Shingles has a second name – herpes zoster, since the causative agent is the herpes virus. The disease affects the nervous system and the skin, and therefore treatment is carried out by both neurologists and dermatologists, depending on which clinical manifestations are most pronounced. Shingles and chickenpox have a common etiology and pathogenesis. Shingles is characterized by elements that evolve from the stage of spotting and vesicle formation to residual hyperpigmentation. Etiotropic treatment of the disease is carried out by acyclovir, virolex, zovirax. It is accompanied by symptomatic therapy, treatment of the affected areas with dermatol ointment, local physiotherapy.
The diseases caused by the herpes virus are classified by modern medicine as infectious, since they have a viral nature; patients and virus carriers are highly contagious; symptoms typical of infectious diseases are pronounced, which consists of a classical triad: general symptoms of infectious diseases, skin manifestations in the form of exanthemes characteristic of shingles and manifestations from the central and the peripheral nervous system.
The causative agent of shingles and chickenpox is a virus of the Herpesviridae family. It, like all viruses of this family, is unstable in the external environment and quickly dies under the influence of sunlight, disinfectants and cleaning agents, as well as when heated. But at low temperatures it is able to persist for a long time and is very resistant to repeated freezing.
Despite the high contagiousness, shingles occurs only in the form of sporadic cases, the peak incidence occurs during the cold season, for every hundred thousand of the population about 12-15 cases of morbidity. The risk group includes older and middle-aged people who have previously had chickenpox. And only a small percentage of those who have had herpes of this form does not acquire persistent immunity, as a result of which re-infection is possible when meeting with the shingles virus. The high contagiousness of the disease is confirmed by cases when children who have come into contact with shingles patients have become ill with chickenpox. Back in 1888, doctors noticed this pattern, which was a confirmation of the theory of a similar etiology and pathogenesis of both diseases.
Shingles is a secondary infection of endogenous origin in people who have previously had chickenpox in clinical or latent form. After chickenpox, the virus is able to persist in the body for a long time and is most likely localized in the spinal ganglia and cranial nerve ganglia, and under the influence of provoking factors, its reactivation occurs. Laboratory diagnostics and features of the pathogenesis of latent forms of the disease have not yet been sufficiently studied, but the reactivation of the virus and its clinical manifestations in the form of shingles occur with a weakening of cellular immunity.
Stressful conditions, injuries, hypothermia, somatic and infectious diseases can also activate the virus. The percentage of morbidity is higher in those people who suffer from oncological diseases, blood diseases or take hormonal and chemotherapy drugs, with age the probability of getting sick also increases significantly.
The pathological anatomy of the disease in its classical form represents inflammatory changes in the spinal ganglia and adjacent areas of the skin, sometimes the posterior and anterior horns of gray matter and spinal cord roots, as well as soft meninges, are involved in the process.
The disease begins gradually, with general prodromal symptoms: headache, dyspeptic disorders, a slight rise in temperature, chills and malaise. In the future, pain and itching are added along the peripheral nerve trunks, itching and burning of the skin at the site of future rashes are possible. These signs are subjective, and the intensity of manifestations in each patient may vary. The duration of the initial period is no more than 4 days, but in children this period is somewhat shorter than in adults.
After a short prodromal period, there is a sharp rise in temperature to febrile and symptoms of intoxication (headache and muscle pain, loss of appetite). At the same time, along the course of one or more spinal ganglia, a painful skin rash appears in the form of pink spots, not prone to fusion, with a diameter of 2-5 mm. But during the day, closely grouped vesicles with serous contents appear against the background of exanthemums. The edges of the vesicles are uneven, the base is edematous and hyperemic. Depending on the state of the immune system and the severity of the course of shingles, there is an increase and soreness of regional lymph nodes. Children may have catarrhal inflammation of the upper respiratory tract (pharyngitis, laryngitis, rhinitis), which complicates the course of the disease.
Exanthemes are localized in the places of projection of the nerve trunk, both unilateral and bilateral lesions of the nerve ganglia are diagnosed. Unilateral lesion is more common, which is localized along the intercostal nerves, the trigeminal facial nerve. Cases when the nerve trunks of the extremities are affected with the development of neuritis are quite rare; sometimes there are exanthemas in the groin area.
