Herpes zoster is an acute inflammatory skin disease caused by the varicella zoster virus, which is known in Chinese medicine as “tangle waist fire dragon” and “tangle waist fire dan”. It is also commonly known as “snake sores” and “spider sores”.
Pathogenesis
Herpes zoster is characterized by clustered vesicles that are distributed in clusters along one side of the peripheral nerve, often accompanied by significant neuralgia. The virus enters the bloodstream through the mucous membrane of the respiratory tract to form viremia, and varicella or occult infection occurs, after which the virus can be latent in the posterior root ganglion of the spinal cord or in the sensory ganglion of the cranial nerve for a long time. When the body is stimulated (e.g. trauma, fatigue, malignant tumor or post-illness weakness), the latent virus is activated and replicates along the axon of the sensory nerve to the skin in the area innervated by the nerve, resulting in blistering and inflammation and necrosis of the affected nerve. The disease usually does not recur because of the long-lasting immunity obtained after healing.
Symptoms
The disease occurs in adults and is more common in the spring and fall. The incidence of the disease increases significantly with age.
Typical symptoms
The rash may be preceded by systemic symptoms such as mild malaise, low-grade fever, and poor circulation, and the affected skin may have a burning sensation or neuralgia, with significant pain sensitivity to touch, lasting 1 to 3 days. The most common sites are the intercostal nerve, cervical nerve, trigeminal nerve and lumbosacral nerve innervation areas. The affected area often first appears as a flushed spot, followed by a corn to soybean-sized rash.
Herpes zoster
The skin between the clusters of blisters is normal; the lesions are arranged in a band along a peripheral nerve, mostly on one side of the body, and usually do not exceed the midline. Neuralgia is one of the characteristics of the disease and can occur before the onset of the disease or with the lesions, and is often more intense in older patients. The duration of the disease is usually 2 to 3 weeks, or 3 to 4 weeks in the elderly, with temporary pale erythema or hyperpigmentation remaining after the blisters dry up and crusts fall off. It is important to emphasize that the cause of shingles is due to a long-term lack of exercise and exercise, not that the elderly are prone to the disease, but the elderly are more likely to sit and not exercise, so the elderly are the majority.
Special manifestations
(1) Ocular herpes zoster (herpes zoster ophthalmicus): the virus invades the ophthalmic branch of the trigeminal nerve, mostly in the elderly, with severe pain, and may involve the cornea to form ulcerative keratitis.
(2) Herpes zoster oticus: It is caused by viral invasion of the facial and auditory nerves and manifests as herpes of the external auditory canal or tympanic membrane. When the geniculate ganglion is involved and the motor and sensory nerve fibers of the facial nerve are also invaded, a triad of facial palsy, otalgia and herpes zoster oticus, called Ramsay-Hunt syndrome, may occur.
(3) Postherpetic neuralgia (PHN): Herpes zoster is often accompanied by neuralgia, which can be present before the onset of the rash, during the onset of the rash, and after the lesions have healed, but it usually disappears after the lesions have completely resolved or within 1 month, and in a few patients the neuralgia can last for more than 1 month, which is called postherpetic neuralgia.
(4) Other atypical herpes zoster: it is associated with differences in the resistance of the patient’s organism and can manifest as strophic (no lesions but neuralgia), incomplete (only erythema and papules appear without blistering and recede), maculopapular, hemorrhagic, gangrenous, and generalized (involving more than 2 ganglia at the same time and producing lesions in multiple areas contralaterally or ipsilaterally); the virus may occasionally spread through the bloodstream and produce a widespread varicella-like rash and Occasionally, the virus may spread through the bloodstream to produce a widespread varicella-like rash and invade organs such as the lungs and brain, called disseminated herpes zoster.
What diseases can be associated with herpes zoster?
Herpes zoster can be complicated by bacterial infection when the rash breaks down locally. If the herpes zoster lesion occurs in a specific area, such as the eye, it may lead to serious consequences. If the infection is secondary to bacterial infection, it can lead to full ophthalmoplegia or even meningitis; after the disease, sequelae such as loss of vision, blindness and facial paralysis can occur. Herpes zoster in the head is mostly found in the anterior part of the head, where the first branch of the trigeminal nerve is located, and can cause hair loss and permanent scarring. Pain can persist for some time after the herpes zoster skin damage has healed. In some elderly patients, neuralgia can last for months or years. It can seriously affect sleep and mood; more severe and prolonged pain can lead to mental anxiety and depression. Herpes zoster can occur in the trigeminal nerve segment of the face. There is a nerve fiber in the trigeminal nerve, the ophthalmic nerve fiber, and some of the nerve fibers are distributed in the cornea and conjunctiva of the human eye and even the whole eye. The patient may suffer from photophobia, lacrimation, eye pain, resulting in vision loss, or in severe cases, total ophthalmoplegia leading to blindness. When the herpes virus infects the motor nerve fibers in the facial nerve, facial palsy occurs. The affected eye cannot close, the affected side has a dull facial expression, the corners of the mouth are skewed to the healthy side, and the patient cannot make blowing movements. Herpes zoster occurring in the auricle and ear canal can cause symptoms of inner ear dysfunction, with patients exhibiting dizziness, nausea, vomiting, hearing impairment, and nystagmus. When the herpes virus invades the central nervous system, i.e., the brain parenchyma and meninges of the body, from the nerve roots at the spinal cord upward, viral encephalitis and meningitis occur, manifesting as severe headache, jet-like vomiting, convulsions, limb convulsions, and life-threatening confusion and coma. When the herpes virus invades visceral nerve fibers from the nerve roots at the spinal cord into the body, it can cause acute gastroenteritis, cystitis, and prostatitis, manifested as abdominal cramps, difficulty urinating, and urinary retention. Therefore, patients with herpes zoster need to be examined for relevant aspects in time to detect and treat complications of herpes zoster.
