Herpes zoster

Herpes zoster or shingles is an infection of the skin and nervous system that mainly affects people over 60 years of age.
This infectious disease is caused by reactivation of the varicella zoster virus (VZV).
A family history of shingles and stress can increase the risk, particularly in people over 50.
The pain caused by the disease, called postherpetic pain, when it lasts can be very painful and can seriously affect the patient’s quality of life. In addition, the pain in the acute phase of herpes zoster can simply be unbearable.

There are different forms of herpes zoster, such as intercostal herpes zoster (the most frequent type), which affects the region of the ribs, as the name implies; ophthalmic herpes zoster, which affects the eyes (this must be treated urgently by a doctor); auricular herpes zoster (in the region of the ears). Generalized herpes zoster mainly affects immunosuppressed people, such as AIDS patients undergoing therapy that weakens the immune system (transplants and cancer ).

If the disease is not properly treated, it can lead to serious complications, such as neurological problems ( meningitis , encephalitis, etc.), vision loss, hearing loss, neuropathic pain, increased susceptibility to skin infections, etc. In the acute phase, symptoms of herpes zoster usually last for a maximum of 1 to 2 weeks.

The diagnosis of the disease is mainly made by clinical observation of the symptoms, such as the appearance of blisters and pain. If necessary, the doctor may request specific tests to identify the virus and differentiate the disease from others, such as PCR and ELISA.

With regard to treatments, we highlight the therapy of the acute phase of the post zosterian phase (after the acute phase). Read on treatments

In the United States, vaccination against shingles is recommended by the CDC (cdc.org, Center for Disease Control & Prevention) for people over 60 years of age. In Brazil, vaccination against herpes zoster has been available on the market since 2014.

Definition

Herpes zoster, also known as shingles or shingles, is an infectious disease of viral origin, caused due to the reactivation of the varicella virus ( chickenpox ).
The disease is characterized by vesicles distributed over the skin, generally on the chest, with a more or less horizontal outline like a belt. By the way, zona means belt in ancient Greek.
It is a disease that mainly affects elderly people (over 60 years old) and those with fragile immune systems (immunosuppressed).

Herpes zoster is a very frequent disease, as most of the population had varicella (chickenpox) in childhood. A reactivation is then possible at any time.

We also emphasize that in certain cases, the disease can develop in children (directly without going through  chickenpox ). These will not develop chickenpox, as they will be immunized.

It is possible to suffer from shingles more than once in your life. Although not very common, in some people, especially several years after the first episode, shingles can recur.

Epidemiology

– In the United States, it is estimated that approximately 1 million Americans suffer from shingles each year ,  according to a 2015 Mayo Clinic article . Nearly a third of Americans will develop shingles during their lifetime, according to July 2017 estimates from the American College of Cardiology . com in October 2017, when a new herpes vaccine (Shingrix®) was launched on the US market.

– In France, estimates put the number of people affected by herpes zoster at around 300,000 each year, according to an article published in  Le Figaro in June 2015.

Herpes zoster and chickenpox
Approximately 90% of people have had childhood chickenpox. Of this population universe, 20% will be affected by herpes zoster throughout their lives.

Herpes zoster and age
One-third of people over 60 who develop shingles have pain after the acute phase of the disease (very severe pain). From the age of 70, this number rises to even 50% (with the presence of pain after the acute phase of the disease).

Causes

Viruses Herpes
zoster is a disease caused by a virus called varicella zoster (VZV, VZV or Herpesvirus varicellae ), it is a DNA virus.

Treatment of shingles 
Shingles can appear directly (eg during childhood) or it can come from reactivation of the chickenpox virus , which usually occurs many years after a person has had this infectious disease in childhood. The cause is a decrease in cellular immunization against VZV over time, which is why age is a significant risk factor for developing shingles.

Herpes zoster often remains hidden or silent in the spinal and cranial sensory ganglia.

VZV can usually reactivate under certain conditions or risk factors such as:

– the stress

– significant exposure to the sun (at the beach, in the mountains, etc.).

– a weakened immune system, especially in people with diseases of the immune system (e.g. AIDS )

– taking certain medications: chemotherapy, radiotherapy, corticosteroids

Note: With age, VZ reactivation can occur naturally without any specific risk factors1.

risk people

People at risk for developing herpes zoster are mainly:

– people over 50 years old. From the age of 85, it is estimated that the risk of developing herpes zoster is 50% for people not vaccinated against chickenpox2.

