At a young age, when there is a meeting of the body with chickenpox, he does not disappear after treatment, and becomes latent state and hides in the nerve cells of the posterior horns of the spinal cord, ganglia of the autonomic nervous system, cranial nerves. It occurs defeat the posterior roots.
In this article we will look at herpes zoster and treatment in adults with effective medications and ointments at home.
Pathogenesis
Infection is possible from the person who is sick with herpes zoster or varicella. transmission path - airborne, contact, also possible transplacental way. Neyrodermatotropny virus, that is, can affect the nervous system and skin epithelial cells. Primary or recovering from chicken pox virus through the skin and mucous membranes, then through the bloodstream and lymphatic system gets into intervertebral nodes and posterior roots of the spinal cord where it can be stored for a long time in a latent state, as well as its related virus herpes simplex.
Activation of infection occurs with a decrease in the immunological resistance. The most frequent reasons for onset of the disease:
- receiving drugs that reduce immunity;
- chronic stress and exhausting work;
- Local hypothermia;
- cancer (Hodgkin's disease, malignant tumors);
- the effects of radiation therapy;
- patients with HIV infection in transition in the acquired immune deficiency syndrome (AIDS);
- organ transplants and bone marrow.
Predisposing factors:
- persons older than 55 years;
- pregnant women;
- after prolonged treatment with antibiotics, cytostatics, glucocorticosteroids.
Compulsory component is a kind of activation of viral infection with lesions ganglionevrit intervertebral ganglia (ganglia or cranial nerves) and dorsal root lesion. The virus may be involved in the process and determining autonomic ganglia meningoencephalitis. May be affected and the internal organs. Thus, in the picture of shingles, unlike chicken pox to the fore primarily neurotropic properties of the virus.
Is shingles contagious?
People who have not previously undergone chickenpox, especially children, can develop it after exposure shingles.
Symptoms of shingles
Rash and the presence of pain - the main symptoms of herpes zoster (see. Photo). When the disease of the patient are always marked pain, the intensity of which is from barely perceptible to painful, exhausting the patient, who stopped for a short period under the influence drugs. Most often, pain in the lesions appear on the skin area corresponding to the affected nerve. The intensity of the pain does not always correspond to the severity of skin rash.
prodromal stage with herpes zoster has its own special color. The main symptoms in this period of weakness, malaise, low-grade body temperature, headache, tingling, itching and burning at the site of future eruptions (dermatome). Prodrome lasts from 2 days to a week or more.
Rash shingles:
- 1 period. The appearance of redness (erythema) in the area of future eruptions. Erythematous, edematous spots, have a rounded shape, the edges are raised. If this spot to hold your finger, you can feel the roughness, which is a set of tiny papules. However, this symptom is often missing.
- 2 period. After 1 - 2 days and for the next 3 - 4 days papules converted into vesicles - blisters filled with liquid. The bubbles come in different sizes can be placed in isolation, at least - are merged with each other.
- 3 period. After 5 - 7 days after the onset of first vesicles pustulizatsiya begins when clear the contents of the vesicles becomes purulent. Pustules quickly opened. In their place are formed crust. In the presence of a significant immune deficiency in a patient in this period, new eruptions.
- 4 period. On the 4th week crusts disappear. In their place there is peeling and pigmentation of varying degrees of severity and coloring. Pigmentation may remain for a long time. Skin rashes are arranged at the portions corresponding innervation of traumatic spinal ganglia.
Most often with herpes zoster affects the skin of the trunk, a little less - limbs. Rash accompanied by pain, which are often herpes character. Eruptions are located on one side.
After the cessation of exacerbation at 10 - 20% of patients develop post-herpetic neuralgia, which is pain when stored for a long time - from several months to several years. Pain associated with lesions of the intervertebral ganglia viruses traumatic spinal nerves and posterior roots of the spinal cord. Severe disease recorded in lesions of the brain and spinal cord, as well as its membranes. If it affects the autonomic ganglia disrupted the function of internal organs.
Pain in herpes zoster - the painful manifestations of the disease. Disturbed sleep, loss of appetite, decreased weight, develop chronic fatigue, depression appears. All this leads to social isolation of the patient.
atypical forms
There zoster gerpisa form in which the symptoms may be atypical for this disease. These include:
- Abortive form - occurs without apparent pain on the skin appear inflamed spots, but the rash is not formed. The treatment is quick, without complications;
- Hemorrhagic - this form is characterized by blisters filled with blood. On the affected area of the epidermis decreases sensitivity arises numbness and tingling, itching skin strongly;
- Bullous form - clinical manifestations of this form of exercise more bubbles with jagged edges;
- Gangrenosum (necrotic) - formed in situ papules purulent ulcers covered with black scab. There is a deep tissue damage, necrotic processes develop when joining a bacterial infection;
- Generalized (disseminated) form - common in immunocompromised patients and in oncology. In this form of the disease rash covers the entire body from both sides, are affected mucous membranes, internal organs and the brain.
