What is shingles?
Herpes zoster is a viral skin disease that is most prevalent in the spring. It is caused by the varicella zoster virus, which is infected and re-emerges latently in the body, causing clusters of herpes along the innervated nerves, accompanied by neuralgia. The elderly and people with chronic wasting diseases, diabetes and tumors are usually susceptible to herpes zoster infection, and the disease is more serious once contracted. The folklore of this disease is known as “string waist dragon”, and in the literature it is called “waist wrapping fire dan”, because herpes zoster invading the waist and chest area accounts for more than 60% of the incidence of this disease.
In fact, the disease may also invade the head, face, ears and upper and lower limbs. Because of the pro-neural nature of the virus, the onset of the disease always extends to the nerves in the form of strips, hence the name “herpes zoster”. If the virus is not detected in time and treated with regular antiviral therapy, it often causes post-herpetic neuralgia.
What are the clinical symptoms of herpes zoster?
1, a few days before the onset of fever, fatigue, loss of appetite, local lymph node enlargement, sensory allergy or neuralgia in the affected area, but also without prodromal symptoms, the lesions appear as local skin flushing, followed by clusters of chestnut-sized papules, which quickly turn into blisters. The herbal fluid is clarified, the walls of the blisters are tense and shiny, surrounded by a red halo.
2, the lesions extend the distribution of one side of the dermal nerve, arranged in a band, the skin between the clusters of blisters is normal. The lesions generally do not exceed the median line.
Neuralgia is one of the characteristics of the disease and can occur before or along with the rash, and is often painless or mild in children, but severe in the elderly, and often leaves prolonged neuralgia after the damage has subsided.
4. The onset of the disease is rapid and dramatic, lasting about two weeks, and may leave temporary pigmentation after healing, without scarring if there is no secondary infection.
Can shingles be infected?
Shingles in young people usually clears up in about 2 weeks and does not recur and is immune for life. Herpes zoster is contagious to children who have not had chickenpox, especially young children aged 2-3 years old who should be isolated, while adults are mostly immune and will not develop the disease if lifted in time, so patients with herpes zoster do not need special isolation, but close contact with children should be avoided.
What is postherpetic neuralgia?
The varicella-zoster virus, while causing skin herpes, infiltrates and destroys nerve cells, triggering nerve cell degeneration, resulting in abnormal nociceptive transmission to function and abnormal pain. It is important to understand that once the degeneration of nerve cells has occurred, it is very difficult to return to the original state. Therefore, it is not possible to predict how long the pain will last, but it is not uncommon to have pain for months, years, or even 10 years or more.
Post-herpetic neuralgia occurs in 10-15% of patients with shingles. Patients older than 50, 60, and 75 years of age are 40%, 50%, and 75% more likely to develop postherpetic neuralgia, respectively, so early diagnosis, treatment, and prevention are key to preventing the development of postherpetic neuralgia.
Treatment
(a) Systemic therapy
1.Anti-viral drugs 2.Anti-pain agents 3.Immunomodulators 4.Corticosteroids
(2) Local therapy
1. When the herpes is not broken, topical application of sulfur and glycerine lotion can be applied.
2. If the herpes has broken down, it should be applied wet with 3% boric acid solution, or mucosal ulcer cream, neomycin ointment, etc. as appropriate.
3. For local pain of skin after herpes healing, topical application of fotarine emulsion, lidocaine cream can be applied.
(iii) Physical therapy
1. When the herpes lesion is not healed, infrared radiation can be used to reduce exudation, keep the wound surface dry and promote skin healing. At the same time, ultrashort wave treatment at the nerve root to eliminate inflammation and edema.
2. If there is pain in the affected innervation area after herpes healing, acupuncture and transcutaneous acupoint electrical stimulation can be received to have certain anti-inflammatory and pain-relieving effects.
(iv) Nerve block treatment
1. For herpes pain that is not sufficiently controlled by drugs, it is necessary to receive regular blocking anesthesia treatment of the involved nerve, including continuous epidural block.
2. For nerve block treatment is not satisfactory, subarachnoid block or total spinal cord anesthesia treatment is feasible.
Total spinal cord block, this treatment is suitable for intractable pain, that is, a large amount of local anesthetic drugs are injected into the subarachnoid space, and all spinal cord and cerebral nerves are blocked to achieve pain relief. This treatment involves fasting and abstaining from food and water for six hours prior to the treatment. Two to three blocks are often required for better results.