–  people with a fragile immune system. This includes patients with HIV/AIDS , patients undergoing chemotherapy for cancer or other illnesses that weaken the immune system.

– people who take medication such as corticoids or immunosuppressants Some of these drugs are used in transplant patients, such as prednisone and other steroids.

We remind you that to have the disease you must have contracted  chickenpox (chickenpox) in childhood.

– Asthmatic people. A survey by the Mayo Clinic (United States) published at the end of 2015 showed that asthmatics had a 70% higher risk of suffering from herpes zoster, compared to people without asthma. This study was published in the journal  Journal of Allergy and Clinical Immunology (JACI) .

Symptoms

We distinguish three different phases with variable symptoms to characterize herpes zoster:

herpes zoster contagion

We observed that early on, patients are contagious by direct contact for a week after the onset of vesicular lesions (after the onset of the acute phase).
But be careful, patients affected by herpes zoster will not transmit herpes zoster, but chickenpox (since it is the chickenpox virus). Pregnant women who have never had chickenpox should therefore be careful and never approach people with herpes zoster in the acute phase (read more in complications of chickenpox in pregnant women).

1. Prodromal phase – Prior to rash

Initially in a first phase just before the rash, the following symptoms are typical of herpes zoster:
– Pain, tingling, feeling of local heat, burning in the nerves (for example, in a nerve in the chest). It is noted that the symptoms appear in a localized way, such as on one side of the body or in a very precise place.
– Sometimes a slight fever and gastrointestinal symptoms may occur.

2. Acute phase – During the rash

In the acute phase or during the cutaneous eruption of herpes zoster, one observes:
– a cutaneous eruption, that is, small vesicles or blisters on a reddish skin (red background), located only on one part of the body. At first, the fluid in the vesicles is clear, but it can become darker after a few days. Then the vesicles dry, form scabs and finally fall off. The cycle is only completed until the vesicles fall off, which can last from two to four weeks.
The rash is usually located on the chest, with a more or less horizontal outline of the vesicles, having the shape of a belt (by the way, zona means belt in ancient Greek). Shingles can also appear on the forehead, cheeks, face (facial shingles), ear (zoster oticus), or around one eye (ophthalmic shingles).
Vesicles often dry up within days. In general, small vesicles appear a few days after the pain typical of the prodromal phase.
– a very strong, sometimes unbearable pain in the region of the rash.

The most affected regions and nerves are the thoracic (53% of cases), cervical (20%), trigeminal (15%) and lumbosacral (11%) regions. In strongly immunosuppressed patients, such as those with HIV/AIDS, the disease may appear in a disseminated manner and with irregular distribution.

3. Post-herpetic phase (after the rash)

In certain cases, herpes zoster can leave complications. We are talking about post-herpetic neuralgia or post-zoster neuralgia (zoster=zoster). This neuralgia (pain in the region of a nerve) is one of the main complications of the disease, and it lasts for at least one month and can last for several months. This complication is especially troublesome in the elderly.
Here are the typical symptoms of post-zoster neuralgia:
– pain, burning, burning in the area where the shingles rash was located (see below);
– feeling of permanent pain;
– strong touch sensitivity .
These complications of the disease can disrupt everyday tasks such as eating or sleeping, and in some cases can even lead to adepression .
It should be noted that in order to limit these complications, it is important to start treatment quickly, as the sooner it is started, the better the chances of curing the disease without complications.

General observation

We emphasize that sometimes the symptoms of herpes zoster can be confused with herpes (another viral infection) or with appendicitis (certainly in the area of ​​pain).

Diagnosis

The diagnosis of herpes zoster is based mainly on the observation of small vesicles (balls) with liquid that form a belt on the right or left side of the body. In other words, the typical clinical picture of the disease is usually sufficient for its diagnosis.
The doctor may order a laboratory analysis based on the detection of the herpes zoster virus ( Herpesvirus varicellae ) in the fluid of the vesicles, to confirm the diagnosis. The laboratory tests that allow identifying the virus are PCR, ELISA or immunofluorescence.

