Bullous form of herpes zoster

Shingles (herpes) is a viral skin disease that manifests itself as unilateral rashes and is accompanied by severe pain. The causative agent of the disease is the chickenpox virus - herpes zoster.

Herpes zoster affects the peripheral nerves in some areas of the skin, which leads to intoxication of the body, inflammation of the dorsal roots of the spinal cord and the appearance of a blistering rash. As a rule, this infection affects adults and children over the age of 10 years, and it develops only in those individuals who have had chickenpox.

At the same time, skin rashes are not the worst manifestation of the disease. Herpes zoster is dangerous because it damages peripheral nerves. Being in the nerve endings, the active virus destroys their structure, thereby causing unbearable pain in shingles and many neurological complications.

What it is?

The herpes zoster virus first enters the body during chickenpox. Elimination of chickenpox rashes does not mean the death of the infectious agent. The virus is kept in a weakened state by the immune system and remains in the body constantly after chickenpox.

Herpes zoster is an external manifestation of the herpes virus activated against the background of decreased immunity. The disease is registered only in people who have had chickenpox!

Activations Herpes zoster is promoted by:

1. hypothermia,
2. previous acute respiratory infection or influenza (any other disease leading to a sharp weakening of the immune system),
3. stress,
4. visiting a solarium or prolonged exposure to the sun,
5. oncology and radiation therapy,
6. severe infections - HIV,
7. long-term use of corticosteroids and treatment with immunosuppressants,
8. pregnancy (often the disease occurs without skin rashes and severe pain, but has a negative effect on the development of the fetus).

Classification

Clinical forms of herpes zoster can be as follows:

1. gangliocutaneous form;
2. eye and ear forms;
3. necrotic form (gangrenous);
4. a form of herpes zoster when it affects the autonomic ganglia;
5. meningoencephalitic form;
6. disseminated form;
7. abortive form.

We will consider all these forms of herpes zoster and the symptoms characteristic of their course below, but first we will consider the main type of course of this disease.

Is shingles contagious to humans?

Shingles is contagious and it is important to understand what routes of transmission of a dangerous viral pathology exist.

The following methods of infection are possible:

1. By airborne droplets, in which the virus is localized in the mucous membranes of the carrier of the infection, from where it enters the air after coughing or sneezing. Subsequently, the virus remains in the form of an aerosol until a healthy person inhales contaminated air.
2. By contact, in which the virus enters the body of a healthy person after direct contact with the skin of an infected person.

How long is shingles contagious? Exactly as much as bubbles with liquid appear and burst on the skin. As soon as they crust over, you don’t have to worry about infection. The source of infection is the liquid that fills them, therefore, if a person with rashes touches them, and then touches objects accessible to other members of his environment, he exposes those around him to the risk of infection.

It should be taken into account that the virus that causes herpes zoster is very unstable; it is destroyed when exposed to solar insolation, disinfectants, and high temperature.

Most often, outbreaks are recorded in autumn and spring.

1. In mild forms of the pathological process, skin nodules do not transform into vesicles.
2. However, in severe forms of the disease, vesicular vesicles transform into ulcers, which after some time begin to ulcerate. In this case, shingles becomes protracted and lasts up to one and a half months.

Symptoms of herpes zoster

It is impossible not to notice the symptoms of shingles in an adult. The clinical picture is characterized by an acute onset, with severe pain and severe burning at the site of the lesion.

The disease affects an area of ​​the human body most often on one side.

Zones of localization of herpes zoster can be:

1. Genitals;
2. Buttocks:
3. Lower and upper limbs;
4. Intercostal areas;
5. Face (part of it along the triangular nerve);
6. Lower jaw;
7. Back of the head;
8. Forehead;
9. Neck.

If herpes zoster affects the facial part, then the rash will be located along the ternary or facial nerve. If an area of ​​the body is affected, the rash will be located along the spinal nerves. This fact is explained by the high accumulation of the virus in the nerve ganglia, in 11 pairs of cranial nerves, in the dorsal horns in each half of the spinal cord. Therefore, cutaneous manifestations are localized along the involved nerve.

