Can Stress Trigger a Shingles Attack?

While the science hasn’t proven a direct casual link, there is some kind of stress-shingles connection. Here’s what to know.

iStock

One could easily say that shingles—the painful, blistering reemergence of the virus that gave you chicken pox when you were a kid—is itself a very stressful situation. And, to make matters trickier, it’s possible that some particularly anxiety-producing experience preceded the outbreak, triggering the rash in the first place. What have researchers learned about the stress-shingles connection, and what do physicians who treat it have to say on the subject? Relax as much as you can—and read on.

Does Stress Literally Cause Shingles?

The quick but incomplete answer is “no.” Shingles (officially termed herpes zoster, or HZ) is caused by a virus—the varicella zoster virus (VZV)—that, before a vaccine became widely available in 1995, caused chicken pox mainly in children up to 12 years of age. At the conclusion of the disease phase of chicken pox, VZV retreats to the central nervous system (CNS), and like a hibernating bear in a cave, goes dormant. The problem is that decades later, the virus can wake up and reemerge along nerve pathways, erupting in painful, itchy blisters and, for some, complications including herpes zoster opthalmicus (which affects the eye and can create blindness) and postherpetic neuralgia (PHN), which is potentially debilitating pain along the same pathways that can last for months, and sometimes years, after the rash retreats. About 1 million Americans develop shingles every year, according to the Centers for Disease Control (CDC), or 1 in 3 adults over 50, when risk begins to climb dramatically.

The reason the virus becomes empowered to charge back with such a vengeance later in life has to do with a decline in the body’s immune response to bacteria, viruses, and fungi that naturally lowers with age. This weakened defense is where experts see a potential relationship between the body’s response to stress—of all kinds, physical and emotional—and how our inner chemistry can affect the immune function from keeping VZV at bay.

Stress, Cortisol, and Your Immune System

“How stress can impact an immune system is complex,” says Marla Shapiro, C.M., M.D., a professor in family and community medicine at the University of Toronto. “The science tells us that stress impacts our hormones, which in turn have an impact on our ability to mount defense responses. With stress our physiologic guard is down, so to speak,” she says.

The hormone at work here, Dr. Shapiro points out, is cortisol. A surge in cortisol in response to stress—the ancient adaptation often referred to as the “fight-or-flight mechanism”—actually boosts immunity by reducing inflammation if the stimulus is brief—akin to a saber tooth tiger, say, attacking a prehistoric cave dweller. But life isn’t prehistoric anymore, and modern stressors can be unrelenting, such as job loss or toxic workplaces, relationship reversals like divorce, health crises, the death of a loved one, poverty, discrimination, and even unprecedented shocks like a global pandemic.

What this means is our cortisol levels surge far more often, and they stay higher for longer. And that’s where our body’s immunity powers get tripped up. Sustained higher levels of cortisol end up increasing inflammation over time, as well as suppressing lymphocytes, those white blood cells that fight off infections. The lower your lymphocyte levels, the more at risk you are for viruses, including the common cold, cold sores, and a nasty virus hibernating in your central nervous system—VZV.

“VZV sleeps in the dorsal root ganglion for years and years and years,” says Jenny Murase, M.D., an assistant clinical professor of dermatology at the University of California, San Francisco, and director of Medical Dermatology Consultative Services for the Palo Alto Foundation Medical Group. (By the way, the dorsal root ganglion is collection of sensory neurons near the spine that bring information from the extremeties to the spinal cord.) “So, when your immunity goes down, you have less of an ability to fight to keep that virus at bay, and it sneaks out onto a nerve and causes it to get inflamed. Then it gets to your skin and causes shingles.”

Joshua Zeichner, M.D., director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City, agrees. “We know that the body’s stress response can impair our immunity,” he says. “The flight-or-fight response is characterized by a surge in cortisol, a hormone that prepares us for that stress, but unfortunately has other negative impacts on our health. And that surge in cortisol and impaired immunity may predispose you to a shingles outbreak.”

“I think the stress of life right now is playing a role,” says Heather D. Rogers, M.D., a faculty member at the University of Washington department of dermatology in Seattle, as well as the founder of Modern Dermatology and Doctor Rogers RESTORE. Since the COVID-19 pandemic reached crisis proportions in the spring, Dr. Rogers says she’s seeing patients present with shingles who don’t fall into predictable risk populations. “I had not seen shingles in my patients under the age of 40 in years,” she says. “Since March, I have had three patients in that age group.”

What Does the Latest Research Show?

In 2020, an analysis of a whopping 88 studies on the risk factors for shingles assessed them by category. While the greatest risk, the researchers concluded, was immunosuppression from HIV/AIDS and cancer therapies (followed by family history, physical trauma, and older age), psychological stress was also found to play a role.

An earlier review of 20 studies published in Innovations in Clinical Neuroscience focused solely on the stress-shingles connection. This research provides more affirmation, citing that the existing literature at the time was “fairly consistent in concluding that stress, stressful life events, and depressive symptoms may partially contribute to outbreaks of HZ (herpes zoster),” according to co-author Randy Sansone, M.D., professor emeritus of psychiatry and internal medicine at Wright State University School of Medicine in Dayton, OH, and director of Psychiatry Education at Kettering Medical Center.

But there’s more. In 2018, a team of Japanese researchers investigated the relationship between psychosocial factors, shingles, and postherpetic neuralgia. (About 10% to 18% of people who get shingles also experience PHN, according to the CDC.) The study, published in American Journal of Epidemiology, followed 12,522 men and women between the ages of 50 and 103 for three years. Participants were asked to asked to label the level of stress in their daily life as extremely high, high, medium, or low; describe their sense of purpose in life; and answer questions about negative life events within each past year, including changes in work and living environments, changes in human relations, and distress over economic issues.

The results were eye-opening. Men with high levels of mental stress were twice as likely to be at risk for shingles, and women who experienced negative life events—particularly changes in their work, living environment, and relationships—had a two to three-fold higher risk of PHN. Conversely, the risk of shingles was 60% lower among men and women who reported a high sense of purpose in life.

However, not all research delivers a stress-shingles connection. A 2015 study in Atlanta that pulled information from claims from private and Medicare data bases focused on nearly 40,000 individuals who’d experienced severe death or illness of a spouse (among other stressful life events) and found only 137 had developed shingles afterward. Based on statistical likelihood alone, the researchers concluded there was “no evidence” that psychological stress triggers shingles.

Stress and Shingles…in Space?

