Shingles: answering frequently asked questions about the disease

• Signs of the disease
• Depriving forms
• Causes
• Initial stage of the disease
• Period of rash
• Crust formation
• Diagnostics
• How to treat an infection?
• What are antiviral drugs used for?
• Possible consequences
• Is shingles contagious?
• When is shingles transmitted?
• Disease prevention
• Which doctor should I consult with this disease?

Shingles has vivid and painful symptoms. Most often, the disease is detected in older people. An unfavorable environment contributes to the development of infection in young people with weak immunity. Shingles often develops against the background of cancer, especially in people with weakened immune systems (after chemotherapy, for example).

Depriving forms

The disease can be typical or atypical.

In the atypical form, symptoms may be mild:

• In the abortive form, the rash is absent or there is a single focus;
• Bullous form - multiple blisters with clear liquid;
• Hemorrhagic form - blisters with bloody fluid, in place of which scars remain.
• The gangrenous form leaves difficult-to-heal ulcers and rough scars.

Prohibited for shingles

Not used to treat rashes:

• clotrimazole and other antifungal drugs;
• oxolinic ointment;
• ointments with hormonal components - Triderm, Hydrocortisone, Akriderm, etc.

If you have shingles, you should not:

• warm the affected areas of the skin;
• open bubbles;
• treat rashes with alcohol;
• use various folk remedies.

Also:

• you cannot go to the bathhouse or sauna;
• do not take a hot bath;
• Do not rub the skin with a rough brush.

Period of rash

The type of rash depends on the severity of the disease. At the initial stage, the rashes look like small pink spots located on healthy skin.

If the process develops typically, then the next day they are replaced by bubbles with a clear liquid - grouped vesicles. After 3 days, their contents become cloudy. The rash occurs in spurts, with breaks of several days.

If a severe gangrenous form develops, the filling of the vesicles may be mixed with blood. It seems that the bubbles move to another place, located around the body.

If the form of inflammation is mild, the manifestation of the disease can only be neurological in nature, when the patient feels pain, but there is no rash. This is herpetic neuralgia.

Herpes zoster (shingles) - symptoms and treatment

There is no incubation period in the usual sense, since herpes zoster is not a primary infection. A whole life can pass, and the manifestation will still occur, although the virus is present in the body.

It is difficult to predict the development of the disease. Its onset and manifestations vary widely and depend on the severity. The disease may be preceded by stress, trauma or acute respiratory infections.

The symptoms of individual forms of herpes zoster are distinguished.

Gangliocutaneous form

This form begins with a prodrome - mild malaise, sensory disturbances, moderate pain in the areas of future rashes. This period lasts up to seven days. Then the pain becomes severe, fever appears, and a moderately severe syndrome of general infectious intoxication appears. Sometimes the pain intensifies even when the wind blows (so-called allodynic pain - from non-painful stimuli).

After 3-10 days, a vesicular rash appears in these places against a background of redness. In this case, the intensity of pain usually decreases. The rash occurs on one side, limited to the area of ​​​​innervation of one sensory ganglion. Vesicles tend to cluster.

Subsequently, the contents of the vesicles become cloudy and sometimes burst open. After 4-5 days from the appearance of the rash, crusts appear. They disappear after 2-4 weeks of illness.

Rashes are allowed without a trace, but only in the absence of scratching and deep inflammatory damage. But pain phenomena can persist for a long time, sometimes up to a year. This requires timely antiviral therapy and pain relief.

In general, the pain with herpes zoster is quite pronounced and intensifies with movement or touch (even a slight one). They can be classified as acute (from prodrome to one month), subacute (1-4 months) and chronic (more than 4 months - postherpetic neuralgia - typical neuropathic pain). The nature of the pain can be different - constant and spontaneous, often burning, pressing. Sometimes the pain is compared to an electric shock. They can cause significant physical suffering to patients, disrupt sleep, and exhaust the patient.

The localization of pain and rash corresponds to the projection of the affected nerves.

Eye shape

Rashes appear on the face, nose and eyes. This is due to damage to the trigeminal nerve and gasserian ganglion. The rash spreads from the level of the eye to the parietal region, abruptly stopping along the midline of the forehead. Sometimes the process affects the eye.

Ear shape

The geniculate node is affected. In this case, the auricle and external auditory canal are captured. Paralysis of the facial nerve and facial muscles may occur - the so-called. Hunt's syndrome. Taste sensitivity is lost.

Gangrenous (necrotic) form

Deep skin damage occurs. Rough scars form, sometimes with hemorrhagic impregnation of the contents - hemorrhagic form. Most often it develops in older people with a complicated somatic history - diabetes mellitus, peptic ulcer, etc.

