Dermatology-Online

Herpes zoster

synonym

Shingles

definition

Shingles is an infection caused by a virus that causes itchy and painful changes in the skin on various parts of the body and requires appropriate drug treatment.

For more information, see the main Herpes article.

Cause / forms

Herpes zoster is a subgroup of the herpes viruses. The virus is known as "Human Herpesvirus-3" (HHV-3). It is believed that about 90% of the population has herpes viruses in the body wear. These dormant for many years without triggering an appropriate infection. But if certain factors come together, such asStress, it can become one Outbreak of a herpes infection come. The herpes zoster infection, which is visible in the form of shingles, is the Varicella zoster virus.
Patients who carry this virus or who become infected with it usually develop one at a younger age Chickenpox disease. Despite the healing of this disease, the virus remains in the body. Mostly for a lifetime it can be present unnoticed and free of symptoms. In some cases, however, it happens that over time it triggers a second infection, which then manifests itself in the form of shingles. It is therefore one of the few pathogens that two very different diseases with a time difference can trigger.

transmission

The virus is through Droplet infection (Sneeze) and over Mucous membranes very easily transferable and the transfer happens mostly already in childhood or adolescence, which regularly leads to many infections in kindergartens.
As a non-latently infected or immune person, it is practically inevitable to contact a person living in the same household who acutely chickenpox or Shingles is sick to be infected.
Once ingested, the virus does not necessarily have to lead to an infection. The viruses can often stay in the body for years without causing symptoms.

Symptoms

After infection, it takes about two weeks for a rash to appear. This time is called the incubation period. In the early stages of the onset of shingles, it can become too moderate to severe pain in the area of the affected nerve segment come. The pain is called stinging and very uncomfortable described. They do not occur permanently, but their intensity can increase from day to day and lead to unbearable symptoms. The pain is followed by one characteristic rashwho made up Reddening of the skin, Flaking skin and Surveys composed. The skin irritations are mostly not extensive, but rather punctiform. However, the overall view of all punctiform skin changes can ultimately have the appearance of a large reddened area. In the further disease state it can to filled vesicles in the area of the skin come. The skin can accordingly very itchy but still pain in every stage of the disease and lead to a corresponding impairment in everyday life.
At chickenpox the rash is accompanied by small oval vesicles and crusts. Usually even that Buccal mucosa infested. However, the sick person is usually fine, and there is usually a real feeling of illness Not, however, it does occasionally fever.
This phase of the rash lasts about one week on, the vesicles fortunately heal without scars. The exception is vesicles that appear after being scratched ignited have and therefore often scarring.

Chickenpox is not dangerous for otherwise healthy people. In people with immunodeficiency (after Organ transplant, HIV patients, Burn injuries), however, there is a risk of an uncontrolled spread of infection, which can then result in up to 40% of the cases is fatal.
If a pregnant woman develops varicella zoster, there is one low Risk of nerve and eye damage in the unborn child. In the early stages of the pregnancy An acute infection can also lead to a Miscarriage to lead.

Consequences of infection

If the herpes zoster affects the eye, there is a risk of blindness, as the cornea often heals with scars after the infection and thus the eyesight is reduced. If the face is affected, it is not uncommon for one-sided paralysis of the facial muscles (facial paralysis) to occur. Although this is very uncomfortable, it is usually not permanent.
Another complication is the involvement of the ear. The sense of hearing and balance are impaired on one side, although the symptoms do not always recede.

Read more about this under: Shingles on the head - you should definitely pay attention to this!

Spread

The skin of the body is covered with sensitive nerves that support the Sensation of touch, pain and temperature to ensure. Larger areas of skin are supplied by a specific nerve. Each of these areas supplied by a certain nerve is designated with a letter and a number and is Dermatome called. The skin lesions spread mostly strictly dermatome separate instead, i.e. affected skin areas are mostly sharply demarcated and end directly at an adjoining dermatome.

After chickenpox has healed, some viruses remain inactive in the so-called Spinal ganglia. These are collections of nerve cells near the spine. The terminal branches of such a spinal nerve each supply a specific dermatome. The viruses often remain in the spinal ganglia for decades. Sometimes, especially in old age, the viruses are reactivated and then infect the dermatome. Usually a sharply outlined belt-shaped area then becomes inflamed, often in the area of the chest, but sometimes also on the face or on the neck. This clinical picture caused by the reactivation of the virus is called shingles.

diagnosis

The diagnosis is usually based on a Eye diagnosis posed as that Pattern of spread of skin irritation characteristic and is based on the body's own dermatomes.

treatment

In less pronounced one can get shingles Treat conservativelyi.e. With cooling compresses and with appropriate ointments try to minimize the itching.
In to a greater extent must have shingles though consistently treated with medication become. The drug of choice is that Acyclovirwhich can be given systemically as an ointment or as a tablet. In the case of severe pain in the skin area, the drug can also be tried Gabapentin to reduce the nerve pain. In this combination, severe herpes zoster infections can also be brought under control in many cases. The duration of treatment varies and depends on the severity of the disease.

Risk factors

Risk factors for developing shingles

at a young age had chickenpox
frequent and intensive contact with carriers of the varicella zoster virus
a weakened immune system: Patients whose immune system is weakened, be it medication or stress, have a significantly higher risk of developing shingles than immunologically balanced patients.