What happens and what forms it comes in
After chickenpox, the varicella-zoster virus persists in the sensory ganglia of the spinal cord and cranial nerves. When cellular immunity decreases, it multiplies and penetrates through nerve fibers into the skin of the corresponding zone - the dermatome. Therefore, the rash is located in a strip and does not cross the midline of the body. The thoracic nerves are most often affected, with the ophthalmic branch of the trigeminal nerve in second place.
- Thoracic and lumbar shape - stripe on the torso
- Ophthalmic herpes - damage to the forehead, eyelids, eyes
- Ramsay Hunt syndrome - ear rash, facial paralysis
- Disseminated form - in people with immunodeficiency
- Postherpetic neuralgia - pain after the rash heals
Causes and risk factors
Shingles can only develop in someone who has had chickenpox. With age, the natural immune control over the virus weakens, so the incidence increases after 50 years. In young people, the disease is often associated with stress, overwork or a hidden decrease in immunity. If episodes occur repeatedly, your doctor may recommend testing your immune system.
- Age over 50
- HIV infection
- Oncological diseases and chemotherapy
- Taking glucocorticoids and immunosuppressants
- Diabetes mellitus, chronic kidney disease
- Severe stress, overwork
Symptoms
1–5 days before the rash, burning, tingling, itching or pain, sometimes very severe, appears in the future area, which leads to erroneous suspicions of heart disease, kidney disease or intercostal neuralgia. Then, groups of bubbles with transparent contents appear on the reddened skin. After a few days they become cloudy, dry out and become covered with crusts, which fall off after 2–4 weeks. Weakness, headache, and slight fever may bother you.
- Burning, shooting pain on one side of the body
- Redness and a group of blisters in a stripe
- Itching and hypersensitivity of the skin
- Weakness, malaise, fever
- Crusts after 7–10 days
- Pain after the rash heals
Diagnostics
Usually the diagnosis is made by a typical picture: a unilateral stripe of blistering rash with pain. In doubtful cases, for example, with an atypical rash or in people with immunodeficiency, PCR of the contents of the vesicles is performed for the varicella-zoster virus. If there is a rash in the eye area, an examination by an ophthalmologist on the same day is required. If the ear and face are affected, consultation with an ENT doctor and a neurologist is necessary; if there are signs of brain damage, hospitalization is required.
- Skin and neurological examination
- PCR of vesicle contents
- Examination by an ophthalmologist for a rash on the face
- Immunity testing for recurrent episodes
- Analysis of cerebrospinal fluid for signs of meningitis
Treatment and prevention
Antiviral drugs are prescribed as early as possible, preferably in the first 72 hours after the rash appears: they speed up healing and reduce the severity of pain. People over 50 years old, with facial lesions and weakened immune systems are prescribed them later. For pain relief, conventional analgesics are used, for severe neuropathic pain - drugs from the groups of anticonvulsants and antidepressants, local agents with an anesthetic. No bubbles are broken and the skin is kept clean and dry. The patient is contagious to people who have not had chickenpox until crusts have formed. For prevention, recombinant zoster vaccine is recommended for people over 50 years of age.
- Antiviral therapy in the first 72 hours
- Pain relief as prescribed by a doctor
- Treatment of neuropathic pain
- Do not open the blisters, cover the rash with clothing
- Avoid contact with pregnant women and children without chickenpox
- Vaccination of people over 50 years of age