Complications

Complications of the disease can be serious when not treated properly and can include:

– Postherpetic neuralgia: This condition is characterized by pain and nerve damage that continues even after the blisters disappear. Nerves, injured, continue sending nerve impulses to the brain that understands as pain. Postherpetic neuralgia occurs in 20% of cases, it is the main complication of herpes zoster.
– Loss of vision: the virus can reach the eyes and damage the optic nerve causing loss of vision, pain and increased susceptibility to infections.
– Neurological problems: the infection can reach the brain causing complications such as encephalitis, meningitis , facial paralysis and hearing problems.
– Skin infections: herpes zoster increases the susceptibility of skin infections such as cellulitis, erypsella, impetus and abscesses. In more severe cases, there may be bacterial spread to the bloodstream (sepsis), endocarditis, glomerulonephritis, and pneumonia .
– Increased risk of stroke and heart attack. Research published in December 2015 showed that people affected by herpes zoster had a 2.4 higher risk of suffering a stroke and a 1.7 higher risk of having a myocardial infarction. This study was notably carried out by Caroline Minassian of the London School of Hygiene and Tropical Medicine. Scientists examined data from more than 67,000 patients with herpes zoster and myocardial infarction or stroke. The risk of stroke or heart attack was particularly high in the week following the diagnosis of herpes zoster. These data were taken from the American Medicare system. The research was published in the specialized journal  Public Library of Science (PLOS) Journal .
A study (in English, research letter)published in the scientific journal Journal of the American College of Cardiology on July 3, 2017, also showed that herpes zoster increased the risk of stroke and heart attack. In this 2017 study, a total of 519,880 patients were followed between 2003 and 2013 and during that period 23,233 cases of herpes zoster were recorded. The researchers found that shingles increased the risk of complications, particularly cardiovascular ones, with strokes increasing by 35% and heart attacks by 59%. Researchers from Asan Medical Center in Seoul, South Korea participated in this study.

When to see a doctor?

We advise you to consult a doctor in all cases of herpes zoster, as it is important to start antiviral treatment quickly in order to obtain maximum effect. This is a medical emergency when herpes zoster affects the eye area (ophthalmic herpes zoster) or if the pain is very intense.
Please note , this is not an exhaustive list, for any suspicious symptoms please consult a doctor.

Treatments

In case of shingles or suspected shingles (see first symptoms of shingles), it is very important to start treatment as soon as possible, preferably within the first three days after the first signs. This measure helps to avoid the complications of herpes zoster, which occur more frequently in people over 50 years old.
It is clear that in case of herpes zoster it is necessary to consult a doctor, who will prescribe a therapy. Briefly, here are the possible treatments to cure shingles. We highlight the treatments to be carried out during shingles and possible treatments in case of complications (for example, post-zoster neuralgia).

Possible treatments in case of herpes zoster

– Against pain, antalgics such as paracetamol , NSAIDs ( aspirin ,  ibuprofen ), stronger antalgics such as morphine derivatives.
– To prevent the multiplication of viruses and reduce the pain and duration of symptoms, antivirals such as aciclovir, valaciclovir , famciclovir , brivudine, etc.
– To avoid pain and reduce the duration of symptoms: corticosteroids. Furthermore, some physicians advise against the use of cortisone and its derivatives in cases of uncomplicated herpes zoster. Cortisone and its derivatives are contraindicated in cases of ophthalmic herpes zoster (in the eye).
– Eventually antibioticsin topical form (cream,…) to avoid bacterial superinfection, in case of bacterial infection of herpes zoster vesicles.

Possible treatments for complications of shingles, such as post-zoster neuralgia

Possible medications, in general, are pain relievers or treatments that act directly on pain:
– paracetamol or NSAIDs ( ibuprofen , aspirin , etc.)
– tricyclic antidepressants (such as amitriptyline )
– topical anesthetics (medicines or patches based on lidocaine ) –
medicines against epilepsy (such as gabapentin )
– corticosteroids (such as prednisone )
– medicines that act on the nerves
– opioids ( codeine , morphine ,…)

Anti-TNF (drugs that act on TNF)
A team of Brazilian researchers from the University of São Paulo (USP) discovered in a study published in 2017 that TNF (tumor necrosis factor), a molecule that acts as an inflammatory mediator, could play an important role in herpes zoster and the emergence in particular pain in the nerves (postherpetic neuralgia). The results of this research suggest that treatments that block the action of TNF may act more selectively and effectively than current treatments such as corticosteroids. The animal model-based study was performed in mice using the herpes simplex virus type 1 (HSV-1), as mice cannot be infected with the herpes zoster virus (chickenpox). The USP scientists note that data from the scientific literature indicate that patients using anti-TNF drugs for the treatment of chronic inflammatory diseases, such as rheumatoid arthritis, are less likely to develop post-herpetic neuralgia. This study was published on June 2, 2017 in the scientific journalThe Journal of Neuroscience (reference – DOI: https://doi.org/10.1523/JNEUROSCI.2233-16.2017).
Read more

Herbal medicine

Although, in the case of herpes zoster, it is necessary to consult a doctor and generally apply a treatment with classic medicines (antivirals), the medicinal plants below can help relieve the pain caused by the disease:

– Cayenne pepper , to be used as a cream or poultice.

