Herpes zoster swelling


O. L. Ivanov, A. N. Lvov
"Directory of the dermatologist"

Herpes zoster; Synonym: shingles) is an acute viral disease. It is manifested by grouping erythematous-vesicular rashes along the nerve trunks, accompanied by severe neuralgic pains.

The causative agent of herpes zoster is the dermatoneurotropic virus - virus varicella-zoster.

The disease is transmitted by the contact andairborne droplets. Cases of infection of adults from patients with herpes zoster are extremely rare. At the same time, children who are in contact with such patients may develop chicken pox.

Herpes zoster is characterized by sporadic; epidemics are not observed. The number of patients increases in spring and autumn.

The pathogenesis of herpes zoster is not completely clear,However, according to modern ideas, shingles can be considered as a secondary infection against the background of a partial decrease in immunity, which developed as a result of the organism's contact with the virus in the past. It is believed that the virus in the latent state is in the nerve ganglia and when the infection is reactivated it progresses along the nerve to the skin, where it causes characteristic rashes.

In most cases, in practically healthy individualsthe disease develops without apparent predisposing factors. However, the infection can be triggered by trauma, X-ray irradiation, hypothermia, a number of other factors, as well as an immune deficit. Of special note is the development of shingles in patients with malignant tumors and leukemia.

Herpes zoster does not recur, which distinguishes it from herpes simplex. In recent years, recurrent herpes zoster is only seen in patients with a background of late stages of HIV infection.

In typical cases, the disease begins with pain in theplace of future localization of the rash. The intensity of pain can be different, and due to the lack of changes in the skin in the first days, the pain syndrome is often regarded as a manifestation of some other disease (angina, pneumonia, renal colic, etc.).

On average, 3-5 days after the onset of pain in thethe focus of the lesion is puffiness and hyperemia of the skin, against which background there are small clustered nodular elements that exist for a short time and are transformed into bubbles with transparent contents. Vesicles usually appear "jerky", in connection with which at the height of the disease you can see a rash at different stages of development. The process takes a large area, has a one-sided character, is localized along the nerves, most often the rash is located on the skin of the thorax, somewhat less frequently in the trigeminal nerve innervation zone, on the neck skin, in the lumbosacral region, along the facial, ear, auditory nerves and limbs. Practically all patients have regional lymphadenopathy. Most of the vesicles subsequently shrivel into crusts, and some spontaneously or as a result of injury the tires are opened with the formation of erosion. After falling off the crusts and epithelialization of erosions, the process ends, leaving behind a temporary reddening.

The total duration of the disease is about 2-3 weeks.

Pain with herpes zoster

Quite often rashes of herpes zosteraccompanied by common phenomena in the form of weakness, malaise, nausea, headaches, fever. Often observed deviations from the typical course of the disease. First of all, this refers to the main subjective symptom - pain. Pain can occur simultaneously with the appearance of a rash or appears later than a rash on the skin, sometimes there is no pain.

The intensity of pain varies in a wide range: from barely perceptible paresthesia to debilitating, painful cutting pains, removed for a short time only by the introduction of drugs.

Possible so-called postherpetic neuralgia - a condition in which severe pain persists for a long time (several months and even years) after the disappearance of the rash.

Atypical rashes with herpes zoster

Atypical can also be the rashes themselves. Often, the bubbles, usually not exceeding the size of a pea, become much larger and reach the size of the plum (bullous form of herpes zoster ).

Vesicles and blisters can be filled with bloody contents, and in this connection, when they are shed, hemorrhagic crusts are formed (hemorrhagic form of herpes zoster ).

The most severe course and persistent skin changes in the form of scars is characterized by gangrenous form of herpes zoster. at which necrotic changes in the bottom of the bubbles develop with the involvement of deeper layers of the skin in the process.

The disease can sometimes be abortive, that is, without the formation of vesicles.

Diagnosis with a typical form of herpes zoster usually does not cause difficulties. If necessary, laboratory diagnostics (isolation of the virus on cell cultures, cytology) is used.

From herpes simplex It is characterized by sharp soreness, unilateral spread of the rash along the nerves and absence of relapses.

When erysipelas edema and hyperemia have clear boundaries, are expressed more sharply, characterized by peripheral growth, mandatory fever and the absence of neuralgic pain.

Treatment is more effective the earlier it is started.

  • acyclovir (zovirax, virolex) inside 800 mg 5 times a day for 5-10 days or the first 2 days intravenously at the rate of 7.5-10 mg / kg and then inside at 3200-4000 mg per day for a week;
  • Valtrex 1 g 3 times a day for 7 days,
  • famvir in a dose of 250 mg 3 times a day for 7 days, and in cases of postherpetic neuralgia, 500 mg 3 times a day.
  • in the observance of a rational regime (washing is forbidden, the skin around the lesions is wiped with 2% salicylic alcohol)
  • application as antiviral drugs of local action, applied to the lesion 4-5 times a day:
    • ointment zoviraks,
    • florenal,
    • tebrofen,
    • megosene,
  • and symptomatic means -
    • Alcohol solutions of aniline dyes,
    • fucocin.
  • To stimulate epithelization, the use of a solution of "Kuriosin" 1-2 times a day is recommended, at the rate of 1 drop per 1 cm2 of surface.

Eliminate the pain symptom

  • acupuncture,
  • impulse diadynamic currents,
  • percutaneous neuroelectrostimulation,
  • combined appointment of microwave irradiation and ultrasound.

In cases of persistent postherpetic neuralgia,treatment of which is usually carried out by a neurologist, along with the previously mentioned methods, amitriptyline and tizercin are prescribed starting with the minimum doses (1/4 tablets of each drug 1 time per day) and, if necessary, increasing it to 1 tablet each 2 times a day.

Return to the list of articles about skin diseases

Tinea and postherpetic neuralgia
A short protocol for managing patients in the family doctor's practice.

Herpes simplex. Simple blistering of the penis.
Lecture notes
Department of Dermatology SPbGMA

Herpes simplex
BA Berenbein, AA Studnitsin
"Differential diagnosis of skin diseases"
A guide for dermatologists.

Genital herpes
Protocol of patient management in the practice of the family doctor.

Shingles.
Lecture notes for students of the Faculty of Medicine.
Department of Dermatology SPbGMA