With shingles, as well as with chickenpox, rashes of various stages can be seen at the same time, starting from the spot and ending with areas of hyperpigmentation after the resolution of vesicles. After a few days, the swelling around the vesicles begins to subside, and with it hyperemia, the contents of the vesicles become cloudy, they gradually dry out, serous crusts form in their place, after which a slight pigmentation of the skin is noted. At the same time, the temperature decreases, the intensity of intoxication syndromes decreases, and by the end of the third week, recovery occurs.
- Generalized form. Sometimes the generalized form of shingles is confused with the associated chickenpox, since rashes are noted not only along the nerve trunks, but also on other areas of the skin, as well as on the mucous membranes. If a generalized herpetic infection is diagnosed or the disease proceeds for more than 3 weeks, then patients should be examined for the presence of immunodeficiency and for the presence of oncological processes.
- Abortive form. If shingles proceeds according to the abortive type, then an erythematous rash along the nerve trunks is characteristic, which quickly disappears without transformation into vesicles. The general condition of the patient does not suffer.
- Bullous form. This form of herpes zoster is characterized by larger vesicles that merge into large bubbles with serous contents. If blood vessels are damaged at the same time, then the contents become hemorrhagic, and when an infection is attached, it becomes purulent. In severe cases, the bubbles merge into solid ribbons, which, when drying out, can also become infected, and later form a dark necrotic scab. The severity of the course of this form depends on the localization of exanthemums: if the facial nerves are affected, then acute neuralgic pains, damage to the eyelids and cornea are added.
The duration of the disease in acute form is 2-3 weeks; with abortive – several days; and with complicated or prolonged course – more than a month. The pains are burning, have a paroxysmal character, and their intensity increases at night. Local paresthesia and impaired skin sensitivity are also the most characteristic symptoms of shingles.
There are cases of damage to the oculomotor nerves, abdominal muscles and the sphincter of the bladder. If serous meningitis develops, the degree of changes in the study of cerebrospinal fluid does not always correspond to the severity of meningial symptoms. In the acute phase, encephalitis and meningoencephalitis are possible; polyradiculoneuropathy and acute myelopathy occur in episodic cases.
After the cure, there is a persistent remission, and relapses occur in several percent of cases. With timely complex therapy, residual phenomena are not observed, but in some patients, neuralgic pain persists for several years.
In the prodromal period, herpes zoster should be differentiated from pleurisy, trigeminal neuralgia and acute abdominal syndrome (appendicitis, renal colic, cholelithiasis). If the rashes are not located along the nerve trunks, then differential diagnosis is carried out with herpes simplex, chickenpox, and the bullous form needs to be differentiated from erysipelas and from skin lesions with immunodeficiency and diabetes mellitus.
Etiotropic therapy consists in the use of selective inhibitors of viral DNA synthesis – acyclovir. Such therapy is effective in the initial stages of the disease. Acyclovir is prescribed intravenously, with a daily dose of 15-30 mg / kg, which is divided into three injections at intervals of 8 hours. A single dose is diluted in 150 ml of isotonic solution. When using tablet forms of acyclovir, a single dose for adults is 800 mg, taking the drug up to five times a day, the total course of therapy is 5 days.
Pathogenetic therapy consists in taking dipyridamole, which inhibits platelet aggregation, for a course of 5 to 7 days. Furosemide is prescribed for dehydration. To activate immunogenesis, intramuscular administration of homologous immunoglobulin is indicated, which is administered 2-3 times a day at 1-2 doses daily or every other day.
Symptomatic therapy of herpes zoster is prescribed individually, depending on the severity of the course. Analgesics, antipyretic and restorative drugs are used, sedatives and hypnotics are used for sleep disorders, in some cases, antidepressants are indicated. If the symptoms of intoxication are pronounced, detoxification therapy with forced diuresis is carried out.
Locally, the vesicles are treated with a solution of brilliant greens, and the crusts are lubricated with 5% dermatol ointment. A reparant based on dialysate from the blood of calves, metacyl ointment is used for sluggish forms of herpes zoster. Locally, on areas of the skin with herpes zoster rashes, UFO, quartz and laser therapy are prescribed. When a secondary infection is attached, a course of antibiotic therapy is carried out.