Experts distinguish three periods, each of which has its own symptoms of herpes zoster:

Onset of the disease

This period is called prodromal. It is accompanied by general malaise, psychovegetative (neurological) pain, which can have varying intensity. The duration of the initial period can be from 48 hours to 4 days.

In parallel, the patient experiences the following symptoms:

1. Feeling weak;
2. Headache;
3. Increase in body temperature to subfebrile levels (fever is extremely rare, but does occur);
4. Chills;
5. Disorders of the functioning of the gastrointestinal tract and associated dyspeptic disorders;
6. Pain, burning, itching, severe tingling in the area of ​​the body or face where rashes will subsequently appear;
7. As symptoms increase, the lymph nodes swell and become painful and hard to the touch;
8. Disturbances in the process of emptying the bladder are observed in severe cases of the disease.

When body temperature drops, the symptoms caused by it in the form of intoxication are significantly weakened.

Period of rash

The time when rashes characteristic of shingles appear. The symptoms and nature of the rash depend on the severity of the inflammatory process. At first, the rashes look like pockets of pink spots 2-5 mm in size, between which there are areas of healthy skin.

1. In the typical form of the disease, the next day, small, closely grouped vesicles and vesicles with transparent serous contents form in their place, which becomes cloudy after 3-4 days.
2. In severe gangrenous form of herpes, the contents of the vesicles may be mixed with blood and black in color. Herpetic rashes have a wave-like course, as with chickenpox, that is, fresh rashes with vesicular elements appear at intervals of several days. The bubbles seem to crawl from one place to another, encircling the body, hence the name of this disease.
3. In mild forms of the inflammatory process, the transformation of skin nodules into pustules does not form and their ulceration does not occur, and the manifestation of herpes is also possible only of a neurological nature - pain without a rash, otherwise it is also called herpetic neuralgia and is often mistaken for manifestations of intercostal neuralgia, osteochondrosis or heart pain. And therefore, inadequate treatment may be prescribed.

Crust formation period

After two weeks (maximum 1.5 weeks), yellow to brown crusts form in the place where the rash was previously. The places where the vesicles were located lose their rich color.

Gradually, the crusts fall off, after which areas of pigmentation remain on the skin.

Shingles pain

A person always suffers from severe pain that occurs even from a slight touch to the skin. This is due to the fact that the virus is localized in nerve cells, disrupting their work and many times increasing the sensitivity of nerve endings. The pain that a person experiences can be compared to burn pain. They are especially aggravated when water gets into the affected areas. In this regard, scientists have not yet come to a common decision - whether it is worth taking a bath for shingles.

Some doctors are of the opinion that it is better to avoid water procedures, others believe that baths with the addition of sea salt help, and others recommend taking only a shower, after which it is enough to simply get the body wet.

When describing the nature of the pain, patients indicate that it can be dull, burning or boring, some people compare it to the passage of an electric current through the affected area. Pain tends to increase after minor mechanical or thermal effects. They can continue to bother a person even after the rash has completely gone away. This happens to about 15% of all people who have had shingles.

The reason for residual pain is that viruses have destroyed nerve tissue, and it will take some time for them to recover. Most often, postherpetic neuralgia in old age can persist for several months, and in young people it disappears a maximum of 10 days after the rash disappears.

Shingles in the photo

Atypical forms

The typical course of herpes zoster is described above. Sometimes the disease gives an atypical clinical picture:

1. Abortive form - there is no stage of formation of watery vesicles. Despite the absence of a skin rash, the pain is just as intense.
2. Bullous form - vesicles increasing in size merge, forming bubbles of large diameter.
3. Hemorrhagic form - deep tissue destruction with damage to the skin capillaries leads to the filling of the blisters with blood. Healing occurs with the formation of scars and dimples on the skin.
4. Gangrenous form - deep ulcers form in place of the vesicles. Healing is delayed, and eventually rough scars form in their place.

Consequences

1. In severe cases of the disease, there may be facial paralysis or other paralysis due to damage to the motor nerves.
2. Disorders of the internal organs, such as pneumonia, diseases of the genitourinary system, and duodenum, are also possible.
3. If the eyes are damaged, optic neuritis may occur and visual acuity will significantly decrease.
4. With a very dangerous encephalitic form of herpes zoster, a complication is meningoencephalitis - a serious disease that most often leads to disability.
5. When a bacterial infection is added, purulent processes aggravate the patient’s condition, and the recovery process after the disease is delayed for months.

