A band-like blister appears on one side of the body ( Blisters ) is a painful disease that causes a group of Chickenpox -It is caused by infection with the varicella zoster virus.
Most people get chickenpox as children. But even after that, the virus can still spread. Trident Nerves (controlling the face) Spinal cord It lies dormant in the form of a gene in the sensory ganglia of nerves (which control the skin of the body except the face).
Over a long period of time, when the body's resistance is weakened due to stress or overwork, the virus changes from its genetic form into viral particles and becomes active again, traveling along the nerves and appearing on the skin, causing inflammation. This is shingles.
How symptoms manifest
First, a neuralgia-like pain occurs, and 4-5 days later, a red rash like an insect bite appears in the same area, which gradually turns into a blister. Pustules (The blisters become infected and filled with pus.) Crust The infection will heal in about three weeks. If your immune system is severely weakened, a rash similar to chickenpox will appear all over your body. Deep ulcers may also form. Scar This can sometimes happen.
The pain can range from none at all to severe pain that keeps you up at night, but generally it is more severe in the elderly, and the pain can continue for six months to several years or more even after the rash has healed. This is called postherpetic neuralgia.
In addition, patients with diabetes or those taking corticosteroids may not feel pain at first, but may experience severe pain after 1 to 2 weeks.
Shingles on the chin or from the ears to the neck can be accompanied by hearing loss, facial paralysis, and taste disorder, known as Ramsay Hunt syndrome. Shingles on the genitals can cause constipation or loss of urine.
Approximately 1% of patients will develop shingles more than once.
Testing and diagnosis
It can be diagnosed based on symptoms, but it can also be caused by insect bites, contact dermatitis, herpes simplex, erysipelas It must be differentiated from the above. It is diagnosed by taking a sample of the rash with scissors and observing the cells under a microscope, isolating the virus, or detecting the viral antigen or nucleic acid.
Treatment methods
In the early stages, the usual treatment is oral administration of antiviral drugs (Zovirax, Valtrex, Famciclovir), but in severe cases, patients are hospitalized and receive intravenous drip infusions of antiviral drugs. If pain is severe or paralysis occurs, corticosteroids are administered.
Once pustules and ulcers form, antiviral drugs are no longer effective, so it is necessary to start taking medication as soon as possible. Early administration of antiviral drugs is said to prevent postherpetic neuralgia.
The chickenpox vaccine, administered to people aged 50 and over, is said to help prevent shingles and postherpetic neuralgia.
What to do if you notice an illness
Visit a dermatologist as soon as possible and get a prescription for antiviral medication. Even if it doesn't start out bad, it may get worse later. Antiviral medications start to work after the third day of taking them.
Also, it can spread the virus to people who do not have chickenpox, so avoid contact with them until they have recovered.
Mariko Honda
Shingles Herpes zoster (Diseases of the elderly)
Special circumstances for the elderly
Shingles (Figure 17) Chickenpox For people with a history of chickenpox infection, Spinal cord It is caused by a virus (varicella-zoster virus) that was latent in the nerves of the brain and reactivates along the nerves under the epithelium, and is often seen in elderly people with weakened immune systems.
Symptoms are often initially a unilateral neuralgia-like pain in the brain and spinal cord, followed by a band-like, discontinuous rash either simultaneously or several days later. Edematous erythema And as time goes by Blisters These blemishes break down and form erosions (defects on the skin surface) or ulcers, and eventually scab over. The entire process takes 2 to 4 weeks, and then it heals naturally.
The most important thing to keep in mind when it comes to shingles in elderly people is that the pain and neuralgia caused by the rash is severe when it appears, and postherpetic neuralgia, which includes pain, numbness, and hypersensitivity, tends to remain even after the rash has healed.
Other points to note are that patients with dementia or impaired consciousness rarely complain of pain, so the onset of the disease may be overlooked; their overall condition may deteriorate due to fever, loss of appetite, and insomnia caused by pain; the formation of large blisters and deep ulcers, Generalization The rash can easily become severe (a scattershot rash similar to chickenpox appears on the skin all over the body).
Treatment and care points
Treatment involves the use of antiviral drugs such as acyclovir (Zovirax), valacyclovir hydrochloride (Valtrex), and vidarabine (Arasena A). In general, mild cases are treated with topical application, moderate cases with oral administration, and severe cases with injections. Severe cases may require hospitalization.
