Herpes zoster is caused by varicella-zoster virus infection. This virus has neurophilic and cutaneous properties, and after an attack, clinical symptoms such as blisters, pain and itching appear on the skin in the affected innervation area.
1. What is the relationship between herpes zoster and chickenpox?
Herpes zoster and chickenpox are two different diseases caused by the same virus, namely varicella-zoster virus. Chickenpox is a highly contagious disease characterized by scattered blisters, mostly seen in children, but can also develop in adults. Herpes zoster is characterized by clusters of small blisters distributed unilaterally along the nerves, with obvious neuralgia, and is mostly seen in adults.
2. How do I get shingles?
In the case of natural infection, the virus invades the body through the mucous membrane of the respiratory tract and then spreads through the bloodstream, resulting in chickenpox or an insidious infection. After that, the virus is latent in the neurons of the nerve roots or ganglia. When the body is under some external factors such as malignant tumor, trauma, fatigue, etc., the latent virus can be activated and reach the skin of the area innervated by the sensory nerve axons downstream to grow and multiply, causing inflammation or necrosis of the infringed ganglia and producing neuralgia. Therefore, anyone who has had chickenpox can develop shingles.
3. What are the clinical manifestations of herpes zoster?
(1) Systemic manifestations: Some people may have mild systemic symptoms at the beginning of the disease, such as low fever, general malaise, and loss of appetite. Skin discomfort, local itching or pain in the area where the rash is about to appear.
(2) Typical skin manifestations: One to four days after the appearance of systemic or local prodromal symptoms, clusters of small blisters or papules appear on the skin. The blisters are clarified or bloody and arranged in a band along the nerve course, often surrounded by a red halo at the base. They usually do not exceed the midline of the trunk. The lesions are usually found in the intercostal nerve or the first branch of the trigeminal nerve, but also in the lumbar abdomen, extremities, and ears. Local lymph nodes are often swollen and painful. In young patients, the lesions dry and crust over after about 2-3 weeks. In older patients, the skin lesions may take more than 6 weeks to heal.
(3) Neuralgia: Neuralgia is one of the features of the disease and may occur before or along with the rash. In some patients, it may last for several months or longer after the rash subsides.
Special manifestations.
(1) Ocular herpes zoster: caused by viral invasion of the ophthalmic branch of the trigeminal nerve, mostly in the elderly, with severe pain, which may manifest as uveitis and keratitis, resulting in impaired vision.
(2) Ear herpes zoster: caused by viral invasion of the facial and auditory nerves, manifesting as herpes of the external auditory canal or tympanic membrane. When the geniculate ganglion is involved and affects the motor and sensory nerves of the facial nerve, a triad of herpes of the external auditory canal, facial palsy, and hearing impairment can occur, called Ramsay-Hunt syndrome.
(3) 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 without blisters), maculopapular, hemorrhagic, gangrenous, and generalized (simultaneous involvement of more than 2 nerve segments with lesions in multiple areas contralateral or ipsilateral). Occasionally, a generalized varicella-like rash, called disseminated herpes zoster, may appear outside the segmental rash; rarely, it is complicated by herpes zoster encephalomyelitis, which, when it occurs, is often fatal.
4. Is herpes zoster contagious? Does it recur?
Patients with shingles do not infect others with shingles. However, it is possible for people who are not immune to varicella-zoster virus to become infected and develop chickenpox or latent infection. The disease can be healed with longer-lasting immunity and rarely recurs.
5. About post-herpes zoster neuralgia
Neuralgia associated with herpes zoster can occur before the onset of the rash, during the onset of the rash, and after the lesions have healed, but mostly disappears after the lesions have completely resolved or within one month. A small number of patients with neuralgia lasting more than a month are referred to as postherpetic neuralgia, and older people over 50 years of age are the main group of people with postherpetic neuralgia, with the older the age, the higher the probability. In some elderly patients, neuralgia can last for months or even years, seriously affecting sleep and mood, and even leading to mental anxiety, depression and other manifestations, resulting in a serious decline in quality of life.
6.How to prevent and control?
First of all, it is important to maintain a peaceful and happy life, pay attention to the combination of work and rest and exercise to prevent the immune function from decreasing, so as to reduce the chance of herpes zoster.
Secondly, you should visit a dermatologist in time to receive regular and reasonable treatment for herpes zoster. According to the condition, comprehensive therapies such as antiviral, anti-inflammatory, immunomodulation, nerve repair promotion and physiotherapy should be actively applied. Shorten the course of the disease and prevent or reduce the occurrence of complications.
Prophylactic vaccination against varicella-zoster has an important impact on the incidence of herpes zoster and its posterior neuralgia. The US FDA approved the herpes zoster vaccine Zostavax in 2006 for people over 60 years of age, and in 2011 it was expanded to cover people over 50 years of age. No herpes zoster vaccine is currently available or used in China.
Herpes zoster is a viral skin disease that is somewhat self-limiting. However, the complications it causes, especially post-herpetic neuralgia, should not be underestimated. Studies have shown that the occurrence of postherpetic neuralgia is significantly correlated with the patient’s age, the extent of skin damage, the time of initial diagnosis, and appropriate treatment. Antiviral therapy started within 72 hours of the onset of herpes zoster can reduce pain and shorten the duration of attacks. Data show that more than half of the elderly are unaware of the severity of shingles and its complications. Therefore, it is important for older adults to take shingles very seriously. Once diagnosed, treatment should be started as soon as possible.