Shingles in adults
Shingles is a disease caused by the herpes virus. It affects not only the skin, but also the nervous system. Shingles and chickenpox have a common etiology and pathogenesis. Modern medicine classifies herpes zoster as an infectious disease that is highly contagious, as it is provoked by the herpes virus. The disease is characterized by the classic triad:
- Symptoms similar to infectious diseases;
- Skin manifestations characteristic of herpes infection;
- Manifestations from the nervous system, both peripheral and central.
Available statistics indicate that one in four people with a history of chickenpox will develop shingles. Moreover, the disease will enter the active stage after a person reaches 50 years of age. It is in this age group that shingles are most often diagnosed. There is no gender difference between patients.
In addition, cases of shingles at a young and mature age have become more frequent lately. Scientists explain this fact by the unfavorable environmental situation in cities, weakening of the immune system of people, and a high susceptibility to infectious and viral diseases. Shingles often accompanies patients with cancer, whose number is steadily increasing. It is especially common in people who have undergone radiation or chemotherapy.
It is known that most people had chickenpox in childhood, which means that the herpes virus, which provokes shingles, exists in their bodies. In this regard, the risk of its reactivation for every inhabitant of the planet is about 10%.
- Shingles symptoms
- The causes of herpes zoster
- Why is shingles dangerous? Consequences and complications
- Diagnostics of the shingles
Answers to popular questions:
- Is shingles transmitted?
- How long can pain persist after herpes zoster?
- Can I wash myself with shingles?
- Can shingles recur?
- How dangerous is shingles during pregnancy?
- Shingles treatment
- When should you see a doctor?
The symptoms of shingles are impossible to miss. The clinical picture is characterized by an acute onset, with severe pain and severe burning at the site of the lesion.
The disease affects an area of the human body most often on one side.
Zones of localization of herpes zoster can be:
- Lower and upper limbs;
- Intercostal areas;
- Face (part of it along the ternary nerve);
- Lower jaw;
- The back of the head;
If shingles affects the facial part, then the rash will be located along the ternary, or facial nerve. If a part of the body is affected, then the rash will be located in the course of the spinal nerves. This fact is explained by the high accumulation of the virus in the nerve nodes, in 11 pairs of cranial nerves, in the posterior horns in each of the halves of the spinal cord. Therefore, skin manifestations are localized along the involved nerve.
Experts distinguish three periods, each of which has its own symptoms of shingles:
Onset of the disease
This period is called prodromal. It is accompanied by general malaise, psychovegetative (neurological) pains, which can be of varying intensity. The start-up period can range from 48 hours to 4 days.
In parallel, the patient experiences the following symptoms:
- Feeling weak;
- An increase in body temperature to subfebrile levels (fever is extremely rare, but it takes place);
- Dysfunction of the digestive tract and related dyspeptic disorders;
- Pain, burning, itching, pronounced tingling in the area of the body or face where the rash will subsequently appear;
- As the symptoms increase, the lymph nodes swell, they become painful and hard to the touch;
- Violations of the process of emptying the bladder is observed in severe disease.
When the body temperature drops, the symptoms of intoxication caused by it are significantly reduced.
The next stage of the disease is characterized by the appearance of rashes on the skin. Their intensity and quantity depends on the severity of the shingles. The rashes look like small spots, the size of which does not exceed 0.5 mm. They are located in hearths, have a pink color. Between them are areas of intact skin.
- If the disease has a classical clinical course, then vesicles will appear at the site of the foci that have arisen a day later. They will be filled with serous contents: colorless and transparent. After 1 day, the liquid inside the bubbles will become cloudy.
- If shingles is difficult, then inside the vesicles you can see a liquid mixed with blood, and they themselves will have a black color. The rash characteristic of shingles is similar in wave-like flow to the rash that occurs with chickenpox. That is, with a period of several days, new vesicles will appear in one place or another. Rashes gradually encircle the body, hence the name of the disease.
- If lichen occurs in a mild form, then only skin nodules may appear without the subsequent formation of pustules. Or a person can only experience pain along the nerves at all, and there will be no rashes.
In connection with the blurred clinical manifestations of the disease, it is so important to make a correct diagnosis, differentiating mild shingles from intercostal neuralgia, osteochondrosis and heart pain.
After two weeks (maximum 1.5 weeks), in the place where the rash was previously, crusts form from yellow to brown. The places where the vesicles were located lose their rich color. Gradually, the crusts disappear from them, after which areas of pigmentation remain on the skin.
