Shingles

• • 20%. people have shingles at least once in their lifetime, and the incidence is rising.
  • Varicella zoster virus can cause two different diseases: chickenpox and shingles.
  • When a person gets chickenpox, the virus continues to live in the body (in the nerve nodes) without causing any symptoms, but when it becomes active it can cause herpes zoster.
  • If you have never had chickenpox and have not been vaccinated against it, it is possible to get chickenpox from a person with shingles through direct contact with the rash or through inhalation of Varicella zoster virus.
  • Approximately 1-6% of people develop recurrent shingles.
  • Shingles should be distinguished from herpes zoster, rosacea, acute eczema, and the disseminated form from chickenpox.

Risk groups

• • Shingles can affect people of all ages, but is most common in people over 50
  • It is also more common in people of all ages, with weak immune systems (e.g. Oncology patients; patients with chronic, autoimmune diseases (rheumatoid arthritis, scarlet fever, etc.) – who are treated with systemic steroids, tumour necrosis factor (TNF)-alpha inhibitors, sphingosine-1-phosphate (S1P) receptor inhibitors, Janus kinase (JAK) inhibitors.
  • People living with HIV and AIDS.

• • A person with chickenpox, less commonly shingles
  • Varicella zoster virus is transmitted by droplets in the air or by contact (touching the rash).
  • Children can get chickenpox from a person with shingles, and vice versa

Provocative factors

• • older age (>50 years)
  • colds
  • stress
  • infections
  • Injuries
  • contact with a person with chickenpox or shingles
  • UV rays

Localisation

• • 50% are intercostal (nn. intercostales, n. thoracicus) nerves in the thoracic and dorsal regions.
  • 20% n.trigeminus; n.VII and n.VIII in the face.
  • Less common are segments of the neck, lumbar spine and sacrum.
  • In immunosuppression, may spread outside the segment to be anaesthetised

• • 3-5 d. general malaise, fatigue, fever, pain and burning in the area of the future rash before the skin is rubbed;
  • Reddish spots-painful unilateral erythema (redness) – grouped papules, vesicles with clear fluid (12-24 hours) following the course of a nerve;
  • Pimples – scabs (7-12 days)
  • In severe cases: bloody-serous, gangrenous rashes
  • Burning, pain, itching

Complications

• • Skin: secondary bacterial infection may be present, with scarring during healing;
  • Eyes: conjunctivitis, episcleritis, uveitis, keratitis, iridocyclitis (glaucoma), chorioretinitis (AIDS), retrobulbar neuritis, vasculitis, optic nerve atrophy. Herpes zoster ophthalmicus – lesion r. ophtalmicus n. Trigemini, vesicles appearing on one side of the eyelids and nose, affecting the cornea.
  • Nervous system: encephalitis, meningitis, granulomatous arteritis, segmental paresis, N. facialis paresis, auditory nerve damage; postherpetic neuralgia is a very common complication. Pain without rashes, lasting for months or years. Hypo- or hyperaesthesia may be present and often requires medical treatment. a neurologist or pain medicine doctor for advice on pain relief.
  • Internal organs: pneumonia, oesophagitis, myocarditis, enterocolitis, pancreatitis, arthritis.

Diagnostics

• • Diagnosis is usually made by questioning and physical examination
  • Laboratory tests can be used to confirm a definitive diagnosis if necessary:
    • • Polymerase chain reaction (PCR)
      • Virological testing – growing the virus in infected cell cultures
      • Direct immunofluorescence – to detect Varicella-zoster virus antigen
      • Serological tests – IgM and IgG (Anti Varicella Zoster IgG and IgM)
      • The material for testing is taken from the rash (vesicles).

Treatment recommendations

At the first sign of the disease, it is recommended to consult a doctor immediately. Do not self-treat, but consult your family doctor or a dermatovenereologist who will draw up the most appropriate treatment plan for you – this is the only way to avoid complications.

• • • Antiviral treatment is effective in reducing pain and symptom duration if started within 72 hours from the start of symptoms.
    • More than 72 hours later the medicine can be given if new rashes appear.
    • Do not rub, scratch or disinfect rashes to prevent them from growing
    • Antiviral treatment is not indicated if the rashes are covered with scabs
    • Other measures: rest, pain relief (cold, antiviral ointments, local steroids, emollients (creams, lotions, ointments – from the pharmacy), antiseptics, antibiotics in case of a secondary bacterial infection, B vitamins).

• In postherpetic neuralgia, it is important to:
  • • early antiviral treatment
    • use of local anaesthetic
    •  a neurologist’s advice on how to relieve the pain (medications: non-steroidal anti-inflammatory drugs (NSAIDs), although usually not very effective, tricyclic antidepressants, antiepileptic drugs; non-medications: transcutaneous electrical nerve stimulation or acupuncture, injections into the affected areas).

Sick leave

• • If the rash is on your face, don’t return to work until the scab has formed (~7-10 days)
  • If the rash is in an area that you can cover (e.g. with a gauze bandage or clothes), you can return to work when you feel well.
  • If you work in a healthcare facility (e.g. hospital, medical centre, nursing home), check with your doctor when it is safe to return to work.

Prevention

• • Vaccination against Varicella zoster virus is recommended;
  • Getting vaccinated can reduce your chances of developing shingles and postherpetic neuralgia
  • The vaccination is recommended for adults over 50 years of age, but younger people can also be vaccinated, especially if their immune system is weaker than usual.