Perhaps most colorfully, a controlled study in the early 2000s followed eight astronauts to see if the physical stress of space flight—before, during, and after—was linked to the reemergence of shingles. The researchers found that while only one astronaut showed the presence of the VZV in their saliva (a marker for reactivation of the virus) before space flight, all eight did after returning to earth. The presence of VZV, according to NASA researcher Satish K. Mehta, Ph.D., indicates that the virus can reactivate in younger, healthy subjects if they experience certain intense physical stresses.

In 2019, Mehta studied a larger group of astronauts, this time searching for incidence of four herpes viruses—Epstein–Barr virus (EBV), varicella-zoster virus (VZV), herpes-simplex-1 (HSV-1), and cytomegalovirus (CMV)—and looking beyond just the physical rigors of space flight. Identifying space travel stressors including (but not limited to) social separation, confinement, sleep deprivation, circadian rhythm disruption, and anxiety, he noted a “rise in secretion of stress hormones like cortisol and adrenaline, which are known to suppress the immune system.” Immune cells—particularly those that normally suppress and eliminate viruses—are not only less effective during spaceflight but remain that way for up to 60 days after returning to earth, according to Mehta.

So, let’s bring it back down to Earth. While there’s no proven direct link between high physical and emotional stress and shingles, there’s plenty of documented causal connections to suspect stress may play at least some role in the virus’s reemergence. That means if you’re an astronaut or just an everyday American trying to stay sane during uniquely stressful times, it’s important to be on guard against all that stresses you out—whether that’s clearing for takeoff or just trying to work from home with your kids or grandkids remote learning in the same room.

“I tell my patients that the brain and the immune system are one organ, not two. What affects one, affects the other,” says Leonard Calabrese, D.O., head of the RJ Fasenmyer Center for Clinical Immunology at the Cleveland Clinic. “Stress in many forms, especially chronic stress such as depression, loneliness, or psychosocial dysfunction, can affect the immune system. The good news is that multiple modalities can alleviate stress and calm the inflammation it causes,” he says, including mindful practices like meditation, yoga, and tai chi. In addition to these practices, consistent (and quality) sleep, healthy diet, regular exercise, and not overdoing the booze have all been shown to help lower stress levels, so try to incorporate one or more into your daily routine.

In other words: Do your best to decompress to avoid a shingles attack. And, if you’re 50 or over, it goes without saying: Get a shingles vaccination to give your immune system the extra rocket boost it needs.

Meet Our Writer

Tracey Minkin

Tracey Minkin has spent her career as both editor and freelance writer for regional and national magazines on topics including cancer clusters on Upper Cape Cod, and the ethical and medical complexities of an in vitro pregnancy of triplets. Her writing has been anthologized in collections and has won regional and national awards. Currently she serves as Contributing Travel Editor at Coastal Living Magazine. She has an MS from Columbia University Graduate School of Journalism.

Is there a Connection Between Stress and Shingles?

Posted by Dr. Helen Ede on July 14, 2021

Developing the shingles virus is common, with almost one out of three people in the U.S. experiencing it within their lifetime. And unfortunately, this number is on the rise, with more people of all age groups developing shingles (or herpes zoster) than ever before. Emerging studies cite a few different reasons for this trend, including having a compromised immune system due to illness or stress.

So, can stress trigger a shingles outbreak? We explore the connection between stress and shingles.

First, What Causes Shingles?

If you’ve had chickenpox as a child, you may develop shingles later on in life. However, very rarely people who have not had chickenpox before have developed shingles. Even after you have overcome the chickenpox, the virus remains dormant in your body’s nerve cells. Shingles occur when the chickenpox virus called varicella zoster virus (VZV) reactivates, causing a painful rash of blisters to appear. Shingles typically last anywhere from two to six weeks. Typically, the first symptom of shingles is a burning sensation or tingling pain that occurs on one side of the body in a band-like pattern. You may also feel itching and severe pain from even the lightest touch.

As you get older, your risk of developing shingles increases. The majority of people who develop shingles are 50 and older. As we age, our immune systems become less effective at defending us against bacterial, fungi and viral infections, making us more susceptible to the shingles virus. 

How Stress and Shingles are Related

The reactivation of the VZV virus is linked to a weakened immune system, which can be a byproduct of stress. When the body is put under extreme stress, it can cause many negative effects on the mind and body, including creating a compromised immune system. Having a lowered immune system can make it harder for your body to defend itself against viruses, including the VZV virus. Other diseases such as HIV, cancer, cancer treatments and immunotherapy can also decrease immune system efficiency.

Everyone reacts differently to stressful situations, but the way you cope with these situations is important in ensuring a healthy body and mind. Here are a few tips for improving and managing the stress in your life for a healthier you:

Sleep: Getting enough sleep is essential for a healthy mind. Unfortunately, many of us do not get enough sleep. The Mayo Clinic states that in general, adults need between seven and nine hours of good sleep each night.

Physical Activity: Receiving the proper amount of exercise can benefit many areas of your life and can even decrease your chances of developing many chronic diseases, such as heart disease, diabetes and certain cancers. It is recommended to get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity each week.

Eat a Healthy Diet: Eating a nutrient-rich diet is not only important for your physical health, but it can play a role in your overall mood. Recent research into the mental health and nutrition connection reveals that eating foods rich in zinc, magnesium, omega 3 and vitamins B and D3 can help improve your mood, reduce anxiety and even help treat depression.

Treating Shingles

The shingles virus is preventable by vaccine. The vaccine Shingrix is more than 90% effective for preventing shingles and postherpetic neuralgia (severe pain where the area of the shingles developed). The risk of developing postherpetic neuralgia also increases with age. For the first four years after you receive the vaccine, protection will remain at least 85% effective. The CDC recommends adults over 50 years of age and older receive the vaccine. In addition, if you have had shingles in the past, you can receive this vaccine to prevent future infections as you may develop the virus two or more times.

While there is no cure for shingles once you have developed it, there are a few prescription antiviral drugs that can help provide relief and reduce the risk of complications. Your doctor may provide you anti-viral prescriptions including Acyclovir (Zovirax), Famciclovir and Valacyclovir (Valtrex). To treat the pain caused by shingles, your doctor may also prescribe you pain medications such as codeine. There are also numbing creams, such as lidocaine, that can be topically applied to reduce pain.

If you are age 50 or over, talk to your primary care provider about getting the vaccine. At PACT, a partner of Hartford HealthCare, our doctors and specialists are dedicated to delivering high-quality patient-centered care. If you or a loved one are searching for a primary care provider, click here to search PACT’s list of Connecticut-based, board-certified doctors near you.