Etiology
Herpes zoster is caused by Varicella-virus (VZV), now named Human Herpesvirus Type 3 (HHV-3), a brick-shaped virus with a three-dimensional symmetrical capsid containing a double-stranded DNA molecule that is less resistant to the in vitro environment and loses its activity quickly in a dry scab. Children who are immune to this virus are infected and develop chickenpox. Some patients are infected and become carriers of the virus without developing symptoms. The virus is neurophilic and can be latent in the neurons of the posterior root ganglion of the spinal nerve for a long time after infection. The rash is usually unilateral and distributed by nerve segments, with clusters of herpes, and is accompanied by pain; the older the person is, the more severe the neuralgia. The disease is known as herpes zoster in modern medicine and as snake bile sores, tangled dragons, and flying snakes in folklore.
Characteristics
Herpes zoster, also known as acute herpes zoster (AHZ), is a form of varicella-zoster virus (VZV).
Acute herpetic skin disease caused by herpes zoster in the lumbar region. The pathogenesis of this disease is that the disease causes primary infection in humans with no or low immunity (e.g., children), and the pathogenic VZV virus enters the bloodstream primarily through the respiratory mucosa to form a viremia, or chickenpox. After the symptoms of chickenpox disappear, the infected virus exists in the nerve cells of the spinal nerve or cranial nerve in latent form for a long time. The majority of people carry the virus for life without recurring infection. Herpes zoster patients, after the disappearance of clinical symptoms produce antibodies, lifelong immunity, there will be some patients turned to posterior neuralgia. If generalized, one should be alert to the possibility of an underlying immunodeficiency disease or malignancy. We found two cases of consecutive patients with herpes zoster in our consultations, and recommended that they be examined and found to have pancreatic cancer. The earlier the disease is treated correctly, the easier it is to cure; conversely, the condition will worsen and the pain will increase, leaving neuralgia in mild cases and accidents in severe cases.
After the primary infection of this disease, the virus hides in the ganglion, and there is no way to remove it yet, and there is no way to predict the time of recurrence, so there is no way to prevent it. However, it has been found that recurrent infection as herpes zoster is closely related to the immune function of the body, such as the elderly, after local trauma, systemic lupus erythematosus, lymphoma, leukemia, AIDS and patients receiving long-term skin hormones, radiation therapy and immunosuppressive drugs are most susceptible to infection, and the disease is long and severe, with more prominent posterior neuralgia.
The main characteristics of herpes zoster.
1. it can develop in both young and old, with adults being more common and having more severe symptoms.
2. the disease can develop in all seasons, with spring and autumn and humid days being the most common.
3. Herpes may appear on any part of the body, with the trunk and face being the most common.
4. the onset of the disease is accompanied by pain, and some patients will continue to have pain after the herpes has crusted over.
5. Blisters and lesions are mostly distributed along a certain peripheral nerve, arranged in bands on one side of the body, not exceeding the midline of the torso.
Hazards
During the onset of the disease, patients will have a variety of discomfort symptoms, nerve pain is the most obvious, making it difficult to sleep and eat in general medical institutions without special treatment, coupled with the high cost, more difficult to bear. If improper treatment or weakness is caused by many factors, it will turn into “post-herpetic neuralgia”, which can take less than a year or more than a few years, and the patient will suffer for a long time. The whole family suffers when one person develops the disease, affecting the quality of life. There are also special types of herpes zoster: ocular herpes, ear herpes, visceral herpes, herpetic meningitis, and herpes zoster without herpes. These herpes are both specific and seriously harmful, some of them can lead to blindness, deafness, and even death. These diseases are very easy to misdiagnose in early stages and should be taken seriously by both doctors and patients. This entry does not discuss these rare clinical types in detail.
