Herpes zoster - causes, symptoms, diagnosis and treatment with antiviral drugs. Herpes zoster - causes, symptoms, diagnosis and treatment with antiviral drugs Herpes zoster without blistering rashes

Shingles (herpes zoster) is an infectious disease caused by type 3 varicella-zoster... Viruses possess the peculiarity of affecting sensitive cranial-spinal ganglia and skin integuments predominantly on one side. The disease almost always proceeds with a pronounced pain symptom. Rashes and pain are the main symptoms of shingles. Treatment for shingles is not always successful. Persisting in the body for a long time, viruses lead to a weakening of the immune system, so there is no complete cure for the disease.

Primary viral infection occurs most often during childhood (chickenpox), and shingles is a recurrence of the disease. After primary infection, the virus hides for life in the intervertebral nodes and dorsal roots of the spinal cord. About 20% of the population get sick during their life.

Viruses varicella-zoster when it enters the human body, it quickly spreads through the blood, cerebrospinal fluid and nerve sheaths. Having settled in the nerve cells of the spinal ganglia, they persist there for life. Hypothermia, sun exposure, alcohol abuse, physical and mental trauma, hormonal cycles - everything that hits the immune system, provokes an exacerbation of the disease. Possessing tropism for the cells of the nervous system, viruses varicella-zoster cause diseases that often proceed as an infectious disease of the central and peripheral nervous systems.

Decreased immunity is the main cause of herpes zoster.

Rice. 1. In the photo, the virus Varicella zoster.

The most severe disease occurs in people with severe suppression of the immune system - cancer patients, HIV-infected, in people taking corticosteroids and undergoing treatment with X-ray therapy.

The main route of transmission of the virus varicella-zoster- airborne. The source of infection is a sick person with chickenpox or herpes zoster, which remains infectious throughout the incubation period and the period of rashes. The disease is most often recorded in women and older people.

Heat, ultraviolet radiation and disinfectants are harmful to viruses. For a long time, viruses persist at low temperatures.

Shingles must be distinguished from herpes simplex, eczema, and streptococcal impetigo.

Rice. 2. The most severe disease occurs in persons with severe suppression of the immune system.

Signs and symptoms of shingles

Prodromal period

The prodromal period with herpes zoster has its own special color. The main symptoms during this period: weakness, malaise, low-grade body temperature, headache, tingling, itching and burning in the places of future rashes (dermatome). The prodrome lasts from 2 days to a week or more.

Rash with shingles

1 period.

The appearance of redness (erythema) in the area of future rashes. Erythematous spots are edematous, have a rounded shape, the edges are raised. If you run your finger over such a spot, you can feel the roughness, which is a lot of tiny papules. However, this symptom is often absent.

Figure 3. In the photo there is an erythematous spot on the skin of the face, on the surface of which papules are visible.

2 period.

After 1 - 2 days and in the next 3 - 4 days, papules turn into vesicles - bubbles filled with a clear liquid. Bubbles are of different sizes, they can be located in isolation, less often - they merge with each other.

Rice. 3. The photo shows herpes zoster. Typical eruptions on the skin of the trunk.

Rice. 4. With herpes zoster, there is an edema of the epidermal cells. Connections between them are broken, in the place of which cavities (bubbles) appear. When the basal layer is damaged, bubbles form under the epidermis. The pattern of rashes is also noted in the cells of the sebaceous glands and hair follicles. Viruses hide inside the cells of the epidermis.

3 period.

After 5 - 7 days from the moment the first vesicles appear, pustulization begins, when the transparent content of the vesicles becomes purulent. The pustules open quickly. Crusts form in their place. In the presence of a significant immunodeficiency in the patient, new rashes appear during this period.

Rice. 5. The photo shows shingles in an adult. Yellowish pustules are visible - vesicles filled with pus.

4 period.

At the 4th week, the crusts disappear. In their place, peeling and pigmentation of varying severity and color appear. Pigmentation can remain for a long time.

Skin rashes are located in areas corresponding to the innervation of the cranial-spinal ganglia.

Rice. 6. After opening the pustules, crusts are formed. Pigmentation is visible in the place where the crusts were.

Most often, with herpes zoster, the skin of the trunk is affected, a little less often - of the limbs. The rash is accompanied by pain, which is often shingles in nature. The rashes are localized on one side.

Rice. 7. In case of herpes zoster, skin lesions are usually unilateral. The rash is localized along an innervated area of the skin called a dermatome.

Rashes and pain are the main symptoms of shingles.

Rice. 8. With herpes zoster in adults, skin lesions are most often one-sided. The rash is localized along an innervated area of the skin called a dermatome.

Pain is a formidable symptom of shingles

In case of illness, the patient always has pain, the intensity of which ranges from barely perceptible to painful, exhausting the patient, which cease for a short period under the influence of drugs. Most often, pain appears in the area of skin rashes corresponding to the affected nerves. The intensity of the pain does not always correspond to the severity of the skin rash.

After the exacerbation stops, 10 - 20% of patients develop postherpetic neuralgia, in which pain persists for a long time - from several months to several years. Pain is associated with the defeat of the viruses of the intervertebral ganglia of the cranial-spinal nerves and the posterior roots of the spinal cord. A severe course of the disease is recorded with damage to the spinal cord and brain, as well as its membranes. With the defeat of the autonomic ganglia, the function of the internal organs is disrupted.

Herpes zoster pain is a painful manifestation of the disease. Sleep is disturbed, appetite is lost, weight is reduced, chronic fatigue develops, depression appears. All this leads the patient to social isolation.

Some clinical forms of shingles

Signs and symptoms of ophthalmic herpes

With damage to the optic nerve, ophthalmic herpes develops. Most often, the disease affects the cornea of the eye (keratitis), somewhat less often - the outer layer of the sclera (episcleritis), the iris and the ciliary body (iridocyclitis). The retina of the eye is very rarely affected. The disease is accompanied by lacrimation.

The defeat of the optic nerve ends with its atrophy, followed by blindness.

With the defeat of the branches of the oculomotor, their paralysis is noted. Ptosis (drooping of the eyelid) develops.

Rashes on the skin around the eyes and on its mucous membranes are difficult. Eyebrows and eyelashes fall out on the affected side.

Rice. 9. On the photo ophthalmic herpes.

Signs and symptoms of herpes zoster when the branches of the trigeminal nerve are affected

With the defeat of the branches of the trigeminal nerve against the background of rashes on the skin of the forehead and face, mucous membranes of the mouth and nose, pains appear that are localized in the area of the skin of the face and head. At the same time, the body temperature rises, edema and pain appear on the side of the lesion in the places where the branches of the trigeminal nerve exit. Neuralgia and trigeminal paralysis last for weeks.

Rice. 10. Rashes with damage to the branches of the trigeminal nerve.

Rice. 11. The photo shows shingles. The mucous membrane of the oral cavity is affected.

Signs and symptoms of cochlear herpes

Herpetic eruptions with damage to the facial, cochlear and vestibular nerves are localized on the skin of the auricle, around it, in the ear canal and even on the eardrum. Pains are localized along the auditory canal and auricle, often radiating to the area of the mastoid process.

The defeat of the vestibular cochlear nerve is marked by tinnitus. Decrease in hearing acuity and laying occurs due to edema of the tympanic membrane, which occurs due to herpes lesions.

Rice. 12. With cochlear (ear) herpes, rashes are localized on the skin of the auricle, around it, in the ear canal and even on the eardrum.

Signs and symptoms of shingles with facial nerve damage

With the defeat of the facial nerve, paralysis of the soft palate, loss of sensitivity of the anterior 2/3 of the tongue and taste disturbance are observed.

Rice. 13. In the photo herpes on the face.

Signs and symptoms of herpes zoster with cervical sympathetic ganglia

With the defeat of the cervical sympathetic nodes, rashes occur on the skin of the neck and scalp. Pain occurs in places of rashes and paravertebral points.

Rice. 14. In the photo, shingles. The rash is localized on the skin of the neck.

Signs and symptoms of shingles in the lower cervical and upper thoracic ganglia

With the defeat of the lower cervical and upper thoracic ganglia, pain appears, a burning sensation and pressure, first in the hand, and then in the entire arm. Swelling of the hand appears, the skin becomes thinner, the movement of the fingers of the hand is painful.

Rice. 15. The photo shows herpes zoster on the skin of the hand and palm.

Signs and symptoms of herpes zoster with lesions of the ganglia of the thoracic spine

With the defeat of the ganglia of the thoracic spine, most patients have intercostal neuralgia, the pain in which is shingles in nature. The slightest touch to the skin, movement and temperature changes greatly increase the pain. Increased pain is noted at night.

Rice. 16. The photo shows herpes zoster. The skin of the trunk is affected.

Signs and symptoms of shingles in lumbosacral ganglia

With the defeat of the ganglia of the lumbar-sacral region, herpetic eruptions appear on the skin of the lumbar region, buttocks and lower extremities. Pain syndrome stimulates pancreatitis, gallbladder inflammation, renal colic, or appendicitis. Sometimes a picture of sciatica is noted.

Rice. 17. In the photo, shingles.

Rice. 18. In the photo there are rare forms of herpes zoster - genital herpes.

When the roots of the spinal cord of the cervical, thoracic and lumbar spine are damaged, the motor functions of the corresponding parts of the body are disrupted, up to paresis. When the membranes of the brain are irritated, patients experience severe headaches.

Forms of clinical manifestations of herpes zoster

Typical (vesicular) form

The typical form is characterized by blistering eruptions and the presence of a painful symptom. Rashes are unilateral (with chickenpox - common).

Bullous form

In the bullous form of herpes zoster, the bubbles merge and reach the size of a plum.

Abortive form

With the abortive form of the disease, papules do not turn into vesicles.

Hemorrhagic form

The hemorrhagic form is characterized by the spread of the inflammatory process deep into the skin (dermis), the contents of the vesicles mix with blood, which makes the crusts dark brown.

Gangrenous form

The gangrenous form is characterized by the development of a gangrenous process at the bottom of the vesicles. After wound healing, cicatricial changes remain.

Herpes zoster without blistering

It is assumed that there is a form of the disease without blistering eruptions.

Herpes zoster without pain

There is a form of herpes zoster with skin eruptions but no pain.

Immunity inhibits the development of the disease. A good immune system prevents the spread of viruses in the patient's body.

Rice. 19. In the photo there is a hemorrhagic form of herpes zoster.

Rice. 20. With common rashes, the course of the disease is often complicated by the addition of a secondary infection. Treatment of shingles in this case is much more difficult.

Shingles treatment

Treatment of shingles remains a daunting task today. Despite the wide range of injections, pills, creams and ointments for herpes, the infection is difficult to treat. The reason for this is the development of resistance of viruses to antiviral drugs. Viruses persisting in the body for a long time lead to a weakening of the immune system.

Treatment of shingles with antiviral drugs

Chemotherapy drugs inhibit the synthesis of viral DNA, as a result of which the process of viral replication in the cell is suspended. Antiviral drugs - nucleoside analogs currently have evidence-based activity: Acyclovir (Zovirax), Valacyclovir (Valtrex), Penciclovir (Vectavir), Famciclovir (Famvir).

Acyclovir (Zovirax) is the most commonly prescribed antiviral drug. Vacyclovir (Valtrex) and Famciclovir (Famvir)- new antiviral drugs. Famciclovir has the highest, 77% bioavailability.

Acyclovir applied 5 times a day. Famciclovir and Valacyclovir applied 3 times a day, which greatly facilitates the patient's treatment process.

Alpizarin- antiviral herbal remedy.

Antiviral drugs are the mainstay of treatment for herpes zoster, which should begin with the first signs of the disease, which will significantly accelerate the healing of skin lesions and reduce the incidence of postherpetic neuritis.

Rice. 21. In the photo there are antiviral drugs Acyclovir and FamVir.

Treatment of shingles with immunostimulants

One of the important directions in the treatment of shingles, in addition to antiviral therapy, is the correction of the specific and nonspecific link of immunity, which is achieved by the use of immunoglobulin, interferon inducers, interferon preparations and stimulation of T and B-cell immunity and phagocytosis.