Meningoencephalitic form

It is more often observed when the rash is located on the head. The temperature rises, headaches, nausea and vomiting occur, which does not bring relief, meningeal syndrome, impaired consciousness, coma. The mortality rate for this condition is over 60%.

Disseminated form

Occurs with AIDS. The rash spreads throughout the entire skin. Often this affects internal organs - lungs, brain, liver, kidneys. The prognosis is unfavorable.

Ganglioneuralgic form

There are no characteristic rashes, but there is obvious pain. Diagnosis is extremely difficult. Due to the very late diagnosis, treatment is limited to pain relief only. The use of antiviral drugs in the delayed period clearly does not affect the process.

Herpes zoster during pregnancy

In pregnant women, herpes zoster (in the absence of HIV) usually does not have any differences. It does not affect the course of pregnancy and does not cause damage to the fetus/child[2][3][6][8][10].

What are antiviral drugs used for?

The goal is to exclude the development of complications. Antiherpetic treatment helps the ulcers heal quickly and improves the patient's condition.

The course of treatment and dosage of medications is determined by the doctor taking into account the general condition of the patient. On average, treatment time does not exceed 10 days.

If a gangrenous form with a bacterial infection develops, antibiotics, immunomodulators, physiotherapeutic procedures and vitamins are prescribed.

When it comes to treating rashes, there are different opinions regarding the use of drying agents. In any case, they should be used with caution so as not to worsen the condition of the skin by burning.

Hormonal medications should not be used as they suppress the immune system.

Treatment of the disease in elderly patients is not always successful, since antiviral drugs are not justified.

Prevention

Disease prevention – strengthening the immune system:

• healthy lifestyle;
• hardening;
• regular physical activity;
• proper nutrition;
• proper rest, sleep.

Despite the fact that water procedures during the treatment of herpes zoster are contraindicated, the complication of the disease is caused by poor hygiene. Therefore, it is important:

• avoid taking hot baths - prefer a warm, short shower;
• exclude washcloths, cosmetics and anything that can irritate the skin;
• just blot the inflamed areas;
• use 2 towels - one for healthy skin, the other for infected skin (change daily).

If the disease progresses, you should limit yourself to wet wipes, and do not wet the damaged skin. When the ulcers turn into crusts, you can take a shower.

In any case, treatment is prescribed individually and exclusively by a doctor.

IMPORTANT:

Self-medication can aggravate the disease and provoke life-threatening consequences.

Other articles by the author

• Pyoderma
• Herpes zoster
• Pityriasis rosea
• Shingles

Which doctor should I consult with this disease?

You should first contact a therapist, then an infectious disease specialist or dermatologist. If the form of herpes is severe, the help of a neurologist is necessary; if the eyes are affected, the help of an ophthalmologist is necessary.

We recommend making an appointment at the neurological department of the RAS clinic (Moscow). The best doctors will examine you, study the signs of the disease, identify the causative agent of the infection, make a diagnosis, conduct a consultation, issue clinical recommendations and prescribe effective treatment.

Don't put off visiting a specialist! Specialists from the neurological department of the Central Clinical Hospital of the Russian Academy of Sciences in Moscow remind you: any symptoms that worry you are a reason to consult a neurologist. In this case, the doctor will be able to recognize and treat the disease at an early stage, before the situation worsens and becomes irreversible. You can make an appointment with a neurologist by calling the clinic or using the form on the website.

Causes of the disease

For most people, the herpes zoster virus first enters the body in childhood or adolescence. Chickenpox affects more than half of the population by adulthood. Healing and developing immunity to it does not mean that the pathogen has left the body. Like all types of herpes, this one persists in the nerve endings of the spinal cord and brain for life. Recurrence of chickenpox in these cases is prevented by the specific defense of the immune system. In rare cases: when the body is weakened or due to congenital genetic defects, the disease may return. In adults, activation of herpes provokes a more complex pathology that affects not only the skin, but also the nervous system.

Shingles, unlike chickenpox, occurs quite rarely: no more than 15 cases are recorded per 100 thousand population. The disease occurs mainly in the cold season. The virus tolerates frost well, but is not resistant to extreme heat. The majority of those affected are middle-aged and elderly people. Shingles is an infectious pathology, but it develops not as a result of the transmission of a pathogen from the outside, but due to the activation of what is already inside.

Main provoking factors:

• state of immunodeficiency in HIV carriers;
• severe stress;
• weakening of the body after transplantation of internal organs and other complex surgical operations;
• long-term use of suppressor drugs for rheumatoid arthritis and other autoimmune diseases;
• chemotherapy and radiation treatment for cancer tumors;
• diseases of the hematopoietic system;
• Hormone replacement therapy for endocrine disorders.