Lesions
The lesions of the skin are mainly in the epidermis, with blisters located in the deeper layers of the epidermis and markedly swollen balloon-like epidermal cells visible within the blisters and at the margins. Eosinophilic intranuclear inclusion bodies are seen in the nuclei of the degenerated cells. Lesions were also present within the ganglia corresponding to the rash, manifesting as posterior spinal column segmental poliomyelitis with a violent inflammatory response in the ganglia and posterior nerve roots. Sensory nerve fibers within the dermis also show significant degeneration shortly after the appearance of the rash.
Epidemiology
Herpes zoster causes primary infection in people with no or low immunity, such as infants and children, as chickenpox.
After infection, the virus is present in the ganglion cells of the spinal or cranial nerves in a latent form for a long time, and when activated by certain factors, the virus reaches the skin from one or several ganglia along the corresponding peripheral nerves, causing a recurrent infection, known as herpes zoster.
Herpes zoster can recur after a primary case of chickenpox, but it rarely recurs after the onset of herpes zoster, which is related to incomplete immunity (IgM response) after the onset of the former and complete persistent immunity (IgM response) after the onset of the latter.
Herpes zoster is often sporadic and is related to the immune function of the body. In the elderly, after local trauma, systemic lupus erythematosus, lymphoma, leukemia, and patients receiving corticosteroids, immunosuppressive agents, and radiation therapy for a longer period of time, the disease is significantly more susceptible than normal and has a prolonged and more severe course with more prominent posterior neuralgia.
Clinical diagnosis
Clusters of clusters of blisters in a band-like distribution extending over one peripheral nerve. In obvious neuralgia with local lymph node enlargement. The skin in between is normal.
In the prodromal phase of herpes zoster and herpes zoster without rash, it is sometimes easily misdiagnosed as intercostal neuralgia, pleurisy, or acute abdomen and should be noted.
Herpes simplex is sometimes distinguished from herpes simplex, which occurs at the junction of skin and mucous membranes, has an irregular distribution, has small, easily broken blisters, is not painful, is seen in the course of fever (especially high fever), and is often recurrent.
Occasionally it is confused with contact dermatitis, but in the latter case there is a history of contact, the rash is not related to the distribution of nerves, and there is self-conscious burning and severe itching without neuralgia.
In the prodromal phase of herpes zoster and herpes zoster without rash, neuralgia is easily misdiagnosed as intercostal neuralgia, pleurisy, and acute abdominal conditions such as acute appendicitis, and requires attention. Herpes simplex usually has a history of multiple recurrences at the same site, which does not occur in patients with herpes zoster without significant immunodeficiency. Isolation of the virus from blister fluid or testing for VZV, HSV antigen or DNA is the only reliable method for differential diagnosis.
Economic treatment of herpes zoster.
Oral: Acyclovir tablets Topical: Acyclovir ointment Usually cured in about 10 days, first hand! The cost of treatment is $20. Be sure to pay attention to the contraindications and read the instructions carefully.
1, nerve nutrition oral or intramuscular injection of B vitamins, such as B1: 100mg, B12:250vg, or B1, methylcobalamin 250-500vg, etc.
2.Anti-viral: Famciclovir tablets 0.125g; orally, once every 8 hours; Vanaciclovir, 300mg, orally, 2 times/day; Acyclic guanosine, 200mg, orally, 5 times/day; Polymyxin 2mg, intramuscularly, once every other day. Interferon, 3 million U, intramuscular injection, 1 time/day.
3.Anti-pain: take analgesic tablets such as depot pain tablets orally. Ibuprofen (Fenbid) 300 mg orally 2 times/day; morphine controlled-release tablets,30 mg, orally if necessary. Paraspinal ganglion closure therapy, etc.
4. Combination: triazolyl nucleoside (virazole) 10 mg/kg added to 5% glucose 500 ml IV, once a day, 8 times; adjuvant, oral rehabilitation new liquid 10 ml, 3 times/day; at the same time, external application of rehabilitation new liquid rubbing, severe rupture with rehabilitation new liquid wet compress, 8d; remarkable efficacy.
Herpes zoster home treatment method
Keep the infected area clean, dry and exposed to the air as much as possible (not covered by clothing). Do not scratch or break the blisters. If you are unable to sleep because of pain, try binding the area with a neat, clean elastic bandage.
Try a cold compress of ice for about 10 minutes every few hours for the first 3 or 4 days. Next, soak a cold moist compress in aluminum acetate, an over-the-counter medication that is available as an astringent solution, or as a powder or tablet.
To alleviate the neurological effects, crush two aspirin tablets, mix them in two tablespoons of antiseptic alcohol, and then apply this paste to the surface of the blister three times a day.
To relieve the itching, ask your pharmacist to mix 78% glyburide lotion, 20% antiseptic alcohol, 1% phenol and 1% menthol. You can apply this mixture continuously until the blisters crust over.