Antiviral gamma globulin

Immunoglobulin for the treatment of shingles contains antiherpetic antibodies that neutralize viruses varicella-zoster... The maximum effect is achieved with the introduction of immunoglobulin in the first 72 hours from the moment of contact with the patient. Mandatory for the administration of the drug is the patient's condition when they take corticosteroids, cytostatics, immunosuppressants, for HIV infections and leukemia.

Vaccine against varicella-zoster viruses

The herpes vaccine activates cellular immunity. It is able to prevent the development of primary infection, the emergence of a state of latency of viruses and facilitate the course of an existing disease. The vaccine stimulates specific reactions of antiviral immunity and restores the functional activity of immunocompetent cells.

A combination of antiviral drugs and vaccine therapy provides a sustainable effect in the treatment of herpes zoster.

Treatment of herpes zoster with interferon inducers

Interferon inducers have an antiviral effect, since they regulate the synthesis of cytokines - regulators of intercellular and intersystem interactions. The drugs induce interferons in T and B leukocytes, enterocytes, macrophages, liver cells, epithelial cells, tissues of the spleen, lungs and brain, the synthesis of their own α, β and γ interferons, thereby adjusting the immune status of the body. Interferon inducers are presented Amiksin, Neovir, Ridostin, etc.

They have antiviral activity and are inducers of interferon, a herbal preparation: Alpizarin and Helepin-D.

Natural and synthetic compounds are able to induce the production of endogenous interferon: Levamisole (Decaris), Dibazol, Vitamin B12, Pyrogenal, Prodigiosan.

Topical treatment for shingles

Local treatment of shingles occupies a special place in the complex treatment of the disease. Its importance increases manifold in cases of the development of resistance to antiviral drugs. With local application of antiviral drugs, a high concentration of the drug is provided in the lesions. At the same time, there is no toxic effect of drugs on the entire body.

Antiviral drugs

Rice. 22. In the photo, Acyclovir ointment for herpes and Acyclovir HEXAL cream.

Vectavir cream... The drug contains the antiviral substance penciclovir. It is used for herpes zoster at any stage of the disease from the age of 16. The cream is applied 5 times a day (every 4 hours) for 4 days.

Rice. 23. In the photo, Vectavir herpes cream for external use with antiviral activity. It is used at any stage of the disease.

Herbal antiviral drugs

Alpizarin ointment

The ointment is prepared on the basis of alpizarin obtained from the herb of 2 species of the alpine penny plant of the legume family or technical mangiferin obtained from the leaves of the mango family of the sumac family. 5% ointment is used in adults for 3 to 5 days. The treatment can be extended up to 3 to 4 weeks.

Rice. 24. On the photo is an ointment for the treatment of genital herpes of plant origin Alpizarin.

Interferons

Vireferon contains interferon alpha-2b (hydrogel ointment). The ointment is applied to the skin and mucous membranes in a thin layer. Then dry the greased areas for 15 minutes. During this time, a protective film is formed. Herpes ointment Interferon alpha-2 recombinant applied 2 times a day (every 12 hours) for 3 - 5 days.

Rice. 25. On the photo is an ointment for herpes with interferon Vireferon.

Symptomatic treatment for shingles

Eliminate pain

Analgesics are used to reduce pain, inflammation, and fever in shingles. The drugs of the group of non-narcotic analgesics have proven themselves well. Paracetamol and its analogues, Ibuprofen and its analogues, Naproxen, Ketoprof n, Ketorolac, gel with lidocaine... Stronger drugs are available at the pharmacy only with a doctor's prescription. Ganglion blockers relieve pain and spasm.

Severe neuropathic pains are relieved by drugs of the anticonvulsant group - Gabapentin or Pregabalin... Pain relievers must be taken with injections of B vitamins.

Rice. 26. Tylenol pain relief drug. The active ingredient is paracetamol.

Rice. 27. Medicine for pain relief Advil. The active ingredient is ibuprofen.

Before using pain relievers, you must carefully read the instructions. Like any drugs, drugs of this group have side effects - they cause allergies, irritate the mucous membrane of the gastrointestinal tract, and have a toxic effect on the liver and blood. In people younger than 20 years of age, pain relievers can cause acute hepatic encephalopathy (Reye's syndrome).

Strictly follow the instructions for use of the drugs. Do not use pain relievers for more than 10 days!

Antihistamines eliminate itching: Diphenhydramine, Suprastin, Tavegil, Diazolin and etc.
Promote healing of the ointment with Methyluracil and gel or ointment Solcoseryl.
When a secondary infection is attached, the use of antistaphylococcal antibiotics is indicated - ointments with Tetracycline and Erythromycin.

It is strictly forbidden to take corticosteroids and irradiate the affected areas with ultraviolet rays. By drastically reducing immunity, they open the way for viruses to other tissues of the body.

Millions of people around the world suffer from a variety of diseases caused by herpes viruses. Herpetic infection has various forms of manifestation. Shingles (herpes zoster) is one of them. Rashes and pain are the main symptoms of shingles. Persisting in the body for a long time, varicella-zoster viruses lead to a weakening of the immune system and damage the structures of the peripheral and central nervous system, causing ganglioneuritis and other serious complications. Shingles treatment is aimed at fighting viruses, increasing immunity, treating skin manifestations and pain. Most popular

Herpes is associated with many common cold sores, which, although they do not look very pleasant, do not cause serious discomfort. However, this infection is multifaceted and one of its varieties is herpes zoster, which is characterized not only by damage to the skin, but also to the nervous system. The causative agent of shingles is varicella zoster or herpes zoster, which can be infected in early childhood.

What is shingles

In the classification of viral diseases according to ICD-10, this disease is called herpes zoster. The disease is characterized by the appearance of skin rashes on the body or mucous membranes, damage to the cells of the central and peripheral nervous system. Herpes zoster is often accompanied by nerve damage and severe pain. Anyone can get the herpes virus, but most cases occur in people over 50.

Infected or not

If a person had chickenpox in childhood, his body developed immunity to the pathogens of chickenpox, which reduces the chances of infection again to a minimum. For other patients, contact with patients can provoke the occurrence of shingles. Especially often adults with low immunity get sick and older people suffer. Herpes zoster viruses are transmitted only at the time of the appearance of a characteristic rash, and during the period of wound healing, it is not dangerous.

The causative agent of herpes zoster

Zoster varicella belongs to the family Herpesvididae, genus Poikilovirus. The organism of the pathogen has a round or slightly oblong shape with a core consisting of DNA cells. There is a lipid-containing envelope around the virus. Once in the human body, varicella zoster provokes the development of a primary infection - chickenpox. After successful treatment, the virus does not die, but settles in the spinal cord, subsequently provoking relapses of the disease in the form of shingles.

What does shingles look like?

When clinical symptoms appear, it is not difficult to recognize herpes zoster. At the initial stage, the disease is characterized by the appearance of many small bubbles with liquid. Localization of the rash is the sides, lower back, abdomen. A rash on the face, neck, or ears is less common. The areas affected by varicella zoster have an elongated shape, as if encircling the human body. Hence the name of the disease - shingles.

Varicella-zoster virus - varieties

Herpesvirus infection can have different clinical manifestations, especially in people with reduced immunity. Some patients may develop shingles on their face, others on their ears or eyes. In this regard, doctors adopted the following classification of atypical manifestations of the virus:

Ophthalmic herpes - characterized by severe lesions of the mucous membranes of the eyes, eyelids and branches of the trigeminal nerve.
Ramsey-Hunt syndrome - damage to the facial nerves, leads to paralysis of the facial muscles. Typical symptoms: typical eruptions in the oropharynx and auricles.
Motor lichen - is expressed by muscle weakness, accompanied by damage to the neck or shoulders.
Abortive herpes - characterized by the absence of foci of inflammation and pain.
Hemorrhagic form - the patient may have bubbles with bloody contents, after which heal scars remain.
Bullous type of lichen - manifests itself in the form of large herpetic eruptions with uneven edges.
Gangrenous herpes - provokes tissue necrosis with the subsequent formation of scars.
Disseminated versicolor - herpes zoster affects the skin on both sides of the body.

Causes of occurrence

The occurrence of herpes zoster is directly related to a childhood disease - chickenpox. These diseases are caused by the same pathogen - varicella zoster. If you had chickenpox as a child, your risk of getting shingles increases. The fact is that the smallpox virus does not disappear after recovery, but hides in the nerve cells of the spinal cord. He can stay there for many years, but with a sharp decrease in immunity, he will wake up again.

The causes of herpes zoster can be different, but the main symptoms of herpes zoster appear when the body's immune response decreases. At risk of infection are:

carrying out immunosuppressive therapy;
HIV infection or AIDS;
stress, depression, loss of energy;
Taking certain medications, such as immunosuppressants or antibiotics
chronic diseases of internal organs;
oncological diseases;
surgery on the skin;
the consequences of radiation therapy.

Symptoms of the disease

The classic picture of herpes zoster begins with the appearance of severe shooting pain in the back, lower back or ribs. The victim feels general malaise, weakness, nausea, and sometimes the body temperature may rise slightly. After a few days, indistinct pinkish spots appear in places of pain, and after about a day, bubbles appear. Gradually they dry out, forming crusts. Infectious symptoms may vary slightly depending on the patient's condition and the stage of the disease.

Incubation period

It lasts no more than 3-5 days, during which there are signs of intoxication of the body. During this period, patients complain of severe headaches, chills and weakness. The work of the digestive tract may be disrupted, appetite will be lost. A day or two after the activation of the virus, pain appears in the nerve trunks and itching where later rashes will appear.

Rash period

At the initial stage, small pink spots of 3-5 mm in diameter with uneven edges appear. Then a herpetic rash appears in these places in the form of grouped serous vesicles. You can notice infiltration, swollen lymph nodes. In severe cases, the rash may contain blood clots. Sometimes the temperature rises - up to 39 degrees.

Skin healing

At this stage of herpes, the bubbles gradually burst. The inflammation begins to dry out, redness and swelling disappear. In the place where the rash was previously localized, a crust appears, which comes off on its own. The temperature gradually returns to normal, the rest of the symptoms of intoxication of the body go away. This period takes from 7 to 8 days, the total duration of the disease is 2.5-3 weeks.

Features of the manifestation of herpes zoster

When your immune system is functioning normally, the symptoms of shingles may not appear at all. A person who has had chickenpox can live with the virus all his life and never know about the diagnosis of herpes zoster. However, there are also opposite cases, when the disease can recur or will proceed with an atypical clinical picture. Features of the manifestation of herpes zoster in this case are presented in the table:

Signs of herpes zoster	How does shingles proceed?
	With herpes zoster, painful sensations arise along the growth of the nerve trunks, more often in the intercostal space. Some patients develop aching pain that worsens at night. Others complain of paroxysmal, burning lumbago that persists after compulsory treatment.
Skin rash	If lichen affects the trigeminal nerves, patients complain of severe headache, dizziness. With ear herpes zoster, rashes appear on or around the sink, inside the ear canal. Loss of hearing sense and decreased visual acuity is possible.
Complications	Often, a bacterial infection joins the zoster virus, the causative agents of which are streptococci and staphylococci. Against this background, pneumonia, meningitis, infectious skin diseases, and herpetic neuralgia develop.

When is hospitalization necessary

Only patients with lesions of the optic nerves, the brain, and infection in the ears are hospitalized. With such manifestations of herpes infection, severe complications may appear: meningitis, blindness, trigeminal neuralgia. You should immediately consult a doctor if you experience a severe headache, loss of consciousness, muscle weakness, pain in the ears, cramps, high body temperature. Medical consultation is needed:

if herpes appears in a newborn baby;
during pregnancy or lactation;
if characteristic rashes appear in elderly patients;
patients with diabetes mellitus;
with early diagnosis of cancer or while taking anticancer drugs;
people with chronic heart, liver or kidney failure.

Shingles treatment

It is very important to start therapy in the first 2-3 days after skin rashes appear. This will prevent complications. Effective treatment cannot be complete without the use of antiviral drugs. To relieve pain, the doctor will prescribe analgesics. To raise immunity, immunomodulators are used, and for the prevention of herpes zoster, it is recommended to take vitamins A, E, group B.