The prognosis for mild forms of the disease is favorable; usually there are no relapses or serious consequences of herpes zoster. However, in weakened people after a severe inflammatory process, further exacerbations are possible.

Diagnostics

Laboratory tests play a very important role, as they make it possible to determine with 100% accuracy which virus is the source of the problem.

Tests for herpes zoster:

1. Polymerase chain reaction.
2. Immunofluorescence analysis.
3. Serological method.
4. Lymphoblastic transformation test (for babies in the womb).

One of the most common tests is the polymerase chain reaction, for which the contents of the vial and the patient’s blood are taken. The analysis allows you to identify the exact type of herpes virus through the isolation of its DNA and antibodies to the virus.

Shingles and pregnancy

The occurrence of shingles in pregnant women is quite an alarming signal. Often it is pregnancy that becomes a predisposing factor that provokes the reactivation of the herpes zoster virus, which has been “dormant” for a long time in the body of the expectant mother.

Very often this disease becomes the cause of intrauterine infection. As a result, children are born with signs of severe damage to the nervous system or brain. Newborns may be diagnosed with congenital blindness or deafness. The possibility of miscarriage, stillbirth, or death of the newborn cannot be ruled out.

How to treat shingles in adults

Most cases of shingles in adults resolve on their own, even without treatment. However, effective treatment exists and can significantly relieve the symptoms of the disease and also prevent complications.

The goals of treatment for Herpes zoster are:

1. Speed ​​up recovery;
2. Reduce pain;
3. Prevent complications;
4. Reduce the likelihood of developing postherpetic neuralgia.
5. Drug treatment is necessary for people with a high risk of complications or a protracted course of the disease: people with immunodeficiencies, patients
6. over 50 years old. The benefit of antiviral therapy in healthy and young people has not been proven.

Uncomplicated cases are treated at home (outpatient). Hospitalization is indicated for all people with suspected disseminated process, with damage to the eyes and brain.

Painkillers

Pain relief is one of the key points in the treatment of herpes zoster. Adequate pain relief makes it possible to breathe normally, move and reduce psychological discomfort. In the United States, narcotic analgesics such as oxycodone are used for pain relief.

Non-narcotic analgesics are used:

1. Dexketoprofen
2. Ibuprofen
3. Naproxen
4. Ketorolac
5. Ketoprofen

For post-herpetic neuralgia, capsaicin-based products are effective. The drug of choice for relieving severe pain and preventing post-zosteric neuralgia is amantadine sulfate due to its virostatic properties and the ability to block peripheral NMDA receptors at the stage of pain impulse transmission.

Antiviral agents

Acyclovir, valacyclovir and famciclovir are used to treat shingles. Valacyclovir is a metabolic precursor of acyclovir and is completely converted into it by liver enzymes. The acyclovir molecule has the ability to integrate into viral DNA, thus stopping its replication and multiplication of viral particles. Famciclovir is transformed in the body into penciclovir and acts similarly.

The effectiveness and safety of these drugs has been proven by numerous studies. When starting therapy within 72 hours from the appearance of the first rash, they can reduce the severity of pain, reduce the duration of the disease and the likelihood of postherpetic neuralgia. Famciclovir and valacyclovir have a more convenient regimen than acyclovir, but they are less studied and several times more expensive.

Anticonvulsants

Anticonvulsants (anticonvulsants) are commonly used for epilepsy, but they also have the ability to reduce neuropathic pain. For Herpes zoster, some of them can be used, such as gabapentin and pregabalin.

Corticosteroids

Corticosteroid medications reduce inflammation and itching. Some studies have shown their ability, in combination with antiviral agents, to reduce symptoms of mild to moderate forms of the disease.

Despite these data, corticosteroids have not gained acceptance for the treatment of herpes zoster due to safety reasons. Currently, these drugs are not recommended for use in this disease.

Vitamin therapy and diet

Also, for shingles, it is recommended to take the following vitamins to strengthen the immune system:

These vitamins, being antioxidants, reduce the ability of cells to respond to inflammation and also help increase the body's defenses.