About 40% of patients with cancer of the lymphatic system suffer from a generalized form of the disease in 10% of cases have developed meningoencephalitis, hepatitis, viral pneumonia and other severe complications.
In any form of the disease can occur defeat ganglia of the autonomic nervous system, which may cause atypical symptoms:
- violation of a chair;
- urinary retention;
- extremities chilliness;
- pronounced venous pattern;
- drooping eyelids;
- ceasing of the eyeball;
- constriction of the pupil.
Diagnostics
The answer to the question of how to treat herpes zoster, is determined by the attending physician. In medicine uses algorithms to identify specific changes in disease and the differential diagnosis with visceral diseases (angina, pleurisy et al.), and other infectious pathologies (erysipelas, herpes types 1 and 2, eczema and etc.).
For all patients the survey is as follows:
- A careful history of complaints and symptoms. The doctor must establish whether the transferred chickenpox in a human child, as only in this case, the patient can zoster. In addition, it is necessary to determine the prescription of the rash appears and features of its localization on the skin.
- Clinical and biochemical blood test, there are signs of inflammatory changes: increase in the number of lymphocytes, increasing the concentration of C-reactive protein and fibrinogen.
- In severe cases, diagnostic, when you can not immediately put the diagnosis of red shingles, ie herpes zoster, doctors use a molecular analysis techniques: polymerase chain reaction, immunofluorescence methods and so forth.
Additional diagnostic procedures used in the detection of diseases in children in infancy, when immunodeficient states and in atypical forms of infection complicating the formulation of the right diagnosis.
It should be noted that only a doctor should be engaged in diagnostics, since an incorrect detection of the disease, perhaps the appointment is not an effective treatment of herpes zoster.
How and what to treat shingles
In the treatment of shingles in adults need to consider a few points:
- severity of pain;
- number of lesions and their prevalence;
- the presence or absence of complications;
- body temperature;
- duration of rash.
Most cases of shingles ends independent recovery even in the absence of treatment. However, effective treatment exists and can significantly ease symptoms of the disease and prevent complications.
Herpes zoster treatment goals are:
- Speed recovery;
- Reduce pain;
- Prevent complications;
- Reduce the likelihood of developing postherpetic neuralgia.
For the treatment of herpes zoster used drugs several groups:
- pathogenic agents;
- anesthetics;
- antipyretic drugs;
- antihistamines.
Antivirals - the mainstay of treatment of herpes zoster in adults, they should begin with the appearance of the first signs of disease, which significantly accelerate the healing of skin lesions and reduce the incidence of postherpetic neuritis.
Shingles Treatment in Adults: tablets and ointments
To relieve pain and discomfort physician may prescribe analgesics such as ibuprofen, paracetamol, naproxen or with lidocaine gel. If pains are more intense, such as a strong analgesic oxycodone and gabapentin be administered together with antiviral agents. It is also possible to use non-steroidal anti-inflammatory drugs (see. a list of all NSAIDs shots back pain).
For the treatment of herpes zoster in adults antiherpethetical doctor may prescribe medications to injections, tablets, in the form of creams or ointments:
- Drugs acyclovir - acyclovir, Zovirax, viroleks.
- Drugs valacyclovir - Valtsiklovir, Valtrex. Ester of acyclovir, can be transformed into acyclovir after absorption.
- Formulations of penciclovir - in the form of penciclovir triphosphate also blocks the synthesis of viral deoxyribonucleic acid.
- famciclovir drugs. A prodrug which is converted to penciclovir in hepatic cells
Antiviral therapy is necessary, because without adequate treatment of herpes zoster can produce complications, to antiherpethetical same treatment promotes faster healing of ulcers, reduces pain and improves overall state. And the dosage and course of treatment is determined by specialist with individual flow inflammation related diseases, and an average of no more than 10 days.
In 2019 quite effective drug for the treatment of herpes is considered an antiviral cream Epigenes, which includes glycyrrhizic acid. He has a local anti-inflammatory, antiviral, immunomodulatory, antipruritic effect.
When gangrenous form, when joined by a bacterial infection prescribe broad-spectrum antibiotics. Also, if necessary, can be assigned specialist nimmunomodulyatory such as TSikloferon, Genferon, physiotherapy and a vitamin.