The earlier antiviral drugs are used, the greater the chance of reducing or weakening the disease. In elderly patients, early antiviral drug treatment with sufficient amounts is desirable to prevent symptoms from becoming severe. As symptomatic and supportive treatment, nonsteroidal anti-inflammatory ointments are applied to the rash, and anti-inflammatory analgesics and vitamin B12 (which helps repair nerves) are taken orally to relieve pain.
For post-herpetic neuralgia, lifestyle advice (such as not letting the affected area get cold and warming it thoroughly when bathing), taking antidepressants or anti-anxiety medications, and nerve blocks are effective.
Other important points
Although rare, the virus may be transmitted to others. It is best to avoid contact with infants and pregnant women who have never had chickenpox until the rash has formed scabs.
During the course of the disease or after the rash has subsided, various rare complications may occur, such as Meningitis encephalitis, Ramsay Hunt syndrome ( Facial paralysis , inner ear disorder, taste disorder), Herpes zoster ophthalmicus ( Keratitis , corneal ulcers), motor paralysis, bladder and rectal disorders, etc. may occur.
Once you have had the disease, you acquire lifelong immunity and so the disease is generally unlikely to recur. However, recurrences can occur in rare cases in elderly people and patients whose immune systems have been weakened by illness.
Ryoji Tanei
Figure 17 Shingles ">
Figure 17 Shingles
Shingles Herpes zoster (Skin Disease)
What is the disease?
Arranged in bands on the skin Erythema and Small blisters and a disease characterized by neuralgia-like pain in that area (Figure 59).
What is the cause?
As mentioned in the previous section Chickenpox Chickenpox is caused by infection with the varicella-zoster virus (VZV). This virus can persist even after chickenpox has cleared up. Trigeminal ganglion or Dorsal root ganglion The virus lies dormant in the skin. When this virus is reactivated by some trigger, it causes shingles.
The time it takes for shingles to develop after chickenpox varies from person to person, and it can occur in childhood and adolescence, but is generally more common in people over the age of 50. Collagen disease Unless you have an underlying condition such as those listed above, it is rare for you to get shingles more than twice in your lifetime.
Known triggers include aging, immunosuppression, and excessive fatigue.
How symptoms manifest
The initial symptom is a neuralgia-like pain in the affected area, and after 2-3 days, erythema and small blisters appear, mainly distributed along the course of the nerves. The blisters break and become erosions, forming ulcers, and then Crust The wound will heal and a scab will form.
The pain will decrease as the skin lesions improve, but in some cases persistent pain may remain even after the skin lesions have healed, and this is called postherpetic neuralgia (column).
Complications include Ramsay Hunt syndrome, a condition in which shingles in the trigeminal region is accompanied by facial nerve paralysis.
Testing and diagnosis
The diagnosis is easy if multiple small blisters are seen spreading along the course of the nerve. fluorescence VZV antigen is detected by antibody testing.
Treatment methods
The mainstay of treatment is the use of antiviral drugs such as acyclovir (Zovirax), valacyclovir (Valtrex), or famcyclovir (Famvir).
Various studies have shown that the use of antiviral drugs within 72 hours after the appearance of skin lesions can reduce the severity of skin lesions and pain at an early stage. It can also reduce the incidence of postherpetic neuralgia, the most important sequela of shingles.
The goal of treatment is to prevent postherpetic neuralgia. The degree and nature of pain is closely observed from the early stages of the disease, and adequate pain management (pharmacotherapy, physical therapy, etc.) is implemented if necessary.
What to do if you notice an illness
When only neuralgia-like pain is present and no skin lesions are observed, it is impossible to distinguish it from neuralgia, and shingles can only be diagnosed when a skin rash appears. If you notice any skin lesions, please visit a medical institution (dermatology, anesthesiology, etc.) as soon as possible.
The blisters contain VZV, which can infect people who have never had chickenpox, so it is important to be careful not to spread it to others.
Related Topics
Chickenpox and postherpetic neuralgia (column)
Shinichiro Yasumoto
Figure 59 Shingles ">
Figure 59 Shingles
Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia
