Many people have heard of the disease “shingles”, which is the common folk name for a common skin condition called “shingles”. How common is shingles? Lin Zhimiao, associate professor and deputy chief physician of the Department of Dermatology and Venereology at Peking University First Hospital, told reporters: “Herpes zoster is common in the elderly, and generally speaking, the older you are, the higher the incidence. By the age of 70 and above, one out of every 100 people will get shingles every year. Therefore, the public is not unfamiliar with this disease.” Low resistance susceptibility to the disease “The turn of the fall and winter seasons is the time when shingles is good; while in the spring and summer, the number of incidences decreases.” Lin Zhimiao said that herpes zoster is caused by varicella-zoster virus infection, but a long time often passes from infection to onset – most people are infected with the virus as children, but it remains a recessive infection with no clinical symptoms until they are older Shingles. Occult infection with the herpes zoster virus is very common, and generally more than 90% of the normal population has been infected with the virus. After infection, the virus lurks in the body’s ganglia, commonly the trigeminal ganglion and the dorsal root ganglion of the spinal cord. For most people who are infected with the virus, they will not develop the disease for the rest of their lives, and only a minority of people will become overtly infected and develop the disease. Moreover, the majority of patients only develop the disease once in their lifetime, and herpes zoster rarely recurs. Lin Zhimiao emphasized that the main trigger for the onset of herpes zoster is a low immune system. When the climate becomes cold, when the resistance of the elderly is weakened, or when young people are stressed, stay up late or get drunk, and when immunity is low due to disease or medication, the virus will take advantage of the situation, replicate in large numbers and distribute along the nerve alignment. As a result, clinical manifestations include clusters of skin blisters, pustules, and in severe cases, bloody blisters, often accompanied by severe pain, along the nerve alignment of the unilateral torso or head and face in a band-like distribution. Patients with herpes zoster are contagious and transmission occurs through close contact with the patient. For most adults who already have the virus in their bodies, there is nothing to worry about. However, those who have not yet been exposed to the virus, especially younger children who have not yet had the chickenpox vaccine, are at risk for infection. After first exposure to the varicella-zoster virus, most people are recessively infected. However, if the infection is overt, the person gets chickenpox instead of shingles. This is because shingles and chickenpox are different stages of infection caused by the same pathogen, the varicella-zoster virus – chickenpox is the disease that manifests itself when you are first exposed to the virus; shingles is the disease that manifests itself when the virus that is latent in your body comes back. The herpes zoster is a disease that manifests itself when the virus is latent in the body and then recurs. ”So in the clinic, we’ve had cases where the elderly have had shingles and the infant has had chickenpox. This is because the old man did not pay attention to isolation after getting sick, still in close contact with the child, resulting in the child was infected with chicken pox.” Lin Zhimiao introduced. The pain is more harmful than the rash Lin Zhimiao pointed out that the pain of herpes zoster is intense and persistent, which has a great impact on the patient’s daily life, especially sleep, and can even lead to depression in severe cases. Moreover, the pain can appear before the skin blisters, causing many patients to run to other departments such as neurology and cardiology before receiving treatment in dermatology, delaying diagnosis and treatment. After the onset of pain, most people begin to develop blisters on the skin within 1 week. However, not everyone develops blisters and pain. A small number of people show only neuropathic pain without blisters or erythema, called strophic herpes zoster, which makes clinical diagnosis very difficult. If the patient’s resistance is not too low, he or she is not very old, and the blisters are not that strong, the pain can also be insignificant or even absent. ”The danger of herpes zoster is not in the skin damage, as the blisters can heal or cure themselves; the biggest impact on the patient is the pain.” Lin Zhimiao emphasized that the severity of pain tends to increase with age, for example, in people over 70 years old, the chances of severe pain can reach more than 50 percent, and the pain persists even after the blisters disappear. Severe pathological pain can last for more than 3 months, called postherpetic neuralgia, which can reach 30% to 40% in people over 70 years old and can be tricky to treat. Anti-viral treatment can shorten the course of treatment Lin Zhimiao pointed out that theoretically, shingles caused by viral infection can heal itself after 2 to 3 weeks, and in fact there are many patients with mild symptoms who get better without treatment. However, there is no generalization as to whether a patient should receive antiviral treatment. If the patient has severe skin damage, early intervention is still advisable to reduce the possibility of posterior neuralgia after the blisters have subsided. In addition, timely management of blisters can help prevent the development of secondary infections in the skin lesions. There is sufficient evidence that antiviral therapy is effective in shortening the course of the disease. Acyclovir, the classic antiviral drug, is prescribed and needs to be used under medical supervision. Other antiviral medications include famciclovir and valacyclovir. Usually, these antiviral medications can be taken orally. Antiviral infusions are given to patients unless they are unable to eat normally or take their medication on time (acyclovir needs to be taken by mouth 5 times a day), or if the condition of shingles is very severe. The course of oral herpes zoster antiviral treatment is 7 to 14 days, with most people taking the drug for about 10 days; the course of infusion is 1 week. Oral acyclovir has fewer side effects because it is excreted by the kidneys, so it should be used with caution in patients with poor kidney function. The infusion requires a slow infusion rate to prevent the drug from forming crystals in the kidneys and affecting kidney function. For patients with severe pain, Lin Zhimiao stressed that firstly, early antiviral treatment should be given; secondly, nerve-nourishing drugs such as vitamin B1 and vitamin B12 should be given; and analgesic treatment should also be given. For milder pain, non-steroidal anti-inflammatory drugs can be given. When using such drugs, attention should be paid to whether the patient has digestive tract diseases, and if so, the drugs should be used with caution. More commonly used pain medications are calcium channel blockers such as gabapentin and pregabalin. These drugs are more effective than non-steroidal anti-inflammatory drugs and even morphine-based painkillers for neuropathic pain. However, because these drugs also have certain side effects such as dizziness and headache, it is necessary to gradually increase the dose under the guidance of a doctor to achieve satisfactory pain relief.