Antiviral drugs

The use of these medicines helps to avoid the development of complications. Based on the general condition of the patient and the manifestation of infectious symptoms, the doctor will prescribe one antiviral agent. This could be:

Famvir is prescribed for a week at a dosage of 3 tablets per day. The medicine does not relieve pain and helps to avoid a severe neurological reaction.
Valacyclovir is similar in principle to Famvir. It is prescribed in dosages of 2 tablets three times a day for a week.
The drug Acyclovir is able to accelerate the processes of soft tissue regeneration. Tablets should be drunk 4 pieces 5 times a day for 7 days.
Valtrex - stops the multiplication of the virus. Appointed by the course for 7 days. The optimal dosage is 2 tablets three times a day.

Non-steroidal anti-inflammatory drugs

This group of drugs has an analgesic effect, reduces inflammation, and works as an effective antipyretic agent. Treat herpes zoster with non-steroidal drugs after consulting a doctor. Typically used:

Ibuprofen is drunk 1 tablet up to 4 times a day. The maximum course of treatment is 5 days.
Diclofenac in the form of tablets should be taken at 50-150 mg two to three times a day.
Ketoprofen is initially taken in a shock dosage of 300 mg per day with meals. During maintenance therapy, the dosage is reduced to 150 mg per day.
Piroxicam in doses of 10 to 30 mg once.

Analgesics for pain relief

To relieve pain during treatment, the doctor may recommend local or systemic pain relievers. With a slight damage to the nervous system, the following are effective:

Baralgin is a combined analgesic. It is prescribed orally 1-2 tablets 2-3 times a day.
Naproxen is available in the form of suspensions, rectal suppositories and tablets. Adults are prescribed 1 suppository for the night or 500 mg tablets.
Pentalgin is a combined preparation. It is taken orally as a whole, without chewing 1 tablet 1 time per day.
Analgin is prescribed at 0.25-0.5 grams 2-3 times a day. During treatment, it is necessary to monitor blood counts.

Immunomodulators

During treatment, it is important not only to strictly follow the doctor's recommendations, but also to increase the body's defenses. For this, doctors recommend normalizing nutrition. Eat more fresh vegetables and fruits, drink juices. In addition to a proper diet, immunomodulators may be prescribed:

Cycloferon - 2 or 4 tablets in a scheme for 1-2-4-6-8-11-14-17-20-23 days.
Genferon - 500 IU twice a day for 10 days.
Viferon in candles, 2 pieces in the morning and evening. The duration of treatment is 10 days.
Galavit - 1 candle for the night for 5 days.

Vitamin therapy

Doctors say that with age, natural changes in the gastrointestinal tract lead to the fact that the body is less able to absorb vitamins A, C, group B and various minerals, and this is a serious blow to the immune system. To support the body during the recovery period, doctors recommend taking vitamin and mineral complexes according to the scheme: 10-15 days of intake, then a break for 2 weeks and a new course of treatment.

Treatment of herpes zoster - concomitant therapy

In addition to the main treatment, in consultation with the doctor, you can use other methods of therapy. Physiotherapy procedures improve blood circulation, relieve pain, reduce pigmentation after removing the crust. Correct diet and intake of interferons help to strengthen the immune system. For the entire duration of treatment, the patient is prohibited from taking baths, visiting the pool or in any other way wetting herpetic eruptions.

Physiotherapy procedures

Physiotherapy helps to get rid of many diseases and herpes zoster is no exception. The choice of a specific technique depends on the stage:

If the disease is acute, they suggest:
1. Magnetotherapy - the body is affected by alternating high-frequency magnetic fields. Such procedures have anesthetic and anti-inflammatory effect, accelerate biochemical reactions in tissues. The minimum course is 10 procedures.
2. Ultraviolet irradiation. Under the influence of UV rays, the zoster virus stops multiplying. Such therapy improves immunity, accelerates recovery. For a complete cure, you need to go through 5 sessions.
At the regression stage, they propose:
1. Amplipulse therapy - the technique involves the use of sinusoidal currents of low frequency. The sessions help accelerate cell regeneration, relieve swelling and inflammation.

Local treatment

Therapy using aerosols, gels or antiviral ointments is prescribed only as part of the complex treatment of herpes. As separate drugs, such drugs are ineffective. From external means use:

Alpizarin ointment - has antibacterial and anti-inflammatory effects.
Eperduvin - has a good antiviral effect, stops the number of rashes.
Brilliant solution, castellan - dry the bubbles, have antimicrobial effect.

Diet food

American scientists have found that if you consume 1 gram of lysine every day, the number of relapses of herpesvirus infection will decrease by almost 2.5 times. Cottage cheese, milk, yogurt and other dairy products will help provide the body with this antiviral amino acid. Fish, meat and eggs are rich in lysine. Slightly less amino acids are found in legumes, dried apricots and cereals. At the same time, for the duration of treatment, it is advisable to abandon products containing arginine - these are chocolate, bread and other baked goods made from wheat flour.

Interferons

Interferon ointments or aerosols help build a strong preventative barrier against cold sores. In fact, interferons are proteins that can reduce the amount of virus in human blood. There are many drugs based on these substances. Many of them are available in tablets and are called immunomodulators, but interferons can be used in the form of an ointment or aerosol to complement the main antiviral therapy. These are drugs with trade names:

Eridin;
Zostevir;
Helepin;
Florenvl;
Alpizarin.

Prevention methods

With timely treatment started, compliance with all the prescriptions and recommendations of the doctor, herpes zoster does not cause complications. The main thing is that at the first suspicion or when characteristic symptoms appear, immediately consult a doctor and make a diagnosis. However, rather than treating yourself and taking a bunch of pills, it is better to prevent the development of herpes in advance. There are two main ways to do this: vaccination and immunity stimulation.

Vaccination

Today there is only one vaccination for this type of herpes. It was created on the basis of an artificially grown Varicella-zoster virus. A solution called Zostavax is injected subcutaneously once. The duration of the therapeutic effect varies from three to five years. However, not everyone can get an injection. The vaccine is contraindicated for:

pregnancy;
diseases of HIV or AIDS;
the presence of allergies to components;
colds.

Boost immunity

Doctors believe that the best way to protect yourself from shingles is to always keep your immune system working well. To do this, it is necessary to establish nutrition, eat more fresh vegetables and fruits, drink juices, and regularly undergo a preventive course of vitamin therapy. Sports, daily walks in the fresh air and giving up bad habits help to strengthen the body's protective barrier.

Video

Herpes zoster is an extremely unpleasant and fairly common disease of a viral nature. Symptoms of the disease appear in different parts of the body. Usually this is the face, limbs, genitals, lumbar spine. Sometimes rashes form on other areas of the skin, but most often on the face.

Also, this disease has certain signs of damage to the nervous system. In addition to shingles, the causative agent of the disease - varicella zoster - can lead to the appearance of chickenpox in children, as well as adults who have not previously had this ailment.

What it is?

Herpes zoster is a sporadic illness caused by the reactivation of the herpes simplex virus type III (Varicella Zoster virus). The disease is characterized by a predominant lesion of the skin and nervous system with severe complications.

When varicella-zoster viruses enter the human body, they quickly spread through the blood, cerebrospinal fluid and nerve sheaths. Having settled in the nerve cells of the spinal ganglia, they persist there for life. Hypothermia, sun exposure, alcohol abuse, physical and mental trauma, hormonal cycles - everything that hits the immune system, provokes an exacerbation of the disease. Possessing tropism for the cells of the nervous system, varicella-zoster viruses cause diseases that often proceed as an infectious disease of the central and peripheral nervous systems.

Lifelong latent carriage of varicella zoster is established in about 20% of the inhabitants of our country who have had chickenpox in childhood. Asymptomatic carriage of the "dormant" virus can be lifelong. The main refuge for him are the nerve cells of the body. Under the influence of internal and / or external agents, the virus is activated.

History

Shingles was known in ancient times, but it was considered as an independent disease. At the same time, chickenpox for a long time was often mistaken for smallpox: despite the fact that the clinical differences between the two infections were described as early as the 1860s, reliable differentiation became possible only at the end of the 19th century.

The infectious nature of chickenpox was proven by Steiner in 1875 in experiments on volunteers. The assumptions about the connection of chickenpox with diseases of herpes zoster were made for the first time in 1888 by von Bokay, who observed the disease of chickenpox in children after contact with patients with herpes zoster. These ideas were confirmed only in the late 1950s, when T. Weller isolated the pathogen from patients with both clinical forms of infection.

However, the most convincing were the epidemiological data: the incidence of chickenpox in the foci of herpes zoster was significantly higher than the average among the population (in the foci of herpes zoster, the secondary risk of infection is high). In 1974, Takahashi and his co-workers received a weakened Oka strain of the "wild" virus, and in 1980 a clinical trial of a chickenpox vaccine was initiated in the United States.

How can you get infected?

The herpes zoster virus is highly contagious (transmittable), therefore it easily spreads from person to person by airborne droplets, as well as through contact with the patient's skin. In this case, the body penetrates the liquid contained in the vesicles formed on the epidermis infected with chickenpox or shingles. For the first time, an infected person falls ill with chickenpox, after which the virus persists for a long time in the body.

An exacerbation of the disease in the form of herpes zoster can occur due to the influence of a number of provoking factors:

decreased immunity, severe immunodeficiency conditions;
taking cytostatics, chemotherapy, cancer;
autoimmune diseases, pathological disorders in the composition of the blood;
stress, shock;
poisoning, intoxication;
prolonged hypothermia;
advanced age (over 65).

Chickenpox is a common disease in children, and an adult with a history of this disease can activate a dormant virus by contact with a child. Herpes zoster in children under 10 years of age can manifest itself only in the case of congenital disorders of the functioning of the cells of the immune system, as well as with chickenpox transferred in the first months of life.

Is herpes zoster contagious?

If a person in contact in childhood had chickenpox, and he has developed a strong immunity, then the risk of contracting herpes zoster is practically reduced to a minimum. However, in people who have not previously had chickenpox, contact with a sick shingles can lead to the development of chickenpox. This risk is especially increased in children and adults after fifty years of age with low immunity.

It should be noted that herpes zoster is contagious during the period of herpetic eruptions. During the period of healing and formation of crusts, this disease ceases to be dangerous.

Can I get sick again?

The varicella-zoster virus, entering the human body, causes chickenpox (chickenpox). However, after recovery, this virus is not eliminated, but remains in the human body in a latent state. This virus is asymptomatic in nerve cells in the dorsal roots of the spinal cord.

The activation of the virus occurs when the body is exposed to negative factors that contribute to a decrease in immunity. In this case, the disease is repeated, only not in the form of chickenpox, but in the form of shingles. As a rule, re-manifestation of herpes zoster is not observed in the future. In patients with normal health, recurrence of herpes zoster is observed in two percent of cases.

In ten percent of people, a relapse of herpes zoster is observed in the presence of the following pathologies:

HIV infection;
AIDS;
oncological diseases;
diabetes;
lymphocytic leukemia.

In this regard, in order to reduce the risk of recurrence of the disease, as well as to prevent the development of herpes zoster, a vaccine against the Varicella-zoster virus has been released since 2006. This vaccine has shown good results, reducing the risk of developing the disease by 51%.

Herpes zoster symptoms in adults

How the symptoms develop depends on the state of the adult's immune system. The weaker the protection, the brighter the effect of the virus is. Severe forms are characterized by the appearance of necrotic areas with deep scars, which worsen the appearance.

Most often, the skin of the trunk is affected, a little less often of the limbs. The rash is accompanied by pain, which is often shingles in nature. They are localized on the one hand.

Initial period

Prodromal, characterized by general malaise, neuralgic pain of varying intensity, it lasts an average of 2-4 days:

Headache
Subfebrile body temperature, less often fever up to 39C
Chills, weakness
Dyspeptic disorders, disruption of the gastrointestinal tract
Pain, itching, burning, tingling in the area of peripheral nerves in the area where later there will be rashes.
Most often, with an acute process, regional lymph nodes become painful and enlarge.
In a severe course of the disease, urinary retention and other disorders of some systems and organs may appear.

After a decrease in temperature, other general intoxication disorders also subside.

Rash period

The time when the rash appears, characteristic of shingles. The symptoms and nature of the rash depend on the severity of the inflammatory process. At first, the rash looks like foci of pink spots 2-5 mm in size, between which areas of healthy skin remain.