A person always suffers from severe pains that arise from even a slight touch to the skin. This is due to the fact that the virus is localized in nerve cells, disrupting their work and increasing the sensitivity of nerve endings many times over. The pain that a person experiences can be compared to burn pains. They are especially intensified when water gets on the affected areas. In this regard, scientists still have not come to a single decision - whether to take a bath with shingles.
Some doctors are of the opinion that it is better to avoid water procedures, others believe that baths with the addition of sea salt help them well, and still others recommend taking only a shower, after which the body will just get wet.
When describing the nature of pain, patients indicate that they can be dull, burning or boring, some people compare them to the passage of an electric current through the affected area. The pain tends to increase after minor mechanical or thermal exposure. They may continue to bother a person even after the rash has completely subsided. This happens to about 15% of all those who have had shingles.
The reason for the residual pain is that the viruses have destroyed the nerve tissue, and it will take some time for them to heal. Most often, postherpetic neuralgia in old age can persist for several months, and in young people it goes away after a maximum of 10 days after the rash disappears.
The causes of herpes zoster
It is known that shingles is caused by the varicella zoster virus, which also provokes chickenpox. However, these two diseases are radically different from each other in symptoms and the course of inflammation.
Having had chickenpox once in childhood, one should not assume that the virus was completely defeated by the immune system. It simply goes into a latent state and exists in the body in a dormant state. The place of its localization is the cranial nerves and nerve nodes. The virus can be in a suppressed state for many years, as long as the human immune system controls its reproduction and produces antibodies against it in the required volume.
When a certain link of the immune system fails, the zoster virus reactivates, but it no longer causes chickenpox, but shingles. Therefore, the opinion that, having had chickenpox once more, you will never face this disease again is erroneous. Re-infection cannot occur, since the virus is already in the body, but the disease can worsen with a high degree of probability, only it will proceed like shingles.
Experts identify the following reasons for the appearance of shingles:
Elderly age. Having crossed the threshold of 50-60 years, a person's risk of developing the disease is 7 times higher than that of young people. About 5% of retirees go to doctors with complaints of the symptoms of shingles. The explanation for this fact is very simple, because in old age there is a natural decrease in immunity, the level of endorphins decreases, the process of assimilation of vitamins and microelements worsens. The peak of requests is in autumn and spring.
At a young age, shingles develops due to a malfunction of the immune system.
- Diseases of the blood and blood-forming organs;
- Autoimmune pathologies, lack of immunity;
- Oncological diseases of a malignant nature;
- Undergoing chemotherapy or radiation therapy;
- Organ or bone marrow transplants;
- Serious injuries received;
- Chronic diseases such as: hepatitis, cirrhosis, renal and heart failure, tuberculosis.
- Taking certain medications, for example, immunosuppressive drugs (cytostatics, glucocorticosteroid hormones).
- Chickenpox infection in adulthood. Although rare, people with chickenpox after childhood may have symptoms similar to shingles in parallel.
- An increase in the amount of the zoster virus in the body. Since the disease is transmitted by airborne droplets, or by contact, with additional interaction with the virus, people with impaired immune systems may experience symptoms of shingles.
- Severe neurological and infectious diseases, hypothermia of the body, stress, physical overwork - all these are provoking factors for the manifestation of symptoms of the disease.
- Epidemic outbreaks of chickenpox in the children's team often occur due to the close interaction between a child and an adult with shingles.
Why is shingles dangerous? Consequences and complications
At a young age, a person who is faced with shingles most often does not feel any consequences or complications of the disease. It will end for the patient with complete recovery and the disappearance of all symptoms.
However, if the functioning of the immune system is impaired, then serious health problems may develop:
- The disease can affect the work of the spinal cord and brain, since the virus has the ability to actively multiply there. If there is a transition to the brain tissue, then they are subject to destruction, which can lead to paralysis of the lower and upper extremities, paralysis of the facial nerve. In addition, there is a threat of respiratory failure and death of the patient.
- If the virus infects the organs of vision, then optic neuritis may develop. This threatens the formation of glaucoma, damage to the cornea and complete blindness of the patient.
- Meningoencephalitis is another possible complication of shingles. If the patient does not die as a result of meningoencephalitis, then he becomes disabled.
There is a possibility of developing disorders of the functioning of the duodenum, abdominal muscles, genitourinary system (sphincter of the bladder), lungs (accession of pneumonia).
- If the disease is accompanied by the addition of a bacterial infection, then the person's condition worsens, and the healing process is significantly delayed.
As a rule, complications occur only in people with weakened immunity. If the disease is mild, then it does not threaten relapses and quickly passes.