Looking For a Family Medicine or Primary Care Doctor in Connecticut?

ACCEPTING NEW PATIENTS:

DR. HELEN EDE IN MADISON, CT
Voted Best Family Doctor 2020 by the New Haven Register Reader’s Poll

Dr. Ede works in our newest Division, PACT Sterling Primary Care. To schedule an appointment, please call 203-806-9401 or request an appointment online.

Shingles | Michigan Medicine

Topic Overview

What is shingles?

Shingles is a painful skin rash. It is caused by the varicella zoster virus. Shingles usually appears in a band, a strip, or a small area on one side of the face or body. It is also called herpes zoster.

Shingles is most common in older adults and people who have weak immune systems because of stress, injury, certain medicines, or other reasons. Most people who get shingles will get better and will not get it again. But it is possible to get shingles more than once.

What causes shingles?

Shingles occurs when the virus that causes chickenpox starts up again in your body. After you get better from chickenpox, the virus “sleeps” (is dormant) in your nerve roots. In some people, it stays dormant forever. In others, the virus “wakes up” when disease, stress, or aging weakens the immune system. Some medicines may trigger the virus to wake up and cause a shingles rash. It is not clear why this happens. But after the virus becomes active again, it can only cause shingles, not chickenpox.

You can’t catch shingles from someone else who has shingles. But there is a small chance that a person with a shingles rash can spread the virus to another person who hasn’t had chickenpox and who hasn’t gotten the chickenpox vaccine.

What are the symptoms?

Shingles symptoms happen in stages. At first you may have a headache or be sensitive to light. You may also feel like you have the flu but not have a fever.

Later, you may feel itching, tingling, or pain in a certain area. That’s where a band, strip, or small area of rash may occur a few days later. The rash turns into clusters of blisters. The blisters fill with fluid and then crust over. It takes 2 to 4 weeks for the blisters to heal, and they may leave scars. Some people only get a mild rash. And some do not get a rash at all.

It’s possible that you could also feel dizzy or weak. Or you could have pain or a rash on your face, changes in your vision, changes in how well you can think, or a rash that spreads. A rash or blisters on your face, especially near an eye or on the tip of your nose, can be a warning of eye problems.

Call your doctor now if you think you may have shingles. It’s best to get early treatment. Medicine can help your symptoms get better sooner. And if you have shingles near your eye or nose, see your doctor right away. Shingles that gets into the eye can cause permanent eye damage.

How is shingles treated?

Shingles is treated with medicines. These medicines include antiviral medicines and medicines for pain.

See your doctor right away if you think you may have shingles. Starting antiviral medicine right away can help your rash heal faster and be less painful. And you may need prescription pain medicine if your case of shingles is very painful.

Good home care also can help you feel better faster. Take care of skin sores, and keep them clean. Take your medicines as directed. If you are bothered by pain, tell your doctor. Other treatments may help with intense pain.

Who gets shingles?

Anyone who has had chickenpox can get shingles. You have a greater chance of getting shingles if you are older than 50 or if you have a weak immune system.

There is a shingles vaccine for adults. It lowers your chances of getting shingles and prevents long-term pain that can occur after shingles. And if you do get shingles, having the vaccine makes it more likely that you will have less pain and your rash will clear up more quickly.

Cause

Shingles is a reactivation of the varicella-zoster virus, a type of herpes virus that causes chickenpox. After you have had chickenpox, the virus lies inactive in your nerve roots and remains inactive until, in some people, it flares up again. If the virus becomes active again, you may get a rash that occurs only in the area of the affected nerve. This rash is called shingles.

Anyone who has had even a mild case of chickenpox can get shingles. This includes children.

Transmission

Exposure to shingles will not cause you to get shingles. But if you have not had chickenpox and have not gotten the chickenpox vaccine, you can get chickenpox if you are exposed to shingles. Someone who has shingles can expose you to the virus if you come into contact with the fluid in the shingles blisters.

If you are having an active outbreak of shingles, you can help prevent the spread of the virus to other people. Cover any fluid-filled blisters that are on a part of your body that isn’t covered with clothes. Choose a type of dressing that absorbs fluid and protects the sores.

Symptoms

When the virus that causes chickenpox reactivates, it causes shingles. Early symptoms of shingles include headache, sensitivity to light, and flu-like symptoms without a fever. You may then feel itching, tingling, or pain where a band, strip, or small area of rash may appear several days or weeks later. A rash can appear anywhere on the body but will be on only one side of the body, the left or right. The rash will first form blisters, then scab over, and finally clear up over a few weeks. This band of pain and rash is the clearest sign of shingles.

The rash caused by shingles is more painful than itchy. The nerve roots that supply sensation to your skin run in pathways on each side of your body. When the virus becomes reactivated, it travels up the nerve roots to the area of skin supplied by those specific nerve roots. This is why the rash can wrap around either the left or right side of your body, usually from the middle of your back toward your chest. It can also appear on your face around one eye. It is possible to have more than one area of rash on your body.

Shingles develops in stages:

Prodromal stage (before the rash appears)

• Pain, burning, tickling, tingling, and/or numbness occurs in the area around the affected nerves several days or weeks before a rash appears. The discomfort usually occurs on the chest or back, but it may occur on the belly, head, face, neck, or one arm or leg.
• Flu-like symptoms (usually without a fever), such as chills, stomachache, or diarrhea, may develop just before or along with the start of the rash.
• Swelling and tenderness of the lymph nodes may occur.

Active stage (rash and blisters appear)

• A band, strip, or small area of rash appears. It can appear anywhere on the body but will be on only one side of the body, the left or right. Blisters will form. Fluid inside the blisters is clear at first but may become cloudy after 3 to 4 days. A few people won’t get a rash, or the rash will be mild.
• A rash may occur on the forehead, cheek, nose, and around one eye (herpes zoster ophthalmicus), which may threaten your sight unless you get prompt treatment.
• Pain, described as “piercing needles in the skin,” may occur along with the skin rash.
• Blisters may break open, ooze, and crust over in about 5 days. The rash heals in about 2 to 4 weeks, although some scars may remain.

Postherpetic neuralgia (chronic pain stage)

• Postherpetic neuralgia (PHN) is the most common complication of shingles. It lasts for at least 30 days and may continue for months or years. Symptoms are:
  • Aching, burning, stabbing pain in the area of the earlier shingles rash.
  • Persistent pain that may linger for years.
  • Extreme sensitivity to touch.
• The pain associated with PHN most commonly affects the forehead or chest. This pain may make it difficult for the person to eat, sleep, and do daily activities. It may also lead to depression.

