We often hear people talk about “tangled waist fire dragon”, “tangled waist fire dan”, “snake dan” and “spider sores”. This is actually what we call herpes zoster. Its main characteristic is edematous erythema or clusters of blisters and blood blisters on normal skin, distributed in bands but most of them do not go beyond the midline of the body, and many of them will be accompanied by significant pain.
You may ask, why do people get shingles? In fact, the varicella zoster virus enters the bloodstream through the respiratory tract mucosa, and when infected with the virus, chickenpox occurs in people with low resistance, while in people with high resistance the virus lurks in the posterior spinal root ganglion or cranial nerve sensory ganglion for a long time.
When a person’s body is stimulated (such as a major mental or physical trauma, fatigue, malignant tumor or post-illness weakness, etc.) resulting in a decrease in body resistance, the latent virus is activated and travels down the sensory nerve axon to the skin in the area innervated by the nerve. The lighter the nerve pain, the more painful and uncomfortable the skin will feel. The older the person is, the more painful it is, and in some cases, the pain can be felt for months or even years after the skin symptoms have disappeared. However, one of the advantages of this disease is that once you have had it once, you rarely get it a second time, which is what we call a “root cause” and is medically called lifelong immunity.
Herpes zoster occurs in adults and can develop throughout the year, but is more common in the spring and fall. The incidence of shingles increases significantly with age. Shingles is actually self-healing. If you are in good health and do not have any complications, the shingles rash will usually go away on its own within 2-3 weeks. However, if the disease is severe or if it develops in the eye, ear or vulva mucosa, it needs to be treated promptly and neuralgia should be prevented.
Because neuralgia can occur before the skin damage or along with the skin lesions, or even when the skin damage subsides in some cases, it is often misdiagnosed, especially in patients who develop it before the skin damage. Therefore, when we encounter unexplained pain that is confined to one side of the body, we should first think of herpes zoster.
Herpes zoster that occurs on the face can easily be combined with trigeminal neuralgia, especially in the eye and ear lesions. If the ocular herpes zoster virus invades the ophthalmic branch of the trigeminal nerve, it can involve the cornea to form ulcerative keratitis, which occurs mostly in the elderly, and the patient feels severe pain. If the herpes zoster virus in the ear invades the facial and auditory nerves, it may manifest as herpes of the external auditory canal or tympanic membrane.
Herpes zoster that occurs in the vulva can easily damage the lumbosacral nerve and cause urinary and fecal disorders. Therefore, it is important to treat shingles in these areas promptly to prevent both postherpetic neuralgia and shingles complications.
I. Treatment of shingles
So how should shingles be treated? General conventional treatment starts with oral antiviral drugs such as acyclovir tablets 0.125g; orally, once every 8 hours; vancomycin, 300 mg, orally, twice/day or famciclovir tablets 250 mg, orally, 3 times/day; acyclovir, 200 mg, orally, 5 times/day; in severe cases, antiviral drugs can be ordered orally while applying glucocorticoids such as prednisone 30 mg or Dexamethasone 5 mg orally or intravenously to reduce neuroinflammation and thereby reduce post-neuralgia.
Analgesic medications such as oral analgesic tablets such as Depo-Provera may also be considered for neuralgia that severely affects sleep and quality of life. Ibuprofen (Fenbid) 300 mg orally twice/day; morphine controlled-release tablets, 30 mg. If necessary, paraspinal ganglion closure therapy can also be used. For patients with severe disease or serious complications, hospitalization is required.
Topical skin applications such as penciclovir ointment or acyclovir ointment may be considered, and if there is itching, glyburide lotion may be used. If there is an infection, local anti-infective creams such as Bactrim can be considered, and oral antibacterial agents can be taken if necessary. As for postherpetic neuralgia, it can be prevented, and the most important point is to apply antiviral drugs in sufficient quantity at an early stage, especially in older patients. If there are no comorbidities or contraindications, early application of hormonal medications for 3-5 days is also an effective way to prevent postherpetic neuralgia.
For patients with postherpetic neuralgia in addition to the above mentioned treatments the following methods can also be used.
1.Medication.
(1) antidepressants: the main drugs are paroxetine (Serotonin), fluoxetine (Benadryl), fluvoxamine, sertraline, etc.
(2) anticonvulsants: carbamazepine, sodium valproate, etc.
(3) narcotic analgesics: morphine as the representative of the analgesic drugs. Available drugs are morphine (mescaline), hydroxymorphinone (oxycontin), oxycodone, fentanyl (Doregis), dihydroetofil, Lugac, etc.
(4) Non-narcotic analgesics: including NSAIDs, tramadol, aconitum alkaloids, capsaicin, etc.
2.Nerve block: when severe pain is difficult to be controlled by drugs, the application of direct and effective sensory nerve block therapy should be considered. The choice of block localization should depend on the scope of PHN lesion and treatment response. The general principle should be from superficial to deep, from simple to complex, from terminal to nerve trunk and nerve root.
Nerve destruction: radiofrequency temperature-controlled thermocoagulation for nerve destruction is the most direct and effective method to treat PHN. Nerve destruction treatment also includes medial thalamus stereotactic radiation therapy (gamma knife or X knife), surgical subdural spinal cord dorsal root destruction treatment, pituitary destruction, sympathetic stem ganglion destruction, etc.
4.Acupuncture therapy in Chinese medicine has obvious anti-inflammatory and pain-relieving effects, and is also effective for posterior neuralgia.
5.Application of Chinese medicine for diagnosis and treatment treatment, the effect is quite good.
Second, to give you a heads up, it is worth stating that
1, in the folklore circulated such a saying, that wrapped waist dragon if wrapped around the waist a circle will die, this is no scientific basis. But this usually happens in patients with particularly low resistance such as malignant tumors, AIDS, systemic lupus erythematosus, radiation therapy, burns and the use of certain drugs (such as immunosuppressants and adrenal corticosteroids), which require early and active treatment.
If a child who is not immune to this virus is infected with the herpes fluid, chickenpox can occur, but the chances are low. Adults are mostly immune, so even if they are exposed, they will not develop the disease. Therefore, herpes zoster does not cause an epidemic in the population. Herpes zoster patients also do not require special isolation, but close contact with children should be avoided.
3. There are often middle-aged and elderly patients who are still in pain even after the herpes zoster has completely cleared, and who are afraid to touch the local skin even though it is intact. This is why? We know that the occurrence of herpes zoster is caused by the activation of the virus latent in the body, the body of pain is the inflammation or even necrosis of the affected ganglion, the severity and duration of pain and the rash do not necessarily remain consistent.
Especially in elderly people, the various functions of the body are decreasing with age, and it is more difficult to repair damaged nerve tissues, so it is easy to have posterior neuralgia. The pain can last for months or even longer, especially if the patient is in poor health or is not treated in time.
The precautions for the prevention and treatment of herpes zoster
1. Try to keep the skin area clean, dry and exposed to the air as much as possible (without clothing coverage). Do not scratch or break the blisters.
2, more rest, in terms of diet, avoid eating greasy food, seafood and eggs, poultry also try not to eat, eat some light food.
3, prevent secondary bacterial infection. Do not rub the affected area to avoid rupture of blisters. You can use topical Chinese herbs or Revnur wet compresses to promote the drying and crusting of blisters.