Diagnostics of the shingles
To make a correct diagnosis, the doctor often needs to examine the patient and clarify his complaints.
To clarify the diagnosis, additional tests may be required: a blood test for antibodies, PCR diagnostics, and growing virus cultures. As a rule, such research methods are necessary to clarify the diagnosis with a blurred form of the disease and make it possible to differentiate shingles from diseases similar in symptomatology.
Answers to popular questions:
Is shingles transmitted? The herpes virus is highly contagious, but herpes zoster is transmitted only in isolated cases. Most often, the disease is diagnosed in the spring and autumn.
If a person has already had chickenpox once, then the likelihood of re-infection and development of the disease after interacting with a patient with chickenpox is not great. However, as modern medical practice shows, more and more people suffer from disorders in the immune system. This is due to the unfavorable environment, with the abundance of harmful products in the daily menu, with the presence of multiple contaminants in the air and water.
In addition to this, a small part of people have not developed a strong immunity to an infection that has once been transferred, therefore, upon contact with a person with shingles, re-infection may occur. So, the answer to the question of whether shingles is a contagious disease is positive. They can be infected.
In doing so, it is useful to take into account the following facts:
- The disease is transmitted from an infected organism to children and adults who have not previously encountered this virus.
- If a person has already had chickenpox in the past and is in good health at the time of repeated contact with the infection, then infection will not occur.
- Contact of a child with a person with shingles leads to the development of chickenpox. (read also: Causes, symptoms, types and diagnosis of chickenpox)
- Due to the fact that most people have the zoster virus in a dormant state, the risk of developing shingles is in every person.
- The disease is contagious until new blisters appear on the patient's body. When they are opened and covered with a crust, the virus poses no threat in terms of infection.
How long can pain persist after herpes zoster? The virus that causes shingles disrupts the functioning of nerve cells. They become more sensitive to any external influences and respond in the human brain with severe pains, similar to burns.
According to available data, up to 14% of people, after visible recovery, continue to experience pain in those parts of the body that were affected. These sensations do not indicate that the infection is continuing to progress. They only indicate that the work of nerve fibers was disrupted due to their defeat by a virus. Doctors call this condition postherpetic neuralgia or neuropathy.
Pain does not always occur after tactile contact or after interacting with water, it can appear on its own.
It was found that at a younger age, shingles, after the inflammation subsides, can remind of itself with pain for several weeks. It is extremely rare that they last more than a month. When the disease affects a person over the age of 50, the pain can persist for up to several months. If a person has suffered from shingles after the age of 70, then neuralgia can haunt him for a year or more.
- Can I wash myself with shingles? You can wash during illness, but you should not do it too often. The best option is taking a shower, after which you should not rub your body with a towel. The skin will get wet enough.
- Can shingles recur? Yes, the disease can recur.
How dangerous is shingles during pregnancy? The virus that causes shingles can cross the placenta. This is another way of contracting the disease. It is known that while carrying a child, a woman's immunity suffers. A drop in defenses can cause the Zoster virus to activate, which was in a suppressed state in the body, or the risk of primary infection increases.
It is especially dangerous when the activation of the virus proceeds imperceptibly for the woman herself, since specific symptoms may be absent.
At this time, the virus crosses the placenta and can cause the following harm to the health of the fetus:
- Death of a child inside a woman's womb and subsequent stillbirth, spontaneous abortion.
- Damage to the child's nervous system, his brain. All this becomes the cause of disability, can lead to loss of hearing, vision, and cerebral palsy.
- If a woman has not had chickenpox before conceiving a child, then she does not have antibodies to this disease, which means she will not pass them on to the fetus. Infection of a baby in early childhood threatens the development of meningeal disorders.
Due to such serious threats to the health of the child, it is necessary to limit the contact of the pregnant woman with people with shingles or chickenpox. In addition, the most favorable conditions should be created for the immune system of the pregnant woman to function in the proper volume.
If shingles does not cause any health problems, then there is no point in treating it. The disease in a mild form goes away on its own in an average of two weeks.
However, the older a person is, or the worse his immune system functions, the higher the risk of complications. Such people need to undergo specialized treatment with antiviral drugs. If therapy is abandoned, then serious health problems can develop.
Regardless of the age of the patient, it is imperative to see a doctor if you have symptoms of shingles. He may recommend taking drugs such as: Acyclovir, Valacyclovir, Famciclovir, which have antiherpetic activity. They are taken either orally or by injection. They contribute to the speedy restoration of the skin and the rapid elimination of the symptoms of the disease. It has not been established exactly whether antiviral therapy has any effect on pain after shingles.