Shingles may be confused with other conditions that cause similar symptoms. The rash from shingles may be mistaken for an infection from herpes simplex virus (HSV), poison oak or ivy, impetigo, or scabies. The pain from PHN may feel like appendicitis, a heart attack, ulcers, or migraine headaches.

What Happens

Shingles is caused by the same virus that causes chickenpox. After an attack of chickenpox, the virus remains in the tissues in your nerves. As you get older, or if you have an illness or stress that weakens your immune system, the virus may reappear in the form of shingles.

You may first have a headache, flu-like symptoms (usually without a fever), and sensitivity to light, followed by itching, tingling, or pain in the area where a rash may develop. The pain usually occurs several days or weeks before a rash appears on the left or right side of your body. The rash will be in a band, a strip, or a small area. In 3 to 5 days, the rash turns into fluid-filled blisters that ooze and crust over. The rash heals in about 2 to 4 weeks, although you may have long-lasting scars. A few people won’t get a rash, or the rash will be mild.

Most people who get shingles will not get the disease again.

Complications of shingles

Delaying or not getting medical treatment may increase your risk for complications. Complications of shingles include:

• Postherpetic neuralgia (PHN), which is pain that does not go away within 1 month. It may last for months or even years after shingles heals. It is more common in people age 50 and older and in people who have a weakened immune system due to another disease, such as diabetes or HIV infection.
• Disseminated zoster, which is a blistery rash that spreads over a large portion of the body and can affect the heart, lungs, liver, pancreas, joints, and intestinal tract. Infection may spread to nerves that control movement, which may cause temporary weakness.
• Cranial nerve complications. If shingles affects the nerves originating in the brain (cranial nerves), complications may include:
  • Inflammation, pain, and loss of feeling in one or both eyes. The infection may threaten your vision. A rash may appear on the side and tip of the nose (Hutchinson’s sign).
  • Intense ear pain, a rash around the ear, mouth, face, neck, and scalp, and loss of movement in facial nerves (Ramsay Hunt syndrome). Other symptoms may include hearing loss, dizziness, and ringing in the ears. Loss of taste and dry mouth and eyes may also occur.
  • Inflammation, and possibly blockage, of blood vessels, which may lead to stroke.
• Scarring and skin discoloration.
• Bacterial infection of the blisters.
• Muscle weakness in the area of the infected skin before, during, or after the episode of shingles.

What Increases Your Risk

Things that increase risk for shingles include:

• Having had chickenpox. You must have had chickenpox to get shingles.
• Being older than 50.
• Having a weakened immune system due to another disease, such as diabetes or HIV infection.
• Experiencing stress or trauma.
• Having cancer or receiving treatment for cancer.
• Taking medicines that affect your immune system, such as steroids or medicines that are taken after having an organ transplant.

If a pregnant woman gets chickenpox, her baby has a high risk for shingles during his or her first 2 years of life. And if a baby gets chickenpox in the first year of life, he or she has a higher risk for shingles during childhood.^{footnote 1}

Postherpetic neuralgia (PHN) is a common complication of shingles that lasts for at least 30 days and may continue for months or years. You can reduce your risk for getting shingles and developing PHN by getting the shingles vaccine.

When should you call your doctor?

If you think you have shingles, see a doctor as soon as possible. Early treatment with antiviral medicines may help reduce pain and prevent complications of shingles, such as disseminated zoster or postherpetic neuralgia.

A rash or blisters on your face, especially near an eye or on the tip of your nose, can be a warning of eye problems. Treatment can help prevent permanent eye damage.

If you still feel intense pain for more than 1 month after the skin heals, see your doctor to find out whether you have postherpetic neuralgia (PHN). Getting your pain under control right away may prevent nerve damage that may cause pain that lasts for months or years.

Who to see

Exams and Tests

Doctors can usually identify shingles when they see an area of rash around the left or right side of your body. If a diagnosis of shingles is not clear, your doctor may order lab tests, most commonly herpes tests, on cells taken from a blister.

If there is reason to think that shingles is present, your doctor may not wait to do tests before treating you with antiviral medicines. Early treatment may help shorten the length of the illness and prevent complications such as postherpetic neuralgia.

Treatment Overview

There is no cure for shingles, but treatment may shorten the length of illness and prevent complications. Treatment options include:

• Antiviral medicines to reduce the pain and duration of shingles.
• Pain medicines, antidepressants, and topical creams to relieve long-term pain.

Initial treatment

As soon as you are diagnosed with shingles, your doctor probably will start treatment with antiviral medicines. If you begin medicines within the first 3 days of seeing the shingles rash, you have a lower chance of having later problems, such as postherpetic neuralgia.

The most common treatments for shingles include:

• Antiviral medicines, such as acyclovir, famciclovir, or valacyclovir, to reduce the pain and the duration of shingles.
• Over-the-counter pain medicines, such as acetaminophen or ibuprofen, to help reduce pain during an attack of shingles. Be safe with medicines. Read and follow all instructions on the label.
• Topical antibiotics, applied directly to the skin, to stop infection of the blisters.

For severe cases of shingles, some doctors may have their patients use corticosteroids along with antiviral medicines. But corticosteroids are not used very often for shingles. This is because studies show that taking a corticosteroid along with an antiviral medicine doesn’t help any more than just taking an antiviral medicine by itself.^{footnote 2}

Ongoing treatment

If you have pain that persists longer than a month after your shingles rash heals, your doctor may diagnose postherpetic neuralgia (PHN), the most common complication of shingles. PHN can cause pain for months or years. It affects 10 to 15 out of 100 people who have had shingles.^{footnote 3} Treatment to reduce the pain of postherpetic neuralgia includes:

• Antidepressant medicines, such as a tricyclic antidepressant (for example, amitriptyline).
• Topical anesthetics that include benzocaine, which are available in over-the-counter forms that you can apply directly to the skin for pain relief. Lidocaine patches, such as Lidoderm, are available only by prescription.
• Anticonvulsant medicines, such as gabapentin or pregabalin.
• Opioids, such as codeine.
• Other medicines that treat pain, such as gabapentin enacarbil (Horizant).

Topical creams containing capsaicin may provide some relief from pain. There is also a high-dose skin patch available by prescription (Qutenza) for postherpetic neuralgia. Capsaicin may irritate or burn the skin of some people, and it should be used with caution.