With a typical form of the disease, the next day, in their place, small, closely grouped vesicles, vesicles with transparent serous contents, which become cloudy after 3-4 days, are formed.
In severe gangrene herpes, the contents of the vesicles may be mixed with blood, black. Herpetic eruptions have a wavy course, as with chickenpox, that is, fresh rashes with vesicular elements appear at intervals of several days. The bubbles seem to crawl from one place to another, encircling the body, hence the name of this disease.

In mild forms of the inflammatory process, the transformation of skin nodules into pustules does not form and their ulceration does not occur, and the manifestation of herpes is only of a neurological nature - pain without a rash, otherwise it is also called herpetic neuralgia and is often mistaken for manifestations of intercostal neuralgia, osteochondrosis, or heart pains. And therefore, inadequate treatment may be prescribed.

Crusting period

Usually after 14-20 days, crusts form at the site of the rash. The entire erythematous background, that is, the places where the vesicles were located gradually become pale, dry out, and the yellowish-brown crusts fall off, leaving a slight pigmentation or depigmentation.

Pain is a formidable symptom of shingles

Atypical symptoms

Signs of shingles with atypical forms of the course are expressed in the following forms:

Gangrenous	often manifests itself with severe immunodeficiency and is characterized by an intensified rash, which, encircling the localization, constantly changes movement. This is expressed by the constant appearance of new rashes.
Abortive	with this form, a vesicular rash does not appear, but neuralgia remains.
Bullous	this form is expressed by the combination of vesicles adjacent to one large papules.
Generalized	with serious disorders of the immune system after typical rashes, herpes zoster begins to affect large areas of the skin and mucous membranes.
Bubble	vesicles increase in size, group and form a large area of rashes, seemingly with ragged boundaries of the lesion.

Before treating shingles, you need to make sure that this is it. Until herpes zoster gives clear symptoms, it is impossible to determine the disease, since neuralgic symptoms may indicate other diseases.

What does herpes zoster look like, photo

The photo below shows how the disease manifests itself in adults.

Click to view

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Diagnostics

In the prodromal period, herpes zoster should be differentiated from pleurisy, trigeminal neuralgia and from acute abdominal syndrome (appendicitis, renal colic, cholelithiasis).

If the rash is not located along the nerve trunks, then differential diagnosis is carried out with herpes simplex, chickenpox, and the bullous form must be differentiated from erysipelas and from skin lesions with immunodeficiencies and diabetes mellitus.

Herpes zoster treatment

In adults, shingles can result in spontaneous recovery and without medical intervention. However, immunocompromised, elderly patients should begin treatment for herpes zoster as soon as possible. This allows you to alleviate the severity of the condition and prevent postherpetic complications.

Of antiviral drugs, adult patients are prescribed pills for 7 to 10 days:

Zovirax - 2 g / day.
Acyclovir - 0.8 g x 5 rubles. in a day.
Famciclovir - 0.5 g x 3 r. in a day.
Valacyclovir - 1 g x 3 r. per day.

To relieve pain in the initial stages of shingles, prescribe:

Aspirin.
Ibuprofen.
Anileridin.
Diclofenac.
Sufentanil.
Paracetamol.

Antidepressants for the treatment of HSV-3 with prolonged pain syndrome are prescribed as follows:

Duloxetine.
Citalopram.
Mirtazapine.
Doxepin.
Maprotiline
Clomipramine.
Escitalopram.
Venlafaxine.

How to treat herpes zoster in order to eliminate specific rashes? Specialists prescribe medicines for external use in addition to antiviral agents for internal use.

Effective ointments against the Zoster virus are Acyclovir, Bonafton, Alpizarin, Helepin, Interferon, Epervudin. It is useful to treat the body with Allergoferon and Infagel gels, as well as with Epigen, Acyclovir, Zovirax creams.

For drying and disinfecting the wounds left after the opening of herpetic elements, it is allowed to use Castellani liquid and brilliant green, boric acid and Calamine lotion, Fukortsin and Chlorhexidine. Treatment is diversified with zinc preparations (Badigeon, Tsindol) and a strong solution of potassium permanganate.

Folk remedies

All of the following recipes for collecting plants (optional) are prepared as follows: insist one tablespoon of herbs in a glass of boiling water for 20-30 minutes, cool and use 1 / 2-1 / 3 cup 2-3 times a day to relieve mild pain and nervous excitability , as well as for insomnia.

Valerian root, mint leaves - 3 parts each, watch leaves - 4 parts.
Mint leaf, watch leaf - 2 parts each, valerian root and hop cones in 1 part.
Fennel fruits and chamomile flowers - 1 part each, marshmallow root, licorice root, wheatgrass rhizome - 2 parts each (recommended for children).
Valerian root - 2 parts, chamomile root - 3 parts, caraway fruit - 5 parts.
Valerian root, hawthorn flowers, mint leaves, mistletoe herb, motherwort herb - 1 part each.
Valerian root, motherwort herb, green oat straws - 1 part each.
Tartar leaves, green oat straw, caraway fruits - 2 parts each, hawthorn flowers, chamomile flowers - 1 part each.
Mint leaves - 1 part, heather herb, lemon balm leaves - 2 parts each, valerian root - 4 parts.
Heather leaves, creeper grass, thyme herb, valerian root - 2 parts each, chicory root - 1 part.
Motherwort herb, cumin herb, heather herb - 2 parts each, hop cones, caraway seeds - 1 part each.

The use of medicinal pharmacopoeial herbs is justified in the mild form of herpes zoster pathogenesis.

See photos

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Effects

A quick and painless recovery from herpetic herpes is due to the general good health of the patient. A young and strong organism with normal immunity copes better with the virus. In general, this disease rarely goes away without any complications - in only 30% of cases. Neuralgic pains after the transferred virus can persist from six months to several years.

The consequences of herpes zoster can be very serious:

transverse myelitis with the transition to motor paralysis;
heart failure;
progression of oncological processes;
Ramsey-Hunt symptom: paralysis of facial muscles, complete or partial hearing loss;
damage to the oculomotor nerves;
brain damage: encephalitis, serous meningitis, meningoencephalitis;
blindness caused by retinal necrosis.

Improperly treated shingles can acquire a recurrent course with subsequent coverage of other nerve trunks. In addition to a neurologist and a skin dispensary, you must definitely visit an immunologist for a competent correction of immunity.

Vaccination

A live vaccine known as Zostavax has been proposed against the onset of the disease.

This vaccine rarely causes side effects, but is contraindicated in immunocompromised patients and may not be effective in patients taking antiviral drugs active against Varicella zoster virus. From an economic point of view, it is advisable to use it for patients over the age of 60.

In a Cochrane Library systematic review of eight randomized, placebo-controlled trials that enrolled 52,269 participants, Zostavax prevented one episode of shingles in older adults in every 70 people vaccinated, meaning it was effective in reducing the risk of shingles by up to 50%. The side effects caused by the vaccine were mainly mild to moderate symptoms at the injection site.

general infectious symptoms: fever, chills, intoxication;
skin lesions: blistering eruptions;
severe pain syndrome (which is explained by the fact that Varicella Zoster, being a dermatoneurotropic virus, penetrates the skin and mucous membranes, affects the spinal and cerebral ganglia, in severe cases - the anterior and posterior horns of the spinal cord and the brain - parts of the spinal cord, including . responsible for pain sensitivity).
there are several clinical varieties of herpes zoster

Herpes zoster (OH) can have a typical or atypical clinical presentation. The typical form of OH is characterized, as a rule, by unilateral localization within one dermatome. The lesions are represented by edematous erythema and vesicles with serous contents grouped against its background. Typical localization of rashes is most often the zone of innervation of the skin from the II thoracic segment to the II lumbar segment, but in children, the process may involve areas innervated by the cranial and sacral nerves. If the V pair of cranial nerves (trigeminal nerve) is damaged, its branches may be affected. With the involvement of the upper branch, skin changes are observed on the scalp, in the forehead, nose, eyes, with the defeat of the middle branch - in the cheeks, palate, with the defeat of the lower branch - in the lower jaw, on the tongue. With the defeat of the VII pair of cranial nerves (facial), rashes are observed in the external auditory canal. The emergence of atypical forms of OH is caused by pronounced disorders of immune reactivity and is accompanied by the appearance of hemorrhagic, ulcerative-necrotic (chronic ulcerative foci), gangrenous, bullous elements, as well as a tendency to dissemination - generalization.

high affinity for the thymidine kinase of the virus (100 times higher) and more pronounced blocking of viral replication between doses of the drug;
Famciclovir has the highest bioavailability (77% versus 10-20% for acyclovir) and the longest residence time in a virus-infected cell (up to 20 hours); [. ] Famciclovir has the ability to penetrate the Schwann cells surrounding nerve fibers;
a constant concentration of the drug in infected cells provides a long-term antiviral effect and makes it possible to take the drug less often (with herpes zoster - 500 mg every 8 hours - 3 times a day - for 7 days ... compare - acyclovir with shingles is taken at 0.8 g 5 times a day for 7 days);
famciclovir is the only antiviral drug that reduces the duration of postherpetic neuralgia in herpes zoster (100 days versus placebo).

(Russian Society of Dermatovenereologists, 2010) ... read

Case history for infectious diseases: Herpes zoster of the 1st branch of the right trigeminal nerve

Herpes zoster of the 1st branch of the right trigeminal nerve

Ischemic heart disease, NK I, hypertension stage II, non-insulin dependent diabetes mellitus type II, chronic atrophic gastritis, chronic cholecystitis, prostate adenoma

I. Passport part

Full Name: -

Age: 76 years (11/14/1931)

Permanent residence: Moscow

Date of receipt: 06.12.2007

Date of supervision: 10/19/2007 - 10/21/2007

II Complaints

Pain, hyperemia and multiple rashes in the forehead on the right, swelling of the upper eyelid of the right eye, headache.

III History of the present disease (Anamnesis morbi)

Considers himself ill since December 6, 2007, when for the first time, at night, there was a headache and swelling of the upper eyelid of the right eye. The next morning, the swelling increased, in the area of the right half of the forehead, hyperemia and a rash in the form of multiple vesicles were noted. Body temperature 38.2 ° C. Regarding the above symptoms, he called an ambulance and received an injection of analgin. In the evening of December 6, 2007, the patient was hospitalized in the Central Clinical Hospital of the UD RF No. 1.

IV Life Story (Anamnesis vitae)

Grew and developed normally. Higher education. Housing conditions are satisfactory, regular meals are full.

Bad habits: smoking, alcohol, drugs denies.

Past illnesses: childhood infections do not remember.

Chronic diseases: ischemic heart disease, NK I, hypertension stage II, non-insulin dependent diabetes mellitus type II, chronic atrophic gastritis, chronic cholecystitis, prostate adenoma

Allergic history: no intolerance to food, drugs, vaccines and serums.

V. heredity

The family denies the presence of mental, endocrine, cardiovascular, oncological diseases, tuberculosis, diabetes mellitus, alcoholism.

VI. Status praesens

The state of moderate severity, consciousness - clear, position - active, physique - correct, constitutional type - asthenic, height - 170 cm, weight - 71 kg, BMI - 24.6. Body temperature 36.7 ° C.

Pale pink healthy skin. The skin is moderately moist, the turgor is preserved. Male-type hair growth. Nails are oblong, without striation and brittleness, there is no symptom of "watch glasses". Visible mucous membranes are pale pink, moist, there are no rashes on the mucous membranes (enanthem).

Subcutaneous fat is moderately developed, the deposition is uniform. No edema.

The parotid lymph nodes on the right are palpable in the form of rounded, soft-elastic consistency, painful, mobile formations, measuring 1 x 0.8 cm. elbow, inguinal, popliteal lymph nodes are not palpable.

The muscles are well developed, the tone is symmetrical, preserved. The bones are not deformed, painless on palpation and tapping, there is no symptom of "drumsticks". The joints are not changed, there is no soreness, skin hyperemia, no swelling over the joints.

The shape of the nose is not changed, breathing through both nasal passages is free. Voice - hoarseness, no aphonia. The chest is symmetrical, there is no curvature of the spine. Breathing is vesicular, chest movements are symmetrical. NPV = 18 / min. Breathing is rhythmic. The chest is painless on palpation, elastic. Voice tremor is carried out equally on symmetrical sections. A clear pulmonary percussion sound is detected over the entire surface of the chest.