The mechanism of development of herpes zoster is not well understood. It is known that the Herpes zoster virus causes inflammatory reactions in the membranes and roots of spinal nerves, as well as the adjacent skin.

Herpes: photo

The herpes simplex virus is clinically manifested by the formation of a group of crowded blisters located on an inflamed base (skin or mucous membrane). The bubbles are first filled with transparent contents, which quickly become cloudy. If you have herpes, treatment must be started before the herpetic vesicles open. Otherwise, not only the ointment for herpes, but also the best tablets for herpes will no longer allow any noticeable acceleration of healing.

What does herpes look like?

Important: the appearance of herpetic rashes is almost always preceded by the appearance of itching or burning in this area, or a feeling of tissue swelling. It is very important to teach the patient to “catch” these first symptoms, because if you start treatment for herpes already at this stage (during the prodromal period of the disease), the number and size of the herpetic blisters that subsequently form will be significantly smaller. And besides, the healing of erosions will occur much faster.

In rare cases, early initiation of therapy can even prevent the appearance of herpetic blisters (for example, when using combination drugs containing “5% acyclovir + 1% hydrocortisone”). Faster healing can also be achieved if treatment for herpes is started in the first 12 hours - from the moment the first herpetic blisters appear. You must understand that the later treatment begins, the lower its effectiveness will be. After opening the vesicles, treatment with antiviral ointments and tablets will no longer affect the healing rate, although it will still be indicated for patients with severe herpes.

Symptoms

Symptoms of postherpetic neuralgia typically occur only in the area of ​​the body affected by shingles and include:

• Pain (can be sharp, cutting, throbbing, burning),
• Numbness, tingling, itching
• Headaches if shingles is localized to the head or face
• Rarely, muscle weakness or paralysis if the nerve supplying a particular muscle is damaged.

Sometimes patients experience allodynia. Allodynia is a reaction that is not proportionate to the stimulus (that is, the patient reacts to minor stimuli such as a slight change in temperature or the touch of clothing with severe pain).

Choosing tablets for herpes -

Herpes treatment in adults: drugs in tablets

• Acyclovir,
• Valaciclovir,
• Famciclovir.

Below we will compare the effectiveness of these antiviral tablets against the herpes simplex virus. It should be noted that Acyclovir tablets are approved for use from 0 years of age, and the drugs “Valacyclovir” and “Famciclovir” - only from 12 years of age. All these drugs are available only with a doctor's prescription.

Acyclovir in tablets of 200 and 400 mg –

Tablet acyclovir has the same disadvantages as creams: low tropism for the virus (i.e., acyclovir molecules do not find viral particles well); in patients with poor immunity + frequent courses of acyclovir use in the past - in 10-27% of cases the herpes virus may be resistant to acyclovir; plus low oral bioavailability. Pros: no age-related contraindications, affordable price, fairly few side effects.

We recommend choosing the original drug with acyclovir - Zovirax 200 mg tablets (instructions for use, see PDF). Moreover, its cost is not much higher than that of Russian generics.

Examples of drugs with acyclovir -

Acyclovir tablets certainly work, especially when it comes to patients with good immunity and rare relapses of herpes. If you have a weakened immune system, if you have taken acyclovir too often in the past, if you decide to start taking the drug more than 24-48 hours after the onset of herpetic rashes, acyclovir will not be particularly effective. In this case, it is better for you to immediately start taking the drug Famciclovir, which works better even at later dates of initiation of therapy, as well as in patients with immunodeficiency conditions.

The regimen of use - if you look at the official instructions, the standard regimen for adults and children over 2 years old - is to take acyclovir 200 mg 5 times a day (for 5 days). A single dosage of 400 mg is recommended in the official instructions - either only for severe herpes infection, or in patients with weakened immune systems. However, most clinical studies (source) show that a dosage of 200 mg has virtually no effect on either the duration of symptoms or the healing time of herpes.

Studies have shown that only 400 mg (respectively, 5 times a day, for 5 days) is an effective single dose. In children under 2 years of age, the dosage is reduced by exactly 2 times - from the adult dosage. In case of severe herpes infection, taking the drug can be extended to 7-10 days. By the way, abroad, at the moment, acyclovir is practically not used for chronic recurrent herpes, giving preference to valacyclovir and famciclovir.

Valacyclovir (Valtrex) tablets –

We have already said above that tableted acyclovir has poor bioavailability, i.e. only about 10-20% of its amount is absorbed in the intestine, which makes it difficult to achieve high concentrations of acyclovir in tissues. This problem is solved by Valacyclovir, which has a bioavailability of 50%. Valaciclovir is a precursor to acyclovir (i.e., it is converted to acyclovir once it enters the bloodstream). Taking tablets with valacyclovir allows you to create a concentration of acyclovir in tissues that can be achieved with traditional acyclovir - only through intravenous infusions of the latter.