– Aloe vera ( aloe vera ) in gel to relieve pain

We also point out that clay poultices can help treat herpes zoster (according to the testimony of an Internet user). Another remedy is kale poultice . Try it yourself too: natural remedy against herpes zoster .

Essencial oils

Dilute in a tablespoon with alcohol at 45°C, 5 drops of the following essential oils: lemon, cypress, basil, geranium, lavender, rosemary, sage and thyme.
Make a compress with this mixture and apply it to the vesicles 3 times a day for 10 minutes.

Note: the treatment must be carried out at the onset of pain; fever and pain usually go away within 24 hours. Treatment should be continued after a few days of healing, because of the risk of recurrence.

Tips

– It is important, in case of suspected herpes zoster, to start a treatment quickly and go to the doctor as soon as possible, in addition to respecting his advice. The faster treatment begins, the better the chances of healing without complications.
– Strengthen your immune defenses. As with many infectious diseases, consume, for example, vitamin C.

– Stay calm or zen. Avoid  stress , as this is a triggering factor for herpes zoster. Do not hesitate to take stress management courses, even at an advanced age, we always have things to learn and if this still helps to avoid the development of shingles, even better!

– With herpes zoster it is caused by the same virus as chickenpox (chickenpox), if you have herpes zoster you should avoid any contact with pregnant women or immunosuppressed people who have not had chickenpox , since it is known that in these people, the chickenpox can lead to fetal malformations and health complications.

– In case of intense itching (during the acute phase of herpes zoster, for example) that causes insomnia , H1 antihistamine (sold freely in pharmacies, ask a pharmacist for advice) may be indicated to complement the classic treatments.

– Take a cold or hot bath, especially when you have herpes zoster blisters, to ease the pain.

Prevention

– Much of the prevention of herpes zoster consists of the vaccine against chickenpox (read below), preventive treatments based on acyclovir or even immunotherapies.
However, a study from the Cochrane reference journal (DOI: 10.1002 / 14651858.CD006866.pub3) published in 2014 the estimate that acyclovir administered within 72 hours after the appearance of herpes zoster was not more effective than placebo in the prevention of post-herpetic neuralgia (PHN), the main complication of herpes zoster.

Vaccination:
Vaccination is the best way to prevent shingles.

Observations about the vaccine against herpes zoster
– With the current vaccine, it is estimated that immunization is approximately 5 years. It is often recommended to receive a booster.
– The vaccine contains live virus, which is why it is relatively expensive.
– If a person has already been ill with herpes zoster, he is immunized and does not need a vaccine.
– A new vaccine (announced in June 2016) is expected between 2016 and 2017 in the US and European markets. This vaccine will no longer contain live virus, but a virus protein. This should facilitate large-scale production and a lower price than the current vaccine.
– A large study called “Shingles Prevention Study” and carried out with 957 people with herpes zoster, showed that vaccination made it possible to reduce the pain typical of herpes zoster by 62% and neuralgia subsequent to herpes zoster (post-herpetic neuralgia) by 67%.

Vaccination balance worldwide
– In the United States, vaccination against herpes is recommended by health authorities, such as the US Centers for Disease Control and Prevention ( US Centers for Disease Control and Prevention ) for people over 60 years of age. As of October 2017, there are two vaccines on the US market: Zostavax® and Shingrix®. Shingrix® is a shingles vaccine that received Food and Drug Administration (FDA) approval in October 2017.
– In France, the shingles vaccine (Zostavax®) has been available in pharmacies since 2015. From age age 65, this vaccine is paid for by the local public health system.
– In Brazil, the vaccine has been available on the market since 2014.

Note on vaccination:
The varicella vaccine is not as effective when used against herpes zoster, but it reduces the risk of suffering complications and severe symptoms from the disease, according to the Mayo Clinic ( Mayo Clinic ).

News:
– Study explains why shingles patients feel pain

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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