Vitamins from this group improve epithelial regeneration, participate in the formation of antibodies, as well as in all metabolic processes.

It should also be taken into account that during treatment, a patient with herpes zoster is recommended to have a gentle diet rich in nutrients, vitamins and microelements. It is recommended to boil or steam food, and you should also reduce the consumption of salty, fatty and fried foods.

For shingles, it is recommended to consume the following foods:

1. dairy (milk, kefir, butter, cottage cheese);
2. vegetables (beets, broccoli, carrots, eggplants, zucchini, pumpkin, tomatoes, peppers, onions);
3. white meat;
4. seafood (salmon, pike perch, herring);
5. nuts (peanuts, pistachios, almonds, walnuts, cashews);
6. fruits (grapes, apricots, apples, kiwi, plums, citrus fruits);
7. cereals (oat, wheat, barley cereals);
8. legumes (peas, beans);
9. green tea, tea with rosehip or raspberry.

Is it possible to swim if you have shingles?

Shingles is a strict contraindication to taking a bath or shower. Areas with rashes and nearby skin should never be wet to prevent the spread of infection.

Partial washing of hands/feet, wiping the neck and face with a damp cloth is acceptable, provided there are no rashes on them. In this case, the patient must be given a personal towel and change his underwear regularly.

How long does the pain from shingles last?

Even after effective treatment, 70% of patients continue to experience intense pain for some time (several months or even years, on average 3-6 months).

Postherpetic neuralgia is caused by the destruction of nervous tissue, and it is the nervous tissue that is characterized by a long recovery. Therefore, it is so necessary to begin comprehensive treatment from the first days of the disease.

Is it possible to get sick again?

When the varicella zoster virus enters the human body, it causes chickenpox (chicken pox).

However, after recovery, this virus is not eliminated, but remains in the human body in a latent state. This virus lurks asymptomatically in nerve cells in the dorsal roots of the spinal cord. Activation of the virus occurs when the body is exposed to negative factors that contribute to a decrease in immunity. In this case, the disease recurs, only not in the form of chickenpox, but in the form of herpes zoster. As a rule, re-occurrence of shingles is not observed in the future. In patients with normal health, relapse of herpes zoster is observed in two percent of cases.

In ten percent of people, a relapse of herpes zoster is observed in the presence of the following pathologies:

1. HIV infection;
2. AIDS;
3. oncological diseases;
4. diabetes;
5. lymphocytic leukemia

In this regard, to reduce the risk of relapse of the disease, as well as to prevent the development of herpes zoster, a vaccine against the Varicella-zoster virus was released in 2006. This vaccine showed good results, reducing the risk of developing the disease by 51%.

The purpose of administering the vaccine is to create artificial active immunity against the Varicella-zoster virus.

Prevention

There is no specific prevention of herpes virus disease. It can only consist of maintaining the natural human immune system and increasing the body's resistance.

This is facilitated by maintaining a healthy lifestyle, giving up bad habits, an active physical regime, following the rules of a healthy diet, adequate sleep, hardening, walks in the fresh air, avoiding the aggressive influence of ultraviolet rays, and a harmonious psycho-emotional state of a person.

Forecast

With the exception of the encephalitic form of herpes zoster, the prognosis of the disease is favorable. Relapses, as a rule, do not occur. Only in very weakened people can the infection become active again.

What is shingles

Herpes zoster (lat. herpes zoster, synonym - herpes zoster, herpes zoster) is a secondary endogenous infection of a viral nature that affects the central and peripheral nervous system.

The causative agent of this type of lichen is the varicella zoster virus (Varicella zoster) from the herpesvirus family, which is the same virus that causes chickenpox. The virus can live in a latent state in the human body for a long time before it is reactivated into herpes zoster.

In fact, most adults today live with this virus in their bodies, and they will never get shingles. But in about one in three adults, the virus can become active again. Instead of causing a second case of chickenpox, it will cause shingles. Scientists still cannot say with certainty what exactly causes the virus to switch from dormant to active mode.

For unknown reasons, the disease is more common in women than men.