Treatment if the condition gets worse

In some cases, shingles causes long-term complications. Treatment depends on the specific complication.

• Postherpetic neuralgia (PHN) is persistent pain that lasts months or even years after the shingles rash heals. Certain medicines, such as anticonvulsants, antidepressants, and opioids, can relieve pain. Most cases of PHN resolve within a year.
• Disseminated zoster is a blistery rash over a large portion of the body. It may affect the heart, lungs, liver, pancreas, joints, and intestinal tract. Treatment may include both antiviral medicines to prevent the virus from multiplying and antibiotics to stop infection.
• Herpes zoster ophthalmicus is a rash on the forehead, cheek, nose, and around one eye, which could threaten your sight. You should seek prompt treatment from an ophthalmologist for this condition. Treatment may include rest, cool compresses, and antiviral medicines.
• If the shingles virus affects the nerves originating in the brain (cranial nerves), serious complications involving the face, eyes, nose, and brain can occur. Treatment depends on the nature and location of the complication.

Prevention

Anyone who has had chickenpox may get shingles later in life. But there are two types of vaccines, Shingrix (RZV) and Zostavax (ZVL), that may help prevent shingles or make it less painful if you do get it.

Two doses of RZV are recommended for adults ages 50 and older, whether or not they’ve had shingles before. It is also recommended for adults who have already had the ZVL vaccine.

ZVL is available for adults ages 60 and older. This vaccine is given as one dose. You can ask your doctor or pharmacist which vaccine is right for you.

If you have never had chickenpox, you may avoid getting the virus that causes both chickenpox and later shingles by receiving the varicella vaccine.

If you have never had chickenpox and have never gotten the chickenpox vaccine, avoid contact with people who have shingles or chickenpox. Fluid from shingles blisters is contagious and can cause chickenpox (but not shingles) in people who have never had chickenpox and who have never gotten the chickenpox vaccine.

If you have shingles, avoid close contact with people until after the rash blisters heal. It is especially important to avoid contact with people who are at special risk from chickenpox, such as:

• Pregnant women, infants, children, or anyone who has never had chickenpox.
• Anyone who is currently ill.
• Anyone with a weak immune system who is unable to fight infection (such as someone with HIV infection or diabetes).

If you cover the shingles sores with a type of dressing that absorbs fluid and protects the sores, you can help prevent the spread of the virus to other people.

Home Treatment

You may reduce the duration and pain of shingles by:

• Taking good care of skin sores.
  • Avoid picking at and scratching blisters. If left alone, blisters will crust over and fall off naturally.
  • Use cool, moist compresses if they help ease discomfort. Lotions, such as calamine, may be applied after wet compresses.
  • Apply cornstarch or baking soda to help dry the sores so that they heal more quickly.
  • Soak crusted sores with tap water or Burow’s solution to help clean away crusts, decrease oozing, and dry and soothe the skin.
  • Ask your doctor about using topical creams to help relieve the inflammation caused by shingles.
  • If your skin becomes infected, ask your doctor about prescription antibiotic creams or ointments.
• Using medicines as prescribed to treat shingles or postherpetic neuralgia, which is pain that lasts for at least 30 days after the shingles rash heals.
• Using nonprescription pain medicines, such as acetaminophen or ibuprofen, to help reduce pain during an attack of shingles or pain caused by postherpetic neuralgia. If you are already taking a prescription pain medicine, talk with your doctor before using any over-the-counter pain medicine. Some prescription pain medicines have acetaminophen (Tylenol), and getting too much acetaminophen can be harmful. Be safe with medicines. Read and follow all instructions on the label.

If home treatment doesn’t help with pain, talk with your doctor. Getting your pain under control right away may prevent nerve damage that may cause pain that lasts for months or years.

Medications

Medicines can help limit the pain and discomfort caused by shingles, shorten the time you have symptoms, and prevent the spread of the disease. Medicines also may reduce your chances of developing shingles complications, such as postherpetic neuralgia (PHN) or disseminated zoster.

Medicine choices

Medicines to treat shingles when the rash is present (active stage) may include:

• Over-the-counter pain medicines, such as acetaminophen or ibuprofen, to help reduce pain. Be safe with medicines. Read and follow all instructions on the label.
• Antiviral medicines, to reduce the pain and duration of shingles.
• Topical antibiotics, which are applied directly to the skin, to stop infection of the blisters.

Medicines to treat postherpetic neuralgia pain may include:

What to think about

For some people, nonprescription pain relievers (analgesics) are enough to help control pain caused by shingles or postherpetic neuralgia. But for others, stronger medicines may be needed. And if prescription medicines don’t help control your pain, you may need to see a pain specialist about other ways to treat PHN.

Other Treatment

Postherpetic neuralgia (PHN), the most common complication of shingles, is difficult to treat. Your doctor may recommend other treatments, along with medicines, to control the pain of PHN.

Other treatment choices

There are other treatments that may be used for shingles and postherpetic neuralgia. These treatments may help, but there is no clear evidence from studies that show how well these treatments work. These other treatments include:

Psychological therapies that help you tolerate long-term pain, such as cognitive-behavioral therapy, may be helpful. These methods can include counseling as well as learning techniques that teach you to shift your focus of attention away from the pain, such as relaxation and breathing exercises.

For severe pain from PHN, you may need to see a pain management specialist. These doctors are trained to help with pain that doesn’t respond to medicines or usual treatments.

References

Citations

1. Gershon AA (2009). Varicella zoster virus. In RD Feigin et al., eds., Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 6th ed., vol. 2, pp. 2077–2088. Philadelphia: Saunders Elsevier.
2. Chen N, et al. (2010). Corticosteroids for preventing postherpetic neuralgia (Review). Cochrane Database of Systematic Reviews (12).
3. Dubinsky RM, et al. (2004, reaffirmed 2008). Practice parameter: Treatment of postherpetic neuralgia. An evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 63(6): 959–965.

Other Works Consulted

• Centers for Disease Control and Prevention (2008). Prevention of herpes zoster: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 57(05): 1–30. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5705a1.htm. [Erratum in MMWR, 57(28): 779. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5728a5.htm.]
• Habif TP (2010). Herpes zoster. In Clinical Dermatology, A Color Guide to Diagnosis and Therapy, 5th ed., pp. 479–490. Philadelphia: Mosby.
• Herpes zoster vaccine (Zostavax) revisited (2010). Medical Letter on Drugs and Therapeutics, 52(1339): 41.
• Wolff K, Johnson RA (2009). Varicella-zoster virus infections. In Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 6th ed., pp. 837–845. New York: McGraw-Hill Medical.

