. In the end, the skin at the site of their location remains slightly pronounced pigmentation.
As for the phenomenon of fever with shingles, it is held for several days, then normalized, the rest of the symptomatology also disappears.
Shingles: symptoms of major forms
The most common form of the disease we are considering is ganglionic form . It is characterized by an acute onset in a complex with fever and symptoms of intoxication. In addition, there are also sharp pains in those areas where the skin rashes that are topical for the disease will subsequently appear. After about four days (and in some cases — about 12 days), there is actually a rash. The concentration of pain and eruption is determined by the area of the affected nerves (mainly intercostal nerves are affected), the nature of these manifestations corresponds to the name of the disease itself — that is, in this case it is shrouded.
In some variants of the course of the disease in this form, the pain sensations become simply unbearable for the patients, and their amplification can occur even with little effect on the skin (movement, cooling) or with a slight touch. In the place where subsequently there is a vesicular rash, initially there is infiltration of the skin and its hyperemia, that is, there is an abnormal infiltration of the infiltrate into the skin with its reddening. Already after this, in a grouped manner, bubbles with transparent, and subsequently cloudy, contents are formed here. Further, the course of the disease is characterized by the drying of these vesicles and their transformation into crusts.
It also happens that the disease in this form occurs with the symptoms of intoxication and with pain, but without the appearance of a rash. Meanwhile, if the rash does appear, it brings some relief to the patient, because the pain in this version is already less pronounced.
The eye form is accompanied by the defeat of the trigeminal node (which is also defined as the gasser node), and also localization of the actual rash for the disease along the trigeminal nerve, that is, on the face , On the nose and eyes.
As for ear shape, then its course is characterized by involvement of the geniculate in the process, as well as the appearance of rashes directly on the auricle, as well as on the skin surrounding it. In addition, the rashes can be concentrated within the area of the external auditory canal. The possibility of paralysis of the facial nerve is not ruled out. The appearance of a rash with this form of the disease is preceded by the symptomatology peculiar to fever and general intoxication.
The duration of neuralgia of the trigeminal nerve can be on the order of several weeks, while it is characterized by a general manifestation of manifestations. The eye shape of the herpes zoster may also be accompanied by viral keratitis, irytitis and glaucoma develop somewhat less frequently.
Necrotizing form of shingles (also known as gangrenous) occurs, as a rule, in weakened patients. It is characterized by a deep lesion of the skin, resulting in later remain scars. In this case, there is reason to believe that in the specificity of the course of this form of the disease, the layering provided by bacterial infection plays an important role.
It is rare enough to practice a meningoencephalic form shingles. It is characterized by extremely severe current, and the lethal outcome occurs in about 60% of cases. The beginning is accompanied by the manifestation of the symptoms of the ganglion-shaped form, as a rule, the region of the intercostal nerves is subject to lesion, somewhat less often the cervical region. The subsequent development of the disease is characterized by the addition of meningoencephalitic symptoms. In particular, the following manifestations are relevant:
- ataxia (coordination disorder in voluntary movements)
- hemiplegia (absolute loss of ability to perform arbitrary limb movements on one side of the body)
- meningeal symptoms are symptoms that indicate the irritation of the meninges (stiff neck muscles, which leads to difficulty in the passive head bending, Kernig syndrome, in which it is impossible to make a full bend of the leg in the knee joint when bending at right angles in the knee and hip joints; Intolerance of skin touches, sounds, bright light, reactive pain sensations when squeezing certain areas)
- development of coma.
Since the appearance of the actual for the disease rash and before the development of subsequent encephalopathy, it usually takes about two days to three weeks.
Generalized form. In some cases, a few days after the formation of a clearly localized exanthema, single and sometimes multiple vesicles may form, and they can appear in the most diverse areas of the skin (mucous membranes are not excluded). Such a course, in turn, can be mistakenly determined as a chicken pox attached to shingles. The generalized course of the disease, as well as the lack of results in the treatment of herpes, after 2-3 weeks, determines the reasons for suggesting that the patient develops immunodeficiency or malignant neoplasms.