Other treatments for itching include taking vitamin E regularly, or applying a hot bath of colloidal oatmeal to relieve pain.
Prescription for shingles.
1. Take rest and take medications and rubs carefully.
2. If unfavorable eye, facial or limb movement is found, seek medical attention again promptly. If there is discomfort in the gastrointestinal tract or chest, you should also seek medical attention promptly.
3.You should stay in bed within 2 hours after taking pain medication to avoid accidents due to dizziness.
4. Children who have not had chickenpox may be infected, thus care should be taken to isolate the patient to avoid spreading to the children.
Herpes zoster is characterized by a long series of blisters on the skin along the course of the nerves, which is why it is called “snake dan” in Chinese medicine. Because it often occurs on the back of the chest and is distributed along the course of the intercostal nerves, it is also known in folklore as the “tangled dragon”. This virus can be latent in the human body for a long time and will develop when the person’s resistance decreases. Therefore, trauma, surgery, infection, and tumors can trigger the disease.
After a few days, small, dense blisters appear, and the surrounding skin becomes red and the lesion is painful like a burning sensation. In more severe cases, systemic symptoms such as swollen lymph nodes and fever can be seen. Herpes zoster usually occurs on one side of the body, or occasionally on both sides at the same time. It usually occurs on the chest, but also on the face along the trigeminal nerve. If it occurs on the face, it can sometimes involve the eyes and affect vision. It usually heals spontaneously after 2 to 3 weeks. It does not leave scars, but a few patients still often have neuralgia.
The main treatment for herpes zoster is pain relief and prevention of secondary bacterial infection. If the eyes are involved, herpes ophthalmic ointment can be used. If necessary, transfer factor or gammaglobulin can be injected. In addition, the disease that triggered shingles should be identified and treated.
Herpes zoster occurs in spring and autumn and is more common in adults. The onset of herpes zoster is often preceded by sensory allergy or neuralgia, accompanied by mild fever, general malaise, loss of appetite and other prodromal symptoms, or sudden onset without prodromal symptoms. The affected area first develops flushed patches, followed by the appearance of numerous clusters of corn to green bean-sized papules, which rapidly turn into blisters, with transparent and clear blisters, shiny and tense walls, and a red halo around the blisters. The skin between the clusters of blisters is normal and the blisters dry up and crust over 10 days. After healing, temporary light red spots or hyperpigmentation are left without scars. The blisters can also break down to form vesicles or even necrosis or secondary septic infection. The total duration of the disease is about 2-3 weeks.
In addition to the typical rash, neuralgia is another characteristic of the disease. The neuralgia is usually present 1 to 2 days before the appearance of the rash until the rash subsides. The pain varies in severity and is not necessarily related to the severity of the rash. Usually children with shingles have very mild or no pain, while older patients tend to have severe, even unbearable pain. Moreover, about 30% to 50% of middle-aged and elderly patients may have intractable neuralgia that lasts for months or longer after the damage subsides.
Because of the rapid onset of herpes zoster, the pain is severe, and new rashes appear at the beginning of the disease, which is like a dragon and snake crawling, some patients feel afraid. And there is also a folklore saying that the entangled dragon will die if it wraps around the waist once, which is not based on science. The disease is caused by the herpes zoster virus and the lesions are often distributed unilaterally along one of the peripheral nerves, generally not exceeding the midline of the body surface, much less forming a circle. In addition to commonly occurring on the lower back and abdomen, they can also occur on the chest, extremities, neck, ears, nose, eyes, and mouth. In a few severe cases, herpes zoster meningoencephalitis and herpes zoster of the gastrointestinal or urinary tract may occur.
Herpes zoster and chickenpox are caused by the same virus (varicella-zoster virus), but the clinical manifestations are different, why? We know that chickenpox is an infectious disease, so is shingles also contagious?
On the surface, the two diseases are not related. Chickenpox occurs in children from 3 to 9 years old, without neuralgia; herpes zoster is mostly seen in adults over 40 years old, with severe pain. The rash pattern and distribution characteristics of the two are also different. However, these are two successive pathogenic processes caused by the same virus that infects the body. Herpes zoster is not caused by the virus outside the body, but only by the recurrence of the virus latent in the body.
The specific process is as follows: the virus first infected the body proliferates in the body, forming a viraemia that spreads throughout the body, leading to the occurrence of chickenpox. The virus can remain latent in the posterior root ganglion of the spinal cord or in the sensory ganglion of the cranial nerve until adulthood, when the latent virus is activated due to a decrease in immunity and stimulation by physical and chemical factors, causing inflammation and necrosis of the invaded ganglion, resulting in neuralgia. At the same time, the reactivated virus can proliferate along the nerve axon to the innervated skin cells, and a series of band-like herpes appears in the skin area innervated by this ganglion, hence the name herpes zoster.