Credits

Current as of:
September 23, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Martin J. Gabica MD – Family Medicine

Does Stress Cause Shingles in Seniors? — Precision Vaccinations

(Precision Vaccinations)

You’re at risk for shingles if you’ve ever had chickenpox. That’s because the varicella-zoster virus, which causes chickenpox, is also responsible for shingles.

Shingles can occur in people of any age, but it usually affects about one million seniors annually.

But, what activates shingles?

It isn’t clear why the varicella-zoster virus reactivates in some people and not others, according to researchers.

People often think of stress as a trigger for shingles, but researchers have looked at this potential link, and can’t find one.

Some research reports shingles is activated when a patient’s immune system is weakened, as when we age, or take immune-suppressing drugs. But why does it also sometimes happen in seemingly healthy people?

This contradiction isn’t unusual, but it can make it difficult to figure out what it all means.

Clinical researchers do report a consensus that T-cell immunity plays a key role in controlling reactivation.

Additionally, psychological stress has commonly been considered to be a trigger for herpes.

Moreover, this contention has been supported by several, but not all, studies.

But, new research using case-only methods to investigate this premise, found no evidence that stress triggers herpes.

Case-only methods are powerful because they are self-matched, eliminating effects of selection bias and measured or unmeasured time-invariant confounders.

But implications of this HZ research are unclear, and may be conjectural.

This new study has limitations, as it is based on administrative data, so misclassifications are possible.

These researchers say patients should, however, immediately seek care for suspected HZ so that the illness can be controlled and curtailed with timely antiviral treatment and pain management, regardless of the underlying HZ trigger.

Meanwhile, for persons aged 60 years and older, effective vaccines are available that can help prevent this disabling disease.

Recently, The US Food and Drug Administration (FDA) has approved Shingrix (Zoster Vaccine Recombinant, Adjuvanted) for the prevention of shingles (herpes zoster) in adults aged 50 years and older.

But, Shingrix has not been approved for the prevention of chickenpox.

Shingrix is a non-live, recombinant subunit vaccine given intramuscularly in two doses. It combines an antigen, glycoprotein E, and an adjuvant system, AS01B, intended to generate a strong and long-lasting immune response that can help overcome the decline in immunity as people age.

By preventing shingles, Shingrix reduces the overall incidence of postherpetic neuralgia (PHN), a form of chronic nerve pain and the most common complication associated with shingles.

Most pharmacies offer shingles vaccines. The retail price of this vaccine varies based upon insurance coverage and location.

Vaccine discounts can be found here.

This study was published by Oxford University Press on behalf of the Infectious Diseases Society of America. This work is written by US Government employees.