The duration of the course will be determined by the doctor, most often it lasts from a week to 10 days.
Relief of pain at the beginning of treatment
Severe pain can occur even during the prodromal period of the disease, they should not be tolerated, it is necessary to seek medical help. The doctor may recommend drugs to combat the virus, or analgesics.
It has been found that attempts to endure pain without taking medications lead to an increase in the pain threshold in humans. In addition, chronic pain may occur that will haunt a person not just for months, but even years.
Therefore, at the appointment with a specialist, it is necessary to be as open as possible and tell in detail about where the pain occurs and what it feels like. Only thanks to complete information about the patient, the doctor will be able to provide really high-quality care.
So, if the pain is not too pronounced, then the use of weak anesthetic drugs may be offered, such as: Paracetamol, Ibuprofen, Aspirin, gel containing Ledocaine, Naproxen.
If the pain is severe, then drugs such as Oxycodone, Gabapentin and others will be required. They are taken in combination with an antiviral drug.
Treating pain left by shingles
There are cases when, after complete recovery, severe pain continues to haunt a person. Attempts to endure them only lead to the fact that subsequently it will be more and more difficult to cope with them. In addition, persistent pain can lead to health problems.
Therefore, in the presence of residual pain, it is necessary to consult a neurologist. The doctor will assess the patient's condition and prescribe suitable treatment for him.
Modern drugs that are used at this point in time are as follows:
- Drugs from the group of tricyclic antidepressants (Amitriptyline).
Additional treatments for pain
As an auxiliary way to combat the disease, a specialist may recommend the following methods:
- Performing blockages that relieve even the most intense pain. This requires the injection of painkillers into the tissues located next to the affected nerves.
- Performing electrical stimulation of nerve endings through the skin. This procedure is aimed at normalizing the functioning of damaged nerve tissues.
Treatment for shingles at home
Treatment of shingles is within the purview of the specialist. The doctor examines the patient and in the event that the disease does not pose a threat to human life, he may recommend that therapy be carried out at home.
Tips on what to do in case of illness and what not to do will be given by a specialist as follows:
- Hands should be washed using soap after every touch of the affected skin area.
- Do not scratch, scratch, or otherwise injure the areas of localization of rashes. Any mechanical damage increases the risk of secondary infection and can cause suppuration or bacterial infection. When itching becomes impossible to endure, you need to consult with your doctor about taking the drug. Suprastin can act as such a remedy.
- Do not put pressure on the affected skin area, do not rub it with clothes.
- Artificial piercing or rupture of vesicles with serous contents is unacceptable. They should resolve naturally.
- Until the moment when bubbles with liquid remain on the skin, you can alleviate your own condition by applying a sterile gauze napkin to them. Pre-moisten it in cool water.
- When the bubbles resolve and crust over, it is imperative that they do not get moisture. Areas with crusts should remain dry, therefore compresses are excluded, water procedures are minimized.
- Any ointments with antibacterial ingredients, except for those recommended by the doctor, are prohibited.
- Under the ban, adhesive plaster, it will only lengthen the process of healing and tissue repair.
- If suppuration of ulcers occurs, then contacting a specialist is mandatory.
When should you see a doctor?
It is known that symptoms similar to those of shingles can occur due to other diseases that also pose a threat to health. Therefore, if any rashes appear on the skin, you should visit a therapist, dermatologist, or infectious disease specialist.
After examination, the doctor will clarify the diagnosis and prescribe treatment.
Be sure to visit a doctor in the following situations:
- The presence of symptoms of the disease in a young child, or in a baby.
- The presence of signs of illness in an elderly person.
- If signs of shingles appear in a pregnant woman.
- If a person has cancer or is being treated for cancer.
- If a person is taking drugs that affect the immune system. This can be: Azathioprine, Methotrexate, Mercaptopurine, etc.
- If a person with shingles symptoms has had an internal organ transplant and is taking medication to reduce the risk of rejection.
- Ate symptoms of the disease developed against the background of an existing chronic infection.
Seeking an ambulance is necessary if, against the background of shingles:
- Severe headaches occur;
- Vomiting and nausea appeared;
- There is tension in the occipital muscles;
- There is a high body temperature, chills;
- The patient loses consciousness;
- The patient experiences disturbances in taste, smell, hearing loss;
- If confusion occurs;
- Convulsions appear;
- Dizziness occurs;
- Ear pains occur.
The author of the article: Kuzmina Vera Valerievna | Endocrinologist, nutritionist
Education: Diploma of the Russian State Medical University named after NI Pirogov with a degree in General Medicine (2004). Residency at Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).