Circulatory system

The apical impulse is not visually determined, there are no other pulsations in the region of the heart. The boundaries of absolute and relative dullness are not shifted. Heart sounds are rhythmic, muffled, the number of heartbeats is 74 in 1 minute. Additional tones are not heard. are not listened to. The pulsation of the temporal, carotid, radial, popliteal arteries and arteries of the dorsum of the foot is preserved. The arterial pulse on the radial arteries is the same on the right and left, increased filling and tension, 74 in 1 minute.

Blood pressure - 140/105 mm Hg.

Digestive system

The tongue is pale pink, moist, the papillary layer is preserved, there are no plaques, cracks, ulcers. Symptom Shchetkin-Blumberg negative. On palpation, the abdomen is soft, painless. The size of the liver according to Kurlov: cm The edge of the liver is pointed, soft, painless. The gallbladder, the spleen is not palpable.

Urinary system

The tapping symptom is negative. Free, painless urination.

Nervous system and senses

Consciousness is not disturbed, oriented in the environment, place and time. Intellect is saved. Gross neurological symptoms are not detected. There are no meningeal symptoms, no changes in muscle tone and symmetry. Visual acuity is reduced.

Vii. Local status

The skin process of an acute inflammatory nature in the area of the right half of the forehead, right eyebrow, upper right eyelid. The rashes are multiple, grouped, not fused, evolutionarily polymorphic, asymmetrical, located along the first branch of the right trigeminal nerve.

Primary morphological elements - vesicles of a pale pink color, protruding above the surface of the hyperemic skin, 0.2 mm in diameter, hemispherical, with rounded outlines, blurred borders. The vesicles are filled with serous contents, the cover is dense, the surface is smooth.

Secondary morphological elements are crusts, small, rounded, 0.3 cm in diameter, serous, yellow-brown in color; after removal, weeping erosion remains.

Rashes are not accompanied by subjective sensations.

There are no diagnostic phenomena.

Hair without visible changes. Visible mucous membranes are pale pink, moist, no rashes. The nails of the hands and feet are not changed.

VIII. Data of laboratory and instrumental studies

1. General blood test from 07.12.2007: moderate leukocytopenia and thrombocytopenia

2.General urine analysis from 07.12.2007: within normal limits

3.Biochemical blood test from 12.12.2007: within normal limits

4. Wasserman's reaction from 10/12/2007 negative

IX. Clinical diagnosis and its rationale

Clinical diagnosis: Herpes zoster of the I branch of the right trigeminal nerve

The diagnosis is based on:

1. Complaints of the patient of pain, hyperemia and multiple rashes in the forehead on the right, edema of the upper eyelid of the right eye

2. History: acute onset of the disease, accompanied by symptoms of general intoxication (fever, headache)

3. Clinical picture: Multiple vesicles are located on the hyperemic skin along the first branch of the right trigeminal nerve, as a result of the evolution of which crusts are formed.

4. The presence of somatic diseases - diabetes mellitus, leading to impaired peripheral circulation and a decrease in local immunity

X. Differential diagnosis

Differential diagnosis is carried out with the following diseases:

1. Herpes simplex. Herpes simplex is characterized by relapses rather than an acute, sudden onset. As a rule, the age of manifestation of the disease is up to 40 years. Symptoms are less severe with herpes simplex. With herpes simplex, there are fewer rashes and their location along the nerve fibers is not characteristic.

2. Herpetiform dermatitis Dühring. With Duhring's dermatitis herpetiformis, polymorphism of the elements is observed, there are urticarial and papular elements that are not characteristic of herpes zoster. Dühring's dermatitis herpetiformis is a chronic recurrent disease. Pain syndrome and the arrangement of elements along the nerve fibers are not characteristic

3. Erysipelas. With erysipelas, the rash is distinguished by a more pronounced redness, a greater delimitation of edema from healthy skin, roller-like edges, uneven edges. The lesions are solid, the skin is dense, the rashes are not located along the nerves.

4. Secondary syphilis. With secondary syphilis, the Wasserman reaction is positive, the rashes are generalized, painless, true polymorphism is observed

XI. Treatment

1. General mode. It is necessary to consult a neurologist to determine the degree of damage to the I branch of the trigeminal nerve on the right.

Exclusion of irritating food (alcohol, spicy, smoked, salty and fried foods, canned food, chocolate, strong tea and coffee, citrus fruits).

3.1. Famvir (Famciclovir), 250 mg, 3 times a day for 7 days. Etiotropic antiviral treatment.

3.2. Salicylic sodium, 500 mg, 2 times a day. To relieve perineural edema.

3.3. Antiviral gamma globulin. 3 ml / m for 3 days. Immunostimulating, antiviral action.

Virolex (acyclovir) - eye ointment. Apply a thin layer to the affected eyelid 5 times a day for 7 days

5.1. Diathermy 10 sessions, 20 min. current strength 0.5A. Reducing irritation of the affected nerve

5.2. Laser therapy. Wavelength 0.89 μm (IR radiation, pulsed mode, LO2 laser emitting head, output power 10 W, frequency 80 Hz). The distance between the emitter and the skin is 0.5–1 cm. The first 3 procedures: exposure time to one field is 1.5–2 minutes. Then there are 9 procedures: exposure time to one field is 1 min.

Stimulating the immune system and reducing irritation of the affected nerve

6. Sanatorium treatment Consolidation of the results of therapy

Disease history

Herpes zoster, herpetic conjunctivitis and related diseases

The main diagnosis: Herpes zoster in the projection of the 1st branch of the V nerve on the right. Herpetic conjunctivitis.

Concomitant diagnosis: ischemic heart disease, exertional angina. Violation of the rhythm of the type of paroxysmal extrasystole.

Patient data

2. Age: 74 years (11/27/35)

3. Place of residence: Ryazan st. Berezovaya, 1 "B" apt. 61

4. Profession, place of work: pensioner

5. Date of illness: 30.09.10

6. Date of admission to the hospital: 2.10.10

7. Date of beginning and end of supervision: 6.10.10-12.10.10

At the time of supervision (6.10.10.-7th day of illness) the patient had no complaints.

morbi

She considers herself ill from 30.09.10, the first day of illness, when, after a bruised eyebrow, she noticed a red formation with a diameter of 0.2 mm. Swelling of the right eyelid and redness of the mucous membrane of the right eye also appeared. She notes a slight rise in temperature up to 38 C and itching. On 1.10.10, the second day of illness, erythema began to grow and already on 2.10.10, the third day of illness, it occupied the right half of the face. She turned to the emergency hospital for help, where she was diagnosed with facial erysipelas and the patient was sent to the infectious diseases department of the Semashko City Clinical Hospital. Hospitalized. 8.10.10-ninth day of illness, complaints of swelling of the right eyelid, headache. General condition is satisfactory, locally without dynamics. 10/11/10 - the general condition is satisfactory, complaints of swelling of the right eyelid. Local positive dynamics is noted. There are no new rashes, there are dried crusts in place of the old ones.

Epidemiological history

Everyone is healthy in the environment. 30.09.10 there was a bruise in the forehead as a result of a fall. He denies contact with infectious patients.

vitae

She was born in Ryazan. She grew and developed normally. Graduated

high school. Upon graduation, she entered the RRTI at the engineering faculty, after which she worked as an engineer at the SAM plant. From 1964 she worked as an engineer at the RSC GLOBUS. From 1990 to the present, he is retired. Material and living conditions are good, he eats 3 times a day, takes hot food.

Past diseases and operations:

Chickenpox, rubella, ARVI, ARI. Cholecystectomy in 1998. Mastectomy in 2010.

Family life: married, has 2 children.

Obstetric and gynecological history: menstruation from 15 years, from 1988 menopause. Pregnancy-2, childbirth-2.

Heredity: grandmother suffers from hypertension.

Allergic history: she denies allergic reactions to odors, foods, drugs and chemicals.

praesens

1. General state: satisfactory

2. Patient position: active

3. Consciousness: clear

4. Body type: normosthenic: the epigastric angle is approximately 90o. Height 162 cm, weight 59 kg.

Nutrition: normal, skinfold thickness 0.5 cm

5. Leather: normal color, elastic, reduced skin turgor, moderately moist. There are no hemorrhages, scratches, scars, spider veins, or angiomas. In the area of the right half of the forehead and scalp, edema, infiltration, hyperemia of the skin. Against this background, small group vesicular elements.

6. Mucous membranes: the condition of the nasal mucosa is satisfactory, the oral mucosa and hard palate are of normal color. The gums are not bleeding or loosened. The tongue is of usual shape and size, moist, coated with white bloom, the severity of the papillae is within normal limits. There are no cracks, bites, sores. The mucous membrane of the pharynx is normal in color, moist, there are no rashes and deposits. In the area of OD, the conjunctiva is edematous and hyperemic.

8. Subcutaneous tissue: the development of subcutaneous adipose tissue is moderate. The thickness of the skin fold in the region of the triceps muscle of the shoulder, scapula, under the collarbone is 0.5 cm. No edema. The saphenous veins are hardly noticeable, there are no subcutaneous tumors.

9. Lymphatic system: lymph nodes: (occipital, parotid, submandibular, axillary, inguinal, popliteal) - not enlarged (in the form of peas), painless, normal density, mobile,

10. Muscular system: moderately developed, there is no pain on palpation, no differences in diameter were found when measuring the limbs, the muscles are in good tone. There is no involuntary muscle tremor.

12. Osteoarticular apparatus: pain on palpation, no bone percussion, joints of normal shape, painless, the skin above them is unchanged. The movements in the joints are preserved in full, without crunching, free. There is no pain on palpation of the joints. The skin temperature over the joints is not changed. Gait is normal. Spine. Mobility in all parts of the spine is not limited. Flexion of the trunk forward in the sitting position is not limited. There is no pain on palpation. The range of motion is performed.

Research of the cardiovascular system

Examination of the heart area.

The shape of the chest in the region of the heart is not changed. The apical impulse is visually and palpable in the 5th intercostal space, 1.5 cm medially from the linea medioclavicularis sinistra, enhanced, with an area of 1.5 cm. The cardiac impulse is not palpable. Feline purring in the second intercostal space on the right at the sternum and at the apex of the heart is not defined. There is no "dance of carotids". Physiological epigastric pulsation is palpated. On palpation, the pulsation in the peripheral arteries is preserved and is the same on both sides.

On palpation of the radial arteries, the pulse is the same on both hands, synchronous, rhythmic, with a frequency of 84 beats per minute, satisfactory filling, not tense, the shape and size of the pulse are not changed. There are no varicose veins.

Borders of relative cardiac dullness

The right border is determined in the 4th intercostal space - 2 cm outward from the right edge of the sternum; in the 3rd intercostal space 1.5 cm outward from the right edge of the sternum.

The upper border is defined between linea sternalis and linea parasternalis sinistra at the level of the 3rd rib.

The left border is defined in the 5th intercostal space 1.5 cm outward from the linea medioclavicularis sinistra; in the 4th intercostal space 1.5 cm outward from the linea medioclavicularis; in the 3rd intercostal space 2 cm outward from the parasternalis sinistra line.

The boundaries of absolute cardiac dullness

The right border is defined in the 4th intercostal space 1 cm outward from the left edge of the sternum.

The upper border is defined on the 3rd rib, between linea sternalis and parasternalis.

The left border is defined at 0.5 cm medially from the left border of relative cardiac dullness.

The vascular bundle is located - in the 1st and 2nd intercostal space, does not go beyond the edges of the sternum.

On auscultation of the heart, clear heart sounds are heard. Rhythm disorders of the type of paroxysmal extrasystole. Bifurcation, splitting of tones is not present. Pathological rhythms, heart murmurs and pericardial friction murmur are not detected. Blood pressure at the time of examination was 125/80.

Respiratory system

The rib cage is of the correct shape, normosthenic type, symmetrical. Both halves of it evenly and actively participate in the act of breathing. The type of breathing is chest. Rhythmic breathing with a frequency of 17 respiratory movements per minute, medium depth.

The chest is painless, rigid. The voice shake is the same on both sides.