Symptoms and treatment in adults may vary depending on the form and stage of the disease.

Causes

Shingles in adults is caused by infection with the varicella zoster virus, the same virus that causes chickenpox in humans. Anyone who has ever had chickenpox can develop the disease. After you have had chickenpox and recovered, the chickenpox virus can remain in your nervous system and lie dormant for many years.

The varicella-zoster virus, or varicella-zoster virus, causes two types of diseases: chickenpox and herpes zoster. Typically, the virus enters the body through airborne droplets and contact. Once on the mucous membranes of the nasopharynx, the virus begins to actively multiply and penetrates the bloodstream and lymph flow. The primary disease usually affects children, causing chickenpox, then the pathogen goes dormant (latent state) and remains in the intervertebral and cranial nerve ganglia for a long period of time without the manifestation of clinical symptoms. Reactivation of the virus occurs against the background of weakened immunity in chronic and oncological diseases.

At some point, the virus may begin to actively multiply and migrate along the nerve fibers to the skin, where the rash occurs.

The area of ​​the dermis innervated by this nerve is affected. Most often these are the intercostal and trigeminal nerves.

The disease can occur in people of any age, most cases are diagnosed in the elderly.

Patients at risk also include:

1. recent infectious diseases;
2. pregnant women;
3. who have been taking antibiotics, glucocorticosteroids, or cytostatics for a long time;
4. HIV-infected;
5. people over 60 years old.

According to WHO statistics, about 10–15% of the population suffer from various types of herpes zoster. In mature people, the immune functions of the body decrease, which provokes reactivation of the virus.

Pain syndrome in elderly patients may persist even after the disappearance of the skin rash (postherpetic neuralgia).

Provoking factors

Provoking factors of the disease include:

1. stress;
2. prolonged hypothermia;
3. oncological diseases of the lymphatic system;
4. treatment with immunosuppressants;
5. diabetes;
6. consequences of radiation and chemotherapy;
7. treatment with steroid hormones;
8. organ and bone marrow transplantation.

Often it is not possible to determine the cause of virus reactivation. Shingles in humans usually does not recur. Recovery occurs without any residual manifestations; in a small number of patients, neuralgia may persist for up to several months or even years.

Relapse of the disease occurs in only 2% of adults against the background of severe immunodeficiency.

There is a high risk of developing herpes zoster in people who have undergone a bone marrow transplant. In 45% of patients, a disseminated form of the disease occurs, in which the rash spreads throughout the body.

Complications often occur in the form of postherpetic neuralgia, bacterial infection, and the formation of necrotic ulcers. Death occurs in 10% of cases.

Is shingles contagious?

Shingles is not contagious. You can't catch it from someone. But you can become infected with the chickenpox virus from people with herpes zoster. Therefore, if you have never had chickenpox, try to stay away from anyone who has chickenpox.

If you yourself suffer from the disease, try to stay away from people who have not had chickenpox or those whose immune systems are weak.

Symptoms of herpes zoster

At the initial stage of herpes zoster, the patient is bothered by burning attacks of pain spreading along the nerve fibers.

The first symptoms are usually pain and burning. It usually hurts on one side of the body. Small red spots appear on the same side of the body.

The pain syndrome intensifies at night and upon contact with external irritants.

In the affected area, tissue sensitivity decreases, tingling and numbness appear, and the skin itches.

Patients complain of an increase in body temperature to 38–39°, chills and general intoxication of the body.

After 3–4 days Erythematous spots that are dense to the touch appear on the skin, gradually turning into papules filled with turbid serous fluid.

After this, the hyperthermia goes away and the pain decreases slightly. New rashes may form within 5–7 days. Later 6–8 days the rash becomes covered with yellow crusts, and also in 2–3 weeks disappears completely even without treatment.

Pigmented areas of the dermis may remain in place of the papules; with hemorrhagic herpes zoster, tissue scarring may occur. The rash is usually unilateral; the generalized type occurs in cancer patients. In this case, herpetic blisters appear throughout the body and can affect internal organs and the brain.

Forms of herpes zoster

Gangliocutaneous form

The most common form of herpes zoster is gangliocutaneous. It has an acute onset with chills, fever and intoxication of the body.