For rash treatment as there are some opposing views. One - that can be used Zelenka - solution of brilliant green, boric acid - liquid Castellani, fukortsin, solid solution of potassium permanganate. All of these tools have a drying effect, and they should be used with caution in order to avoid the formation of burns, which worsens the skin condition. Another view, it is not necessary to handle a rash of these funds, and make better use of antivirals, antiherpethetical creams, ointments, sprays.
You can not use corticosteroids, or oral or in the form of creams and ointments, as this will only worsen the situation. Hormonal agents have a suppressive effect on the immune system, which should itself to cope with viral agents.
Treatment of postherpetic neuralgia with chronic pain in the elderly is not always successful, because antiviral drugs are powerless. Neurologists may appoint plasmapheresis, acupuncture, physical therapy, tricyclic antidepressants, pregabalin, gabapentin.
Vitamins and Diet
Shingles is recommended to use the following foods:
- dairy products (milk, yogurt, butter, cheese);
- vegetables (beets, broccoli, carrots, eggplant, zucchini, squash, tomatoes, pepper, onion);
- white meat;
- seafood (salmon, perch, herring);
- nuts (peanuts, pistachios, almonds, walnuts, cashews);
- fruits (grapes, apricots, apples, kiwi, plums, citrus);
- cereals (oats, wheat, barley groats);
- legumes (peas, beans);
- green tea, rosehip or raspberries.
Also with shingles for immunity it is recommended to take the following vitamins:
- Vitamin A;
- Vitamin E;
- Vitamin C.
These vitamins being antioxidants, reduce the ability of cells to respond to inflammation, but also contribute to the body's defenses.
- B vitamins
Vitamins in the group improved the regeneration of the epithelium, are involved in the formation of antibodies, as well as in all metabolic processes.
It should also be borne in mind that during the treatment of patients with herpes zoster recommended sparing diet rich in nutrients, vitamins and trace elements. Food is recommended boiled or steamed, it should also reduce the consumption of salty, fatty and fried foods.
What else do the treatment at home?
In the treatment of shingles in the home is important to pay attention to the treatment of rashes. In this case, use the ointment is not recommended. Antiseptic agents must be applied in liquid form. It is best for this suitable chlorhexidine. It can be used in any stage of the disease. The product does not cause discomfort.
Besides treatment of lesions, we can not forget about personal hygiene measures. Every day you need to take a shower. However, on the affected areas of the body can not use detergents and washcloth. Designated defeat better simply rinse under running water at room temperature. It is not recommended to use cold or hot water.
Healing of herpes zoster in humans and its treatment necessary medication will not be effective without a proper selection of clothes. It is best to choose natural materials - cotton or linen. Can not be used and close-fitting clothes - it can cause irritation and lead to bubbles in the neighboring areas of the skin.
To which the doctor ask?
Since shingles - a manifestation of acute herpetic infection, when it occurs, you can refer to infectious diseases. In addition it will help in the treatment of a dermatologist. the development of complications the patient consults a neurologist, ophthalmologist.
Consequences and complications
At a young age, a person is faced with shingles, more often than not will feel the any consequences or complications of the disease. She completed for the complete recovery of the patient and the disappearance of all symptoms.
However, if the functioning of the immune system is broken, it may develop serious health problems:
- Meningoencephalitis - another possible complication of shingles. If the patient does not die of meningoencephalitis result, it becomes invalid.
- There is a possibility of malfunctions of the duodenum, the abdominal muscles, the urogenital system (urinary sphincter), lungs (pneumonia connection).
- The disease can have an impact on the work of the brain and spinal cord, as the virus has the ability to actively proliferate there. If there is a transition in the brain tissue, they are destroyed, which can cause paralysis of the lower and upper limbs, paralysis of the facial nerve. In addition, there is the threat of respiratory failure and death of the patient.
- If a virus infects the organs of vision, it is possible the development of optic neuritis. It threatens the formation of glaucoma, corneal lesion and complete blindness of the patient.
- If the disease is accompanied by the addition of a bacterial infection, the condition of the person is getting worse, and the recovery process is significantly delayed.
As a rule, complications occur only in people with weakened immune systems. If the disease is mild, it is not threatened by relapses and passes quickly.
prevention
Against the disease suggested a live vaccine, known as Zostavax.
This vaccine rarely causes side effects, but is contraindicated in patients with weakened immune systems and are not It may be effective in patients taking antiviral drugs active against the virus Varicella zoster. From an economic point of view, it is advisable to use it for patients over the age of 60 years.
In a systematic review of the Cochrane Library of eight randomized, placebo-controlled studies, which covered 52,269 participants, it was found that the vaccine Zostavax in older age groups to prevent one episode of shingles for every 70 vaccinated, that is, it was effective shingles by nearly 50% to reduce the risk. Side effects caused by the vaccine, were represented mainly the lungs and moderate symptoms at the injection site.