Shingles

Complaints of the patient upon admission to inpatient treatment for pain, hyperemia and multiple rashes in the area of the left half of the tongue, lower lip, chin. Data from the examination of the patient's organs. Rationale for the clinical diagnosis: shingles.

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Ministry of Health of the Russian Federation

State budgetary educational institution

higher professional education

Sechenov First Moscow State Medical University

Department of Therapeutic Dentistry

B02 - Shingles

5th year student of 4 groups

Patient's full name: ______

Address, phone: Moscow, _____

Born in 1982

Date of treatment: 10/27/2015

Patient questioning data

Complaints: Pain, hyperemia and multiple rashes in the left half of the tongue, lower lip, chin. Pain radiates to the left ear, food intake is difficult.

Development of the present disease: Considers himself ill for about 2 days, when a sharp pain appeared in the tongue, the left side of the face. More than 1 week ago there was a slight runny nose and cough. She was not treated, looked after her son, sick with chickenpox. I have not seen such rashes before.

Anamnesis of the patient's life

Place of birth: Moscow, Russian Federation.

Past diseases: according to the patient's injuries, there were no operations. Chickenpox at 10 years old.

Hereditary history: according to the patient, there are no hereditary diseases.

Allergic history: not burdened.

Objective research data

General condition: Chills, malaise, headache. Body temperature 38.9 ° C.

Facial examination: The configuration of the face has not been changed. On the skin of the chin and the red border of the lower lip on the left, there are multiple bubbles arranged in a chain. Some of the vesicles are opened, covered with yellowish crusts.

Mouth opening: free

Examination of the lymph nodes: the submandibular lymph nodes on the left are enlarged to 1 cm, painful on palpation, mobile.

Oral examination

Upper and lower lip bridle attachment: within the physiological norm.

The state of the oral mucosa: On the mucous membrane of the lower lip, cheek, lateral surface of the tongue on the left, there are multiple small-point and extensive erosions with scalloped edges on a hyperemic background, covered with fibrinous bloom, sharply painful on palpation.

Examination of the dentition

Anomalies in the shape, position and size of the teeth were not found. Non-carious lesions of the teeth (hypoplasia, fluorosis, wedge-shaped defect, erasure) are absent.

In area 3.1 3.2 4.1 4.2 there is a light brown supragingival calculus. In the area of the teeth 1.7 1.6 1.5 1.4 2.4 2.5 2.6 2.7 there is a large amount of soft plaque.

supragingival calculus

B02 Shingles

K03.6 Deposits on teeth

K02.1 Dentin caries - tooth 28

The diagnosis was made on the basis of the patient's complaints, the peculiarities of the development of the disease, the results of external examination and examination of the oral cavity, the main research methods.

Rationale for the clinical diagnosis

1) the disease was preceded by ARVI;

2) contact with a patient with chickenpox;

3) in the prodromal period, an increase in body temperature, malaise, headache;

4) neuralgic pain along the third branch of the trigeminal nerve on the left;

5) unilateral (asymmetric) lesions;

6) sequential rashes: hyperemia (spot), vesicle, erosion, crust;

7) on the mucous membrane, merged erosion with scalloped edges;

8) the disease has arisen for the first time;

9) lack of intolerance to drugs

Shingles with damage to the third branch of the trigeminal nerve on the left

Medical treatment of erosions with 1% solution of hydrogen peroxide was carried out under application anesthesia "Lidoxor-gel", soft dental plaque was removed. Valacyclovir was applied under the Diplen-Dent film.

General treatment was prescribed:

Antiviral drugs - Herpevir 200 mg 4 times a day after meals for 5 days.

Effective use of deoxyribonuclease (50 mg. 2-3 r per day intramuscularly)

Analgesics and non-steroidal anti-inflammatory drugs - ibuprofenpomg two to three times a day for five days.)

Vitamin preparations - vitamin B-І2 - cyanocobalamin in pomkg injections daily or every other day, the course of treatment is up to 2 weeks;

Interferon inducers - poludan, 2 drops in each nostril 5 times a day

Antihistamines: claritin (cetrin, loratadine) 1 tab. 2-3 times a day.

Examination data: Regression of the inflammatory process, positive dynamics in the healing of erosions.

Under application anesthesia Lidoxor-spray 15%, an antiseptic treatment of the oral cavity with a solution of hydrogen peroxide 1% was carried out, the application of "Solcoseryl" (dental adhesive paste) was carried out.

Examination data: Residual pigmentation is observed on the skin, slight paresthesia in the chin and lower lip, complete healing of the mucous membrane in the oral cavity.

10/27/2015 The patient complains of pain, hyperemia and multiple rashes in the area of the left half of the tongue, lower lip, chin. Pain radiates to the left ear, food intake is difficult. When collecting anamnesis, it was found that the development of the disease was preceded by contact with a patient with chickenpox, as well as a sharp pain in the tongue, left side of the face. More than 1 week ago there was a slight runny nose and cough. Examination: On the skin of the chin and the red border of the lower lip on the left, there are multiple rashes located in the form of a chain. Erosions are covered with crusts, located on a hyperemic background. Body temperature 38.9 ° C. On the mucous membrane of the lower lip, cheek, lateral surface of the tongue on the left, there are multiple small-point and extensive erosions with scalloped edges on a hyperemic background, covered with fibrinous plaque, sharply painful on palpation. Area 42 has a supragingival tartar of light brown color.

Diagnosis: Shingles with damage to the third branch of the trigeminal nerve on the left

Treatment: Prescribed general treatment in the form of admission: herpevir 200 mg 4 times a day after meals for 5 days; ibuprofen pomg two to three times a day for five days, vitamin B-І2 - cyanocobalamin in pomkg injections daily or every other day, a course of treatment up to 2 weeks; poludan, 2 drops in each nostril 5 times a day, Claritin (cetrin, loratadine), 1 tab. 2-3 times a day.

Local: Medical treatment of erosions with 1% solution of hydrogen peroxide was carried out under application anesthesia "Lidoxor-gel", soft dental plaque was removed. Valacyclovir was applied under the Diplen-Dent film. Recommendations: Applications "Kamistad-gel", oral hygiene with a soft toothbrush, re-examination after 3 days.

10/30/2015 On examination: Regression of the inflammatory process, positive dynamics in the healing of erosions.

Local treatment was carried out: under application anesthesia Lidoxor-spray 15%, antiseptic treatment of the oral cavity with 1% hydrogen peroxide solution, application of "Solcoseryl" (dental adhesive paste) was carried out.

11/13/2015 On examination: There is residual pigmentation on the skin, slight paresthesia in the chin and lower lip, complete healing of the mucous membrane in the oral cavity. Recommendations: Carry out antiherpetic vaccination, avoid contact with patients with chickenpox, in autumn and spring it is recommended to take a multivitamin complex ...

The prognosis of the disease is favorable. Relapse is unlikely.

Herpes zoster disease history

The main disease is Herpes zoster in the innervation zone of Th 3 -Th 7 on the left; common ganglionic form with the addition of a secondary infection.

3. Age - 67 years old

4. Permanent residence - Rep. Ingushetia, Karabulak

5. Profession - pensioner

COMPLAINTS (upon admission) for: intense burning pain in the left side of the chest, skin rashes, general weakness.

HISTORY OF THE PRESENT DISEASE (Anamnesis morbi)

Considers himself sick since December 4, 2010, when, 2 days after hypothermia, nausea, weakness, a rise in body temperature to 38 ° C in the morning, stabilization to 36.6 ° C in the evening, pain in the left side of the chest, the next day bubble eruptions appeared on the skin of the chest on the left. She was treated on an outpatient basis. Topically applied rubbing, chlorhexidine, triderm, moisturizer; inside - no-shpa, Voltaren, antibiotic (she does not remember the name) - without a significant effect, severe pains persisted in the area of rashes, weeping crusts appeared. Sent for a consultation with an infectious disease doctor, on December 19 she was hospitalized in the infectious diseases department of the Central Clinical Hospital of the Administrative Department of the Russian Federation for examination and treatment.

Does not work, does housework. Housing and living conditions are satisfactory. Departures outside the place of residence (over the past 2 years), contacts with sick people and animals, parenteral manipulations (over the past 6 months) denies.

LIFE STORY (Anamnesis vitae)

She was born in 1943, grew and developed normally.

Past diseases: chickenpox in childhood, myocardial infarction in 1975 after a spontaneous abortion, stapedoplasty for otosclerosis on the right and left (gg), chronic cholecystitis, chronic pancreatitis.

Heredity and family history: father died in middle age, the cause was heart disease (does not remember nosology), mother died at an advanced age from heart failure (does not know the etiology), relatives are healthy, five pregnancies, four children, children are healthy.

Diet: regular, complete, balanced diet.

Bad habits: smoking, alcohol and drug use denies.

Allergic history and drug intolerance: not burdened.

PRESENT STATE (Status praesens)

on admission, the state of moderate severity, satisfactory at the time of supervision

Mental state: not changed

The position of the patient: sitting, stiffness in the movements of the left arm and bends.

Body type: normosthenic type, height 165 cm, weight 55 kg (BMI = 20.2), stooped posture, slow gait.

Body temperature: 36.6 o C.

Facial expression: calm.

Skin: swarthy; on the skin of the left half of the chest in the area of innervation of Th 3 -Th 7, against the background of hyperemia, there are draining weeping crusts and erosion with scanty purulent discharge. The skin is dry, the turgor is reduced.

Nails: regular shape (there are no "watch glasses" and no koilonychia), pink, no striation.

Visible mucous membranes: pink, moist; sclera pale; there are no rashes and defects;

Hair type: female.

Subcutaneous fat: moderately developed, painless on palpation.

Lymph nodes: occipital, parotid, submandibular, cervical, supraclavicular, subclavian, axillary, elbow, inguinal and popliteal lymph nodes are not palpable.

Muscles: poorly developed. The tone is normal. There is no pain and seals on palpation.

Bones: deformities and tenderness on palpation, no effleurage.

Joints: the configuration is not changed, painless on palpation. Swollen feet and legs; there is no hyperemia. The movements are painless, their limitations are not observed.

Nose: the shape of the nose is not changed, breathing through the nose is free.

Larynx: no deformities and swelling in the larynx region; the voice is quiet, clear.

Chest: the shape of the chest is normosthenic. Symmetrical. The supraclavicular and subclavian fossa are pronounced. The width of the intercostal spaces is moderate. Epigastric angle 90 °. The shoulder blades and collarbones are moderately protruding. The shoulder blades fit snugly against the chest. There is no deformity of the spinal column.

Breathing: chest type. The number of respiratory movements is 18 per minute. Breathing is rhythmic, of the same depth and duration of the inhalation and exhalation phases. Both halves evenly participate in the act of breathing.

Palpation: Painless. Rigid.

Percussion of the lungs: difficult on the left due to severe pain in the area of skin lesions.

With comparative percussion: a clear pulmonary sound is heard over symmetrical areas of the lungs.

Herpes zoster: Aia's case history

Shingles - Treatment and Rehabilitation

Shingles treatment

Homeopathic treatment for shingles

Before starting homeopathic treatment

Blisters, severe pain and itching in the back, shoulders, upper chest. Even after the blisters disappear, he suffers from pain for a long time.

Homeopathic Treatment Results

Complete recovery, blisters, itching and pain are gone.

bring back the hope of restoring health and joie de vivre.

SHINGLES

About article

For citation: Korsunskaya I.M. Shingles // RMZH. 1998. No. 6. P. 10

Key words: Herpes - virus - nervous system - ganglia - sensitivity - antiviral agents - methisazone - acyclic nucleotides - analgesics.

Shingles is a common viral disease, especially against the background of immunosuppression. Diagnosis is based on clinical presentation. Treatment should be comprehensive and include antiviral drugs, ganglion blockers, analgesics.

Key words: Herpes - virus - nervous system - ganglia - antiviral agents - methisazone - acyclic nucleosides - analgetics.

Herpes zoster is a viral disease that is most common especially in immunodeficiency. The diagnosis is based on its clinical manifestations. Treatment should be combined and include antiviral, ganglion-blocking, and analgetic agents.