can stress cause shingles

©1996-2021 MedicineNet, Inc. All rights reserved. In 2018, a team of Japanese researchers investigated the relationship between psychosocial factors, shingles, and postherpetic neuralgia. While the science hasn’t proven a direct casual link, there is some kind of stress-shingles connection. Shingles is a viral infection that causes a painful rash. Perhaps most colorfully, a controlled study in the early 2000s followed eight astronauts to see if the physical stress of space flight—before, during, and after—was linked to the reemergence of shingles. There’s no cure, but treatments can ease symptoms. But there’s more. The Shingles–Depression Link. So, let’s bring it back down to Earth. Currently she serves as Contributing Travel Editor at, Getting a Handle on Hidradenitis Suppurativa, Now What? One of these factors is stress , and if you find yourself breaking out in hives without another likely cause, it’s possible that stress is to blame . There’s some disagreement about how often recurrence occurs. Tracey Minkin has spent her career as both editor and freelance writer for regional and national magazines on topics including cancer clusters on Upper Cape Cod, and the ethical and medical complexities of an in vitro pregnancy of triplets. A surge in cortisol in response to stress—the ancient adaptation often referred to as the “fight-or-flight mechanism”—actually boosts immunity by reducing inflammation if the stimulus is brief—akin to a saber tooth tiger, say, attacking a prehistoric cave dweller. It’s also possible for high levels of stress to cause other rashes that are disease based, like herpes on the genitals or face. But life isn’t prehistoric anymore, and modern stressors can be unrelenting, such as job loss or toxic workplaces, relationship reversals like divorce, health crises, the death of a loved one, poverty, discrimination, and even unprecedented shocks like a global pandemic. While there’s no proven direct link between high physical and emotional stress and shingles, there’s plenty of documented causal connections to suspect stress may play at least some role in the virus’s reemergence. Shingles typically occurs in older people and in people whose immune systems are weakened. “Since March, I have had three patients in that age group.”. The presence of VZV, according to NASA researcher Satish K. Mehta, Ph.D., indicates that the virus can reactivate in younger, healthy subjects if they experience certain intense physical stresses. For this reason, stress can also precipitate outbreaks of shingles in some people. … With stress our physiologic guard is down, so to speak,” she says. Take the Shingles (Herpes Zoster) Quiz featuring pictures, quick facts, symptoms, treatments, and causes of this itchy, painful rash. MedicineNet does not provide medical advice, diagnosis or treatment. In one study , researchers examined medical records of nearly 1,700 patients who had a documented case of shingles … ; Coffee—even without sweetener. Stress can also weaken the immune system. Shingles is also called herpes zoster. Does Stress Literally Cause Shingles? In 2020, an analysis of a whopping 88 studies on the risk factors for shingles assessed them by category. Here’s what to know. The virus remains dormant in nerve cells and reactivates as a result of stress, causing pain and a rash on the band of the skin supplied by the affected nerve. “VZV sleeps in the dorsal root ganglion for years and years and years,” says Jenny Murase, M.D., an assistant clinical professor of dermatology at the University of California, San Francisco, and director of Medical Dermatology Consultative Services for the Palo Alto Foundation Medical Group. Oct. 8, 2009 — Adults with shingles are at increased risk for stroke, especially if they have shingles that affects the eyes, a study shows. While allergies are the main cause of hives, some research has found that stress can also trigger this skin condition where the body releases histamines. Since stress affects the immune system, many researchers believe that stress could be a trigger for shingles. Studies have shown that persons experiencing significant psychological stress are more prone to infection than those who are not under stress. Other risk factors include stress, sun exposure, medications to prevent organ rejection and cancer treatments. Currently she serves as Contributing Travel Editor at Coastal Living Magazine. Most people associate hives — the raised, puffy welts on your skin that spread when scratched — with an allergic reaction, but there are a number of factors that can cause them. However, not all research delivers a stress-shingles connection. The ultimate cause of shingles is a reactivation of the dormant herpes zoster virus, but stress is risk factors for an outbreak. A shingles vaccine can reduce the chances of a recurrence. The good news is that multiple modalities can alleviate stress and calm the inflammation it causes,” he says, including mindful practices like meditation, yoga, and tai chi. Then it gets to your skin and causes shingles.”, Joshua Zeichner, M.D., director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City, agrees. It is believed that this is the reason that shingles is more common in the elderly than in younger people, but the exact reason why the virus begins to start reproducing again is unknown. ©1996-2020 MedicineNet, Inc. All rights reserved. See additional information. Shingles triggers a painful rash or small blisters on an area of skin. “The science tells us that stress impacts our hormones, which in turn have an impact on our ability to mount defense responses. What affects one, affects the other,” says Leonard Calabrese, D.O., head of the RJ Fasenmyer Center for Clinical Immunology at the Cleveland Clinic. The hormone at work here, Dr. Shapiro points out, is cortisol. If you get sick with a cold or a sinus infection, your immune system is focused on fighting the cold, which can trigger shingles. In 2019, Mehta studied a larger group of astronauts, this time searching for incidence of four herpes viruses—Epstein–Barr virus (EBV), varicella-zoster virus (VZV), herpes-simplex-1 (HSV-1), and cytomegalovirus (CMV)—and looking beyond just the physical rigors of space flight. Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox. Stress can also weaken the immune system. Participants were asked to asked to label the level of stress in their daily life as extremely high, high, medium, or low; describe their sense of purpose in life; and answer questions about negative life events within each past year, including changes in work and living environments, changes in human relations, and distress over economic issues. For this reason, stress can also precipitate outbreaks of shingles in some people. Can stress trigger an outbreak of shingles? What does shingles look like? After you’ve had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain… Identifying space travel stressors including (but not limited to) social separation, confinement, sleep deprivation, circadian rhythm disruption, and anxiety, he noted a “rise in secretion of stress hormones like cortisol and adrenaline, which are known to suppress the immune system.” Immune cells—particularly those that normally suppress and eliminate viruses—are not only less effective during spaceflight but remain that way for up to 60 days after returning to earth, according to Mehta. Herpes zoster, also known as shingles, is caused by a reactivation of the varicella-zoster virus (VZV), the same virus that causes chicken pox. According to Cleveland Clinic, amenorrhea is the absence of a monthly period. Is shingles contagious? What is shingles? The quick but incomplete answer is “no.” Shingles (officially termed herpes zoster, or HZ) is caused by a virus—the varicella zoster virus (VZV)—that, before a vaccine became widely available in 1995, caused chicken pox mainly in children up to 12 years of age. In other words: Do your best to decompress to avoid a shingles attack. Shingles is a rash with shooting pain. The risk of postherpetic neuralgia increases with age, primarily affecting people older than 60. Two to four days before the rash occurs there may be tingling or local pain in the area. About 1 million Americans develop shingles every year, according to the Centers for Disease Control (CDC), or 1 in 3 adults over 50, when risk begins to climb dramatically. Stress can be a factor McNeil said there can be a number of reasons why a person under 50 would get shingles. One could easily say that shingles—the painful, blistering reemergence of the virus that gave you chicken pox when you were a kid—is itself a very stressful situation. Her writing has been anthologized in collections and has won regional and national awards. A Beginner’s Guide to Hepatitis C, Ankylosing Spondylitis: We’ve Got Your Back, academic.oup.com/ofid/article/7/1/ofaa005/5698681, academic.oup.com/aje/article/187/2/251/4209708, sciencedirect.com/science/article/abs/pii/S138665321200248X, academic.oup.com/cid/article/60/5/781/290708, onlinelibrary.wiley.com/doi/abs/10.1002/jmv.10555, frontiersin.org/articles/10.3389/fmicb.2019.00016/full. It causes a painful blistering rash. Relax as much as you can—and read on. Herpes zoster virus causes shingles. And that’s where our body’s immunity powers get tripped up. Knowledge is power! Tracey Minkin has spent her career as both editor and freelance writer for regional and national magazines on topics including cancer clusters on Upper Cape Cod, and the ethical and medical complexities of an in vitro pregnancy of triplets. The results were eye-opening. Stress doesn’t technically cause shingles, but it can cause your immune system to weaken — and a weakened immune system can put you at risk for shingles. Although shingles can occur anywhere on your body, it most often appears as a single stripe of blisters that wraps around either the left or the right side of your torso.Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox. It can appear anywhere on the body, but it typically appears on only one side of the face or body. When people get chickenpox, the virus remains in the body. Shingles infections within or near the ear can cause hearing or balance problems as well as weakness of the muscles on the affected side of the face. “I tell my patients that the brain and the immune system are one organ, not two. Stress can cause hives, or a stress rash. Relax as much as you can—and read on. Initially, the virus causes chickenpox. Sustained higher levels of cortisol end up increasing inflammation over time, as well as suppressing lymphocytes, those white blood cells that fight off infections. 3. And, to make matters trickier, it’s possible that some particularly anxiety-producing experience preceded the outbreak, triggering the rash in the first place. Typically the rash occurs in a single, wide stripe either on the left or right side of the body or face. “I had not seen shingles in my patients under the age of 40 in years,” she says. If I’ve been vaccinated for chickenpox, can I still develop shingles later in life? The disease can cause damage to or death of the nerve cells that react to light (called acute retinal necrosis). It is most common on the head or neck. “The flight-or-fight response is characterized by a surge in cortisol, a hormone that prepares us for that stress, but unfortunately has other negative impacts on our health. For the first 30 days, this is described as acute herpetic neuralgia — it can be severely distressing, preventing sleep. Damage to vision and hearing. Studies have shown that persons experiencing significant psychological stress are more prone to infection than those who are not under stress. And, if you’re 50 or over, it goes without saying: Get a shingles vaccination to give your immune system the extra rocket boost it needs. But you can get chickenpox from someone with shingles if you have not had chickenpox before. It usually shows up on just one side of your body. Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care. You’ll get health news, advice, and inspiration delivered right to your inbox. Many people are left with an itchy area from their shingles, which can be as disabling as chronic pain. That means if you’re an astronaut or just an everyday American trying to stay sane during uniquely stressful times, it’s important to be on guard against all that stresses you out—whether that’s clearing for takeoff or just trying to work from home with your kids or grandkids remote learning in the same room. Terms of Use. For most people, postherpetic neuralgia improves … Men with high levels of mental stress were twice as likely to be at risk for shingles, and women who experienced negative life events—particularly changes in their work, living environment, and relationships—had a two to three-fold higher risk of PHN. The condition affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear.The chickenpox (herpes zoster) virus causes shingles. Sometimes, in patients who have a history of chickenpox, the virus can be present in the nervous system for years in a dormant stage. Emotional stress is considered to be a trigger for causing shingles to reactivate as stress leads to a weaker immune system. What is shingles? It can be reactivated later and cause shingles if someone’s immune system is lowered. These problems can be long-lasting or permanent. It’s a vicious cycle: Chronic pain, like that caused by shingles, can lead to depression, and depression can worsen pain. Stress can cause migraines, the pounding pain creates more stress, and the circular pattern can make it tough for headache and migraine sufferers to cope. There is currently a shingles vaccine (Zostavax) that is approved for people over 60 to help prevent this disease because it can cause significant illness and pain in older individuals. The researchers found that while only one astronaut showed the presence of the VZV in their saliva (a marker for reactivation of the virus) before space flight, all eight did after returning to earth. While the greatest risk, the researchers concluded, was immunosuppression from HIV/AIDS and cancer therapies (followed by family history, physical trauma, and older age), psychological stress was also found to play a role. A 2015 study in Atlanta that pulled information from claims from private and Medicare data bases focused on nearly 40,000 individuals who’d experienced severe death or illness of a spouse (among other stressful life events) and found only 137 had developed shingles afterward. “How stress can impact an immune system is complex,” says Marla Shapiro, C.M., M.D., a professor in family and community medicine at the University of Toronto. Shingles, or herpes zoster, is a common infection of the nerves. Since the virus never completely leaves the body, it can reactivate in the form of shingles, causing localized rash and nerve irritation. No one knows for sure what causes the chickenpox virus to become reactivated to cause shingles. These symptoms often accompany a rash, … Her writing has been anthologized in collections and has won regional and national awards. The problem is that decades later, the virus can wake up and reemerge along nerve pathways, erupting in painful, itchy blisters and, for some, complications including herpes zoster opthalmicus (which affects the eye and can create blindness) and postherpetic neuralgia (PHN), which is potentially debilitating pain along the same pathways that can last for months, and sometimes years, after the rash retreats. If you’ve had chickenpox, the virus can lie dormant in your body’s nerve tissue for years when suddenly it’s triggered by stress or a weakened immune system, and manifests as shingles. This can be because of stress, certain conditions, or treatments like chemotherapy. The lower your lymphocyte levels, the more at risk you are for viruses, including the common cold, cold sores, and a nasty virus hibernating in your central nervous system—VZV. The study is … Postherpetic neuralgia (post-hur-PET-ik noo-RAL-juh) is the most common complication of shingles. Our immune system tends to wane as we get older, which is why shingles usually occurs in adults over 50. Stress rash could be the diagnosis if a person can associate the development of hives with stress. People usually recover from shingles in a few weeks to a few months, but the pain of an angry, inflamed nerve can linger, occasionally as … Prolonged itching. “While the exact cause of shingles is unknown, experts do know that the virus can remain inactive in nerve tissues near the spinal cord and brain for decades,” Dr. Grahling says. “We know that the body’s stress response can impair our immunity,” he says. © 2021 Remedy Health Media, LLC ALL RIGHTS RESERVED. The study, published in American Journal of Epidemiology, followed 12,522 men and women between the ages of 50 and 103 for three years. (About 10% to 18% of people who get shingles also experience PHN, according to the CDC.) Conversely, the risk of shingles was 60% lower among men and women who reported a high sense of purpose in life. Read more: Shingles Quiz: Symptoms, Vaccine & Pictures. Scientists aren’t always sure why the virus gets active again, but they know stress can be a cause. A range of skin conditions can cause tightness, itching, and a tingling sensation on the scalp. At the conclusion of the disease phase of chicken pox, VZV retreats to the central nervous system (CNS), and like a hibernating bear in a cave, goes dormant.