With abortive form, its main features are the rapid disappearance of the rash, as well as the absence of vesicles during the course of the disease. The clinic of manifestations of this form of the disease lasts for several days, if it is a question of its acute course, then the period increases to two or three weeks, and if the lengthening flow is up to a month or more.
For any of the forms discussed in this section, it is possible that such a symptom as a lesion of vegetative ganglia can be attached, which in turn determines the possibility of the appearance of a symptom uncommon for shingles (diarrhea, constipation, delay in urination, Horner’s syndrome, various Vasomotor disorders).
As to the severity of the course of the disease, it is often determined by the connection with the immediate area of exanthemal localization. So, if the rash is concentrated in the area of the nososnichnogo, frontal or supraorbital nerves, then the symptoms of herpes zoster in such cases are replenished with neuralgic pains, lesions of the eyelids, swelling and redness of the skin, in some cases affects the cornea of the eye.
It is not superfluous to consider the nature of pain in herpes zoster, which, as we have already noted, focuses on the subsequent appearance of exanthem. So, the pain in this case is burning and paroxysmal, its amplification is noted at night, which often occurs in combination with pronounced emotional manifestations. In frequent cases, there is local paresthesia (numbness, tingling of the skin), and frequent violations of skin sensitivity.
In addition, the possibility of the appearance of radicular paresis (which implies a weakening in arbitrary movements) of the areas of the oculomotor and facial nerves, abdominal muscles and limbs, as well as the sphincter of the urinary bladder region, is not excluded.
In addition to these features, shingles can be combined with serous meningitis developing against it, while the actual inflammatory changes occurring in the cerebrospinal fluid (in the cerebrospinal fluid) are rarely accompanied by meningeal symptoms. A very rarely acute period of the course of the herpes zoster is accompanied by the development of encephalitis and meningoencephalitis.
Shingles are much more severe during HIV infection or other immunodeficiencies. In these cases, the duration of the period until the appearance of rashes increases, the drying of the crusts, as one of the stages of the course of the disease, occurs no earlier than three weeks.
The greatest risk of development of herpes zoster in a progressive form is relevant for patients diagnosed with lymphoma or lymphogranulomatosis. So, about 40% of patients in this case are faced with the appearance of a rash that spreads along the skin surface throughout the body. Up to 10% of patients, in addition to disseminated (widespread) manifestations of skin lesions, face development of meningoencephalitis, viral pneumonia, hepatitis and other complications of severe type.
After the first episode of the appearance of herpes zoster, as a rule, there is a stable remission. As for the recurrence of this disease, it is extremely rare (of the order of several percent). In most cases, the recovery of patients occurs without any residual manifestations of the disease, although the pain in the area of actual lesions can persist for a long period of time (from several months to several years).
Often the clinic of symptomatic manifestations is the basis for establishing an appropriate diagnosis. The initial period of the disease is often accompanied, however, by an erroneous diagnosis, based on the conclusions associated with its primary symptoms (intoxication, pain, fever). The diagnosis in this case can be established in such an option as lung infarction, pleurisy, angina pectoris, acute appendicitis, etc.
Differentiation is made from such diseases as herpes simplex, acute eczema, erysipelas. To diagnose the generalized form of the disease, differentiation is required from a disease such as chicken pox.
In some cases, it is possible for the doctor to remove tissue samples and the contents of the formations for a more complete study. A blood test for HIV is mandatory, because it is the herpes zoster that can act as the only marker that indicates the presence of the disease.
Both the features of the course of shingles, and its outcome are determined based on how quickly the patient asked for medical help. In particular, the treatment is based on the use of ointments, antiviral drugs, non-steroidal anti-inflammatory drugs, immunomodulators. Vitaminotherapy and physiotherapy with quartz are also used.
Treatment of herpes zoster requires the exclusion of bathing and alcohol. Recommended foods rich in vitamin C (citrus fruits, cranberries, etc.). Treatment of shingles with folk remedies should be carried out only in conjunction with treatment determined by a doctor, while, as a rule, folk remedies are oriented mostly on increasing immunity and suppressing pain. The prognosis for shingles is generally favorable, but it is relevant for all forms except for the form of encephalitic.
If you suspect a herpes zoster, you should seek the advice of specialists such as an infectious disease specialist and a neurologist.