THEM. Korsunskaya - Cand. honey. Sci., Assistant, Department of Dermatovenereology, Russian Medical Academy of Postgraduate Education

I.M. Korsunskaya, Candidate of Medical Sciences, Assistant, Department of Dermatovenereology, Russian Medical Academy of Postgraduate Training

Zoster zoster (Herpes zoster) is a common viral disease that attracts the attention of not only dermatologists, neuropathologists and virologists, but also doctors of other specialties.

The history of this disease has a long history, but only at the end of the last century, neuropathologists Erb (1893) and Landori (1885) first suggested the infectious genesis of Herpes zoster, which was confirmed by the following clinical data: fever, cyclic course, disease of two members of the same family and more. The virus (Varicella zoster - VZ) belongs to the group of DNA viruses. The size of the virus is from 120 to 250 microns. The nucleus of the virion is made up of DNA coated with protein. The virion contains more than 30 proteins with a molecular weight of up to 2.9 10 daltons. Viruses of this group begin to reproduce in the nucleus. In the cross-sectional neutralization tests performed by Taylor-Robinson (1959), the varicella-zoster virus and the Herpes zoster virus were equally neutralized by convalescent sera. At the same time, sera taken from patients with Herpes zoster in the acute period had a greater neutralizing activity than sera taken at the same time from patients with chickenpox. A. K. Shubladze and T. M. Mayevskaya believe that this is apparently due to the fact that Herpes zoster is a secondary manifestation of the infection caused by the varicella-zoster virus. Most modern researchers believe the VZ virus is the cause of this disease.

To understand the pathogenesis of Herpes zoster, the data of pathoanatomical studies are important, indicating a connection between the sites of the rash with the defeat of the corresponding ganglia. Later, Head and Campbell (1900), on the basis of histopathological studies, came to the conclusion that both neurological phenomena in Herpes zoster and the areas of skin rashes that characterize them arise as a result of the development of a pathological process in the intervertebral nodes and their homologues (gasser's node, etc.) ... But already Volville (1924), having studied the nervous system of patients who died from the generalized form of Herpes zoster, came to the conclusion that the defeat of the intervertebral ganglia in Herpes zoster is not necessary. The spinal cord is often involved in the inflammatory process, and not only the posterior horns are affected, but also the anterior ones. Volville and Shubak (1924) described cases when herpetic eruptions were the first manifestations of a polyneurotic process proceeding according to the type of Landry's paralysis. Wolville believes that the inflammatory process first affected the sensitive neurons, and then spread to the spinal segments and peripheral nerves. In the case described by Shubak, in the pathological examination, nests of inflammatory infiltration were found in the sciatic nerves, cervical sympathetic nodes and the corresponding spinal ganglia, posterior horns of the spinal cord.

Stamler and Stark (1958) described the histological picture of fulminant ascending radiculomyelitis zoster, in which death occurred as a result of bulbar and spinal respiratory paralysis. Demyelination of the conductors of the spinal cord with glial and lymphocytic reactions, perivascular infiltration and proliferation, changes in the neurons of the spinal ganglia, posterior horns and posterior roots were found.

In 1961 Cro, Dunivitz and Dalias reported seven cases of Herpes zoster with central nervous system involvement. The disease proceeded in the form of aseptic meningitis, meningoencephalitis with involvement of cranial nerves, encephalomyelitis, polyradiculoneritis. A histopathological examination revealed a picture of "posterior poliomyelitis". The authors consider it sufficient for the histological diagnosis of Herpes zoster, when the disease proceeds without clear herpetic eruptions.

Pathological and virological studies indicate that the Herpes zoster virus is widely disseminated throughout the body: during an illness it can be isolated from the contents of vesicles, saliva, lacrimal fluid, etc. This suggests that herpetic eruptions can be caused not only by sedimentation virus in sensitive ganglia and damage to the parasympathetic effector cells located in them, but also by its direct introduction into the skin. Penetrating into the nervous system, it is not only localized within the peripheral sensory neuron (spinal ganglia, etc.), but also spreads to other parts of the central nervous system. When it is introduced into motor cells and roots, a picture of amyotrophic radiculoplexitis arises, into the gray matter of the spinal cord - myelitic syndrome, into the cerebrospinal fluid system - meningoradiculoneuritis or serous meningitis, etc.

The clinical picture of Herpes zoster consists of skin manifestations and neurological disorders. Along with this, in most patients, general infectious symptoms are observed: fever, an increase in hormonal lymph nodes, a change (in the form of lymphocytosis and monocytosis) of the cerebrospinal fluid. Usually, erythematous spots of a round or irregular shape, raised, erythematous are found on the skin, when held with a finger, a certain shagreen appearance of the skin (tiny papules) is felt. Then, in these areas, groups of bubbles appear sequentially, often of different sizes. Vesicles can merge, but most often they are located in isolation, although close to one another - the vesicular form of Herpes zoster. Sometimes they look like a small bubble surrounded on the periphery with a red rim. Since the rash occurs simultaneously, the elements of the rash are at the same stage in their development. However, the rash may appear in separate clusters within 1 to 2 weeks. In the latter case, when examining the patient, you can find rashes of various stages. In typical cases, the bubbles at first have a transparent content, quickly turning into cloudy, and then dry up into crusts. A deviation from the described type is the milder abortive form of Herpes zoster. With this form, papules also develop in the foci of hyperemia, which, however, do not transform into vesicles, this is how this form differs from vesicular. Another variety is the hemorrhagic form of Herpes zoster, in which the vesicles have a bloody content, the process extends deep into the dermis, the crusts become dark brown in color. In severe cases, the bottom of the vesicles is necrotic - the gangrenous form of herpes zoster, after which cicatricial changes remain. The intensity of the rashes in this disease is very variable: from confluent forms, which almost do not leave healthy skin on the affected side, to individual vesicles, although in the latter case, the pain can be sharply expressed. Such cases gave rise to the assumption that Herpes zoster could exist without a skin rash.

One of the leading symptoms of the disease is neurological disorders, usually in the form of pain. Most often it occurs 1 to 2 days before the appearance of the rash. The pains, as a rule, are of an intense burning character, the zone of their distribution corresponds to the roots of the affected ganglion. It should be noted that the pain syndrome intensifies at night and under the influence of a variety of stimuli (cold, tactile, kinesthetic, barometric) and is often accompanied by hypertensive-type vegetative-vascular dystonia. In addition, patients have objective sensory disorders: hyperesthesia (the patient can hardly tolerate the touch of linen), hypoesthesia and anesthesia, and hyperalgesia may exist simultaneously with tactile anesthesia.

Objective sensory disorders are variable in form and intensity, usually limited to temporary sensory disorders in the area of rash or scarring. Anesthesia concerns all types of sensitivity, but in some cases a dissociated type of disorder is observed; sometimes within the same type of sensitivity, such as hot and cold. Occasionally, hyperesthesia takes on the character of irritation in the form of causalgia.

In all cases, the intensity of the pain syndrome corresponds to the severity of the skin manifestations. In some patients, despite the severe gangrenous form of the disease, pain is insignificant and short-term. In contrast, a number of patients have a long-term intense pain syndrome with minimal skin manifestations.

Some patients in the acute phase have diffuse cephalalgia, aggravated by a change in the position of the head, which is possibly associated with a meningeal reaction to Herpes zoster infection. In the literature, there are indications of damage to the brain and its membranes.

According to a number of authors (A.A. Kalamkaryan and V.D.Kochetkov 1973; M.K. Zucker 1976, etc.), herpetic ganglionitis of the Gasser's node is more common than ganglionitis of the intervertebral nodes. In most patients with this localization of the process, there is an increase in temperature and swelling of the face on the affected side, as well as soreness at the points of exit of the trigeminal nerve.

The cornea is often affected in the form of keratitis of various kinds. In addition, other parts of the eyeball are affected (episcleritis, iridocyclitis, iris zoster). The retina is very rarely involved (hemorrhage, embolism), more often the changes concern the optic nerve - optic neuritis with an outcome in atrophy, possibly due to the transition of the meningeal process to the optic nerve. With ophthalmic herpes (iritis), glaucoma may develop; usually, with zoster, gynotension of the eyeball is observed, which is apparently caused by damage to the ciliary nerves. Complications with zoster from the motor nerves are quite common, they are located in the following order: III, IV, VI nerves. From the branches of the oculomotor nerve, both external and internal branches are affected. Ptosis is common. Skin rashes in ophthalmic heath are usually more severe than on other parts of the body, possibly depending on the structure of the skin around the eye. Quite often, vesicle necrosis, severe neuralgia, accompanied by lacrimation, are observed. Bubbles are poured out not only on the skin, but also on the mucous membranes of the eye.

As a result of the process in the cornea with ophthalmic zoster, atrophy of the optic nerve and complete blindness can develop. In addition, in some patients, loss of eyebrows and eyelashes is noted on the affected side.

The maxillary branches of the trigeminal nerve are affected both in the area of the skin and in the area of the mucous membranes (half of the hard and soft palate, the palatine curtain, the upper gum, the inner surface of the buccal mucosa, while the nasal mucosa may remain unaffected). The branches supplying the mucous membranes may be more affected than the branches of the skin, and vice versa. Damage to the nerves of the upper and lower jaws does not always remain strictly localized, since pain sometimes radiates to the area of the ophthalmic and other branches.

In Herpes zoster, the autonomic nervous system is usually affected. However, clinical observations have shown that the animal nervous system can also be involved in the pathological process. Evidence of this is that in some patients, simultaneously with the defeat of the Gasser's node, there was a peripheral paresis of the facial nerve on the side of herpetic eruptions. With ophthalmic zoster, both the external and internal muscles of the eye are paralyzed. Paralysis of the IV pair is rare. Oculomotor palsies are usually partial rather than complete; more often other muscles are affected by m. levator palpebrae. There are cases of ophthalmic zoster with an isolated change in the shape and size of the pupil; unilateral symptom of Ardzhil - Robertson (Guillen). These paralysis sometimes partially or completely go away spontaneously, without special treatment.

And the defeat of the geniculate node in this form of Herpes zoster was first pointed out by Nordahl (1969). Usually herpetic eruptions appear on or around the auricle, and sometimes in the ear canal and even on the eardrum. There is a sharp soreness in the circumference of the auricle, swelling of the lymph nodes, impaired sensitivity. Dysfunctions of the facial, cochlear, vestibular nerves occur in the first days of the rash or precede them. Pain in such cases is localized in the depths of the ear canal and auricle with irradiation to the mastoid, auricular and temporoparietal regions. Objective sensory disorders are found behind the ear, in the fold between the auricle and the mastoid process. This cutaneous area is supplied with the X ear branch of the pair, which innervates the posterior walls of the ear canal. Finally, in cases of a very common ear zoster, the latter captures not only the external auditory canal, the auricle, the mastoid process, but also the eardrum, which sometimes suffers extremely severely. In such cases, the area innervated by pairs V, VII and X is affected, and the defeat of these nerves is accompanied by damage to the ganglia of the corresponding cranial nerves or the anastomoses connecting the terminal branches of all of the listed nerves.

Often, simultaneously with the paralysis of the VII couple, paralysis of the soft palate, anesthesia and paresthesia in the tongue, often a taste disorder in the anterior two-thirds of the tongue due to damage, is observed. The defeat of the Vlll pair usually begins with tinnitus, which sometimes persists for a long time after the disappearance of other phenomena. Hyperacusis with the defeat of the VIII pair is called paresis n. stapeblii, although this symptom can also occur with isolated and previous lesions of the auditory nerve and is in such cases a symptom of irritation. Hypoacusia can occur regardless of damage to the auditory nerve due to local lesions of the middle ear, eruption of vesicles on the tympanic membrane, laying of the external auditory canal, due to swelling of the mucous membrane on the basis of a rash of zoster.

Vestibulatory phenomena, in contrast to cochlear ones, usually develop extremely slowly and are expressed in different ways: from mild subjective symptoms of dizziness to significant static disorders.

Neuralgia with ear zoster, in contrast to ophthalmic, is rare.

Long-term results are not always favorable, as persistent paresis of the facial nerve and deafness may occur.

Volville emphasizes that the combination of paralysis of VlI and VIII pairs, although it occurs especially often with zoster, nevertheless also occurs with damage to the Gasser's node, ll, lll, cervical ganglia, and, finally, all these areas can be affected simultaneously.