Herpes Zoster (Shingles) | Boston Children’s Hospital

What is herpes zoster (shingles)?

Herpes zoster, or shingles, is a common viral infection of the nerves, which results in a painful rash of small blisters on a strip of skin anywhere on the body. Even after the rash is gone, the pain may continue for months.

• Shingles is relatively rare in children.
• Your child is most at risk if he had chickenpox during the first year of life or if you had chickenpox very late during pregnancy.
• A rash most often occurs on the trunk and buttocks, and usually goes away in one to two weeks.
• Medication may help alleviate some of the pain, but the disease has to run its course.

What causes herpes zoster?

Herpes zoster is caused by the reactivation of the chickenpox virus. After a person has had chickenpox, the virus lies dormant in certain nerves for many years.

Is herpes zoster common?

Shingles is more common in people with a depressed immune system and those over the age of 50. It’s quite rare in children, and the symptoms are mild compared to what an adult may experience.

What are the symptoms of herpes zoster?

The rash associated with herpes zoster most often occurs on the trunk and buttocks. It may also appear on the arms, legs, or face. While symptoms may vary child to child, the most common include:

• skin hypersensitivity in the area where the herpes zoster (shingles) is to appear
• mild rash, which appears after five days and first looks like small, red spots that turn into blisters
• blisters, which turn yellow and dry, often leaving small, pitted scars
• rash goes away in one to two weeks
• rash is usually localized to one side of the body

How do we diagnose herpes zoster?

Diagnosis usually involves obtaining a medical history of your child and performing a physical exam. Your doctor also may want to:

• take skin scrapings (gently scraping the blisters to determine if the virus is shingles or another virus)
• run blood tests

How do we treat herpes zoster?

Medication may help alleviate some of the pain, but the disease has to run its course. Your doctor will prescribe medication based on your child’s age and the severity of the symptoms. Immediate treatment with antiviral drugs may help lessen some of the symptoms and minimize nerve damage.

Shingles | HealthLink BC

Topic Overview

What is shingles?

Shingles is a painful skin rash. It is caused by the varicella zoster virus. Shingles usually appears in a band, a strip, or a small area on one side of the face or body. It is also called herpes zoster.

Shingles is most common in older adults and people who have weak immune systems because of stress, injury, certain medicines, or other reasons. Most people who get shingles will get better and will not get it again. But it is possible to get shingles more than once.

What causes shingles?

Shingles occurs when the virus