The drug Valtrex is the original drug of Valaciclovir (we recommend this drug), but there are also a large number of cheaper generics. The cost of the original drug “Valtrex” (UK) is from 1350 rubles for 10 tablets. 500 mg each. There is a good Bulgarian generic “Valvir” - it costs from 750 rubles for a package of 10 tablets. 500 mg each. The cost of the Russian “Valacyclovir-Akos” will be from 450 rubles (for a package of 10 tablets of 500 mg).

Regimen: There is a short 1-day treatment regimen. Clinical studies have shown that taking high dosages of the drug for 1 day was the most effective for the treatment of herpes on the lips and facial skin, as well as herpetic stomatitis. In this case, the dosage regimen is 2000 mg 2 times a day, with an interval of 12 hours (1 day in total). But it should be noted that such a short regimen will be effective only if treatment begins no later than 12 hours from the moment the herpetic eruptions appear, and also in patients with satisfactory or good immunity.

If more than 12 hours have passed since the appearance of the rash, and also if you have a weakened immune system, it is optimal to use the standard treatment regimen of 500 mg 2 times a day for 3-5 days (for severe herpes infection - up to 10 days). When choosing a drug, keep in mind that if your herpes virus is resistant to acyclovir, taking valacyclovir will also be ineffective.

Famciclovir tablets (Favirox, Famvir) –

Famciclovir products are the most modern and effective tablets for herpes. Above we told you about the cream “Fenistil-pencivir” (based on penciclovir), which is used on the skin of the face and the red border of the lips. So, drugs with famciclovir are tablet analogues of penciclovir. Most often in pharmacies you can find drugs with famciclovir - under the trade names “Favirox” or “Famvir”.

The advantage of famciclovir drugs like Favirox is their rapid antiviral effect due to maximum bioavailability (for famciclovir it is about 74%, for example, for valacyclovir it is only 54%, and for acyclovir only 10-20%). Therefore, a package of three 500 mg tablets is enough for a short 1-day course of therapy to relieve the manifestations of herpes on the lip. Read more about this application scheme below.

→ Favirox instructions for use (view PDF)

Regimen for using famciclovir - there is a short 1-day treatment regimen: either take 1500 mg once, or 750 mg 2 times a day (with a 12-hour interval between doses) - our experience suggests that the second option is still better. This 1-day regimen is effective only if you start taking the drug before 12 hours from the moment the herpetic rash appears, and also if the patient’s immunity is normal. In case of weakened immunity, and/or if treatment is started later than 12 hours from the moment of the appearance of herpetic eruptions, the standard dosage regimen should be used.

The standard regimen according to the instructions is 250 mg 2 times a day for 5 days (however, in severe cases of herpes infection, dosage can be extended to 7-10 days). Here I would like to add that numerous clinical studies show the weak effectiveness of this standard regimen - especially in patients with poor immune system conditions. Studies have shown that the effectiveness of therapy increases significantly when famciclovir is prescribed in higher dosages. In patients with good immunity, a more effective regimen will be 500 mg 2 times a day (for 5 days). In immunocompromised patients - 500 mg 3 times a day (for 7 days).

Important: once again we draw your attention to the fact that short 1-day treatment regimens for herpes in adults (herpes on the lips and skin around the mouth, on the face) work well only if the following conditions are met. Firstly, only if you start taking medications no later than 12 hours from the moment the herpetic rash appears. Secondly, if you have a satisfactory or good immune system. If treatment is started later than 12 hours from the onset of the rash, as well as in patients with weakened immune systems, short 1-day courses of therapy are usually ineffective. Here we already need a standard regimen of administration.

Important : if more than 12 hours have passed since the first rash appeared (and even more so if more than 24 or 48 hours), it is better to opt for famciclovir, because the latter works better at later dates of initiation of therapy for herpetic infection.

Risk factors

Only those who have had chickenpox can get shingles. But there are certain groups that are more susceptible to postherpetic neuralgia:

• Age – the chance of postherpetic neuralgia is higher in the older age group. (30% of people over 60 years of age who have had herpes zoster subsequently develop postherpetic neuralgia) and only 10% of the younger group develop postherpetic neuralgia.
• Localization of rashes - symptoms of neuralgia are more pronounced if the rashes were in the forehead or eyes.
• Concomitant pathology – The presence of a suppressed immune system (after chemotherapy or taking immunosuppressants) or diseases such as AIDS.

Early treatment of herpes zoster is important. Treatment started within 2-3 days after the rash appears can help reduce symptoms and avoid the risk of postherpetic neuralgia.