Zoster rashes are also described in the area of innervation of the IX pair: the posterior part of the soft palate, arch, posterolateral parts of the tongue, part of the posterior pharyngeal wall; the same area is innervated, except for IX, also by the branches of the X pair: the root of the tongue, larynx, padglottis, basal and posterior part of the pharyngeal wall. Although zoster predominantly and even electively affects sensitive systems, nevertheless, movement disorders are sometimes observed with it, especially when localized rashes in the head, neck, and extremities. Paralysis with zoster are radicular in nature, and the defeat of the posterior roots in these cases is accompanied by phenomena from the side of the corresponding anterior roots.

The defeat of the cervical sympathetic nodes is often accompanied by a rash on the skin of the neck and scalp. In this case, pain is observed not only in the places of the rash, but also in the area of the paravertebral points. Occasionally, seizures mimicking facial sympathies may occur.

With ganglionitis of the lower cervical and upper thoracic localization, along with the usual symptoms of this disease, Steinbrocker syndrome can be observed. Dominant in the picture of this syndrome are pains of a sympathetic nature in the form of burning or pressure, arising from the origin in the hand, and then in the entire arm. Soon, swelling of the hand appears and rapidly grows, extending to the entire arm. Trophic disorders join in the form of cyanosis and thinning of the skin, hyperhidrosis, brittle nails. The movements of the fingers of the hand are limited, painful. Often, pain and other autonomic disorders persist even after the rash has disappeared. Thoracic ganglionitis often simulates the clinical picture of myocardial infarction, which leads to errors in diagnosis.

With herpetic lesions of the ganglia of the lumbosacral region, most often the rash is localized on the skin of the lower back, buttocks and lower extremities; along with pains at the sites of rashes, pain syndromes may occur that simulate pancreatitis, cholecystitis, renal colic, appendicitis. Herpetic lesions of the lumbosacral ganglia are sometimes accompanied by the involvement of the animal nervous system in the process, which gives a picture of ganglioradiculitis (Nori's, Matskevich's, Wasserman's radicular syndrome).

Sometimes, along with rashes along the nerve trunk, vesicular rashes appear throughout the skin - a heperalized form of shingles. Usually the disease does not recur. However, it is known from the literature that there are recurrent forms of the disease against the background of somatic burden: HIV infection, cancer, diabetes mellitus, lymphogranulomatosis, etc.

In the treatment of Herpes zoster of various localization and severity, early prescription of antiviral drugs is necessary. It is known that the virus contains proteins that form its envelope and carry an enzymatic function, as well as nucleic acid - the carrier of its genetic properties. Penetrating into cells, viruses are freed from the protein protective envelope. It was shown that at this moment it is possible to inhibit their reproduction with the help of nucleases. These enzymes hydrolyze viral nucleic acids without damaging the nucleic acids of the cell itself. It was found that pancreatic deoxyribonuclease sharply inhibits the synthesis of DNA-containing viruses, such as herpes viruses, vaccinia, adenoviruses. Considering the above, patients with Herpes zoster are recommended to prescribe deoxyribonuclease intramuscularly 1 - 2 times a day, 30 - 50 mg for 7 days. In addition, in patients with rashes on the oral mucosa, conjunctiva and cornea, the drug is used topically in the form of an aqueous solution. The appointment of deoxyribonuclease contributes to the rapid regression of skin rashes and a decrease in pain.

Good results are obtained with the use of methisazone. It is administered orally at the rate of 20 mg per 1 kg of the patient's body weight per day in 3 divided doses after meals for 6 to 7 days. The drug is contraindicated in severe liver and kidney damage, gastrointestinal diseases in the acute stage. It is not recommended to take alcoholic beverages during treatment. No complications were observed when using the drug.

Metisazone does not affect the adsorption of the virus by the cell and its penetration into the cell. It does not affect the synthesis of viral DNA and does not disrupt the synthesis of many viral proteins. The drug apparently interferes with the synthesis of late proteins that go on to build a viral particle. It has also been suggested that methisazone induces the formation of new ribonucleic acid in the cell, which ensures the synthesis of a protein with antiviral properties. When administered orally, methisazone can be detected after 30 - 40 minutes in the blood serum, and after 2 - 3 hours - in the urine.

In recent years, antiviral chemotherapy drugs from the group of synthetic acyclic nucleosides have been used to treat Herpes zoster. The most well-studied at present is acyclovir. The mechanism of action of acyclovir is based on the interaction of synthetic nucleosides with replication enzymes of herpes viruses. Herpesvirus thymidikinase is thousands of times faster than cellular one, binds to acyclovir, so the drug accumulates almost only in infected cells. This explains the complete absence of cytotoxic, terratogenic and mutagenic properties in acyclovir. A synthetic nucleoside is lined up in a chain of DNA under construction for "daughter" viral particles, and this process is interrupted, thus the reproduction of the virus stops. The daily dose of acyclovir for shingles is 4 g, which should be divided into 5 single doses of 800 mg each. The course of treatment is 7-10 days. The best therapeutic effect is achieved with early prescription of the drug; the terms of rashes are reduced, crusts form rapidly, intoxication and pain syndrome decrease.

Acyclovir of the second generation - valacyclovir, retaining all the positive aspects of acyclovir, due to the increased bioavailability, allows to reduce the dose to 3 g per day, and the number of doses - up to 3 times. The course of treatment is 7-10 days.

Famciclovir has been used since 1994. The mechanism of action is the same as that of acyclovir. The high affinity of the thymidine kinase of the virus for famciclovir (100 times higher than the affinity for acyclovir) makes the drug more effective in the treatment of shingles. The drug is prescribed at 250 mg 3 times a day for 7 days.

Along with antiviral drugs, ganglion blockers such as gangleron are used to reduce pain. Gangleron is used intramuscularly in the form of a 1.5% solution of 1 ml once a day for 10-15 days or 0.04 g in capsules 2 times a day for 10-15 days, depending on the severity of the pain syndrome. In addition, the use of carbamazepine gives good results, especially with Herpes zoster of the gasser's node, the drug is prescribed with 0.1 g 2 times a day, increasing the dose by 0.1 g per day, if necessary, up to 0.6 g of the daily dose (in 3 - 4 receptions). After reduction or disappearance of pain, the dose is gradually reduced. Usually the effect occurs within 3 - 5 days after the start of treatment.

With a pronounced pain syndrome, analgesics are prescribed per os and in the form of injections, reflexology. In reflexology, both points of general action and points, respectively, of the affected ganglion are usually used, the course is 10 - 12 sessions. It is also recommended to prescribe multivitamins, in particular vitamins of group B. Locally, you can use irrigation with interferon or ointment with interferon, aniline dyes, aerosol eridine, ointment florenal, helepin, alpizarin. For gangrenous forms of herpes zoster, pastes and ointments containing an antibiotic, as well as solcoseryl, are used.

After resolution of skin rashes, treatment is carried out by neuropathologists until the neurological symptoms disappear.

Thus, the treatment of herpes zoster should be comprehensive and include both etiological and pathogenetic agents.

1. Barinsky I.F., Shubladze A.K., Kasparov A.A., Grebenyuk V.N. - "Herpes". - M. - 1986.

2. Shishov A.S., Leshinskaya E.V., Martynenko I.N. - Journal of Clinical Medicine. - 1991. - No. 6. - S. 60–72.

3. Batkaev E.A., Korsunskaya I.M. - Viral dermatoses. - M. - 1992.

Vaccination is the creation of stable immunity against infection. However, it is possible to vaccinate a patient with herpes zoster only if the period without exacerbations is at least two months. Therefore, if a person has rather frequent exacerbations, then with the help of immunomodulatory drugs, it is necessary to bring the patient's health to such a level that the period of remission is at least two months.

However, it should be noted that all patients suffering from herpesvirus infection are prescribed a blood donation to determine the immune status. Subsequently, in accordance with the changes that are in the immune system of a given person, on the basis of individual changes, immunocorrective therapy is selected, which is included in all complex methods for the treatment of herpes viral infection.

Vitamin therapy and diet

Also, with shingles, to strengthen the immune system, 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, and also help to increase the body's defenses.

B vitamins.

Vitamins from this group improve the regeneration of the epithelium, participate in the formation of antibodies, as well as in all metabolic processes.

It should also be borne in mind that during treatment, a patient with herpes zoster is recommended a sparing diet rich in nutrients, vitamins and trace elements. It is recommended to cook or steam food, and you should also reduce the consumption of salty, fatty and fried foods.

dairy products ( milk, kefir, butter, cottage cheese);
vegetables ( beets, broccoli, carrots, eggplant, zucchini, pumpkin, tomatoes, peppers, onions);
white meat;
seafood ( salmon, walleye, herring);
nuts ( peanuts, pistachios, almonds, walnuts, cashews);
fruits ( grapes, apricots, apples, kiwi, plums, citrus fruits);
cereals ( oat, wheat, barley groats);
legumes ( peas, beans);
green tea, tea with rose hips or raspberries.

Prevention of herpes zoster

There are the following measures for the prevention of herpes zoster:

vaccination;
increased immunity.

Vaccination

The vaccine against the Varicella-zoster virus was approved in 2006 after a successful study of about forty thousand people aged sixty and over. The results of the study showed that the introduction of the vaccine reduced the incidence of herpes zoster by 51%.

The purpose of this vaccine is to provide an artificial active immunity against the Varicella-zoster virus. This vaccine contains live cultures, but with reduced virulence ( the ability of a microorganism to infect).

There is currently the only prophylactic vaccine against shingles, the Zostavax vaccine. This vaccine is given once, intradermally. The duration of action of a prophylactic drug, on average, is from three to five years.

This vaccine is indicated:

for the prevention of relapses in persons already suffering from shingles;
adults who have not had chickenpox;
people suffering from postherpetic neuralgia.

There are the following contraindications for vaccination:

the presence of allergic reactions to the components of the vaccine;
with colds ( if the body temperature is 37.5 degrees or higher);
the presence of HIV infection or AIDS;
during pregnancy.

There are no serious complications after the administration of the vaccine. About one in three people vaccinated may experience redness, itching, and swelling at the injection site. Also, one in seventy may experience a headache after vaccination. One of the serious and dangerous complications after the administration of the vaccine is the development of an allergic reaction to the components of the drug.

Symptoms of an allergic reaction following a vaccine are:

weakness;
pallor of the skin;
dizziness;
swelling of the throat;
palpitations;
labored breathing;
wheezing.

Note: With the development of these signs, it is necessary to seek help from a doctor as soon as possible.

people who have contact with a patient with herpes zoster;
people with reduced immunity;
newborns if the mother had chickenpox during pregnancy.

Boost immunity

Since it is known that the main reason for the development of shingles is a decrease in immunity, the methods of preventing this disease are aimed directly at strengthening the body's defenses.

To increase immunity, the following recommendations should be followed:

daily walks in the fresh air;
hardening of the body;
moderate daily physical activity;
rejection of bad habits ( alcohol, smoking);
nutrition should be balanced ( proportional ingestion of fats, proteins and carbohydrates into the body);
periodic visits to the sauna or bath;
avoidance of stress.

If the patient has immunological disorders, immunomodulatory therapy is individually selected and prescribed.

Answers to frequently asked questions

Can I get herpes zoster again?

The varicella-zoster virus, entering the human body, causes chickenpox ( chicken pox). However, after recovery, this virus is not eliminated, but remains in the human body in a latent state. This virus is asymptomatic in nerve cells in the dorsal roots of the spinal cord. The activation of the virus occurs when the body is exposed to negative factors that contribute to a decrease in immunity. In this case, the disease is repeated, only not in the form of chickenpox, but in the form of shingles. As a rule, re-manifestation of herpes zoster is not observed in the future. In patients with normal health, recurrence of herpes zoster is observed in two percent of cases.

In ten percent of people, a relapse of herpes zoster is observed in the presence of the following pathologies:

HIV infection;
AIDS;
oncological diseases;
diabetes;

The purpose of the vaccine is to create an artificial active immunity against the Varicella-zoster virus.

Is herpes zoster contagious?

It should be noted that herpes zoster is contagious during the period of herpetic eruptions. During the period of healing and formation of crusts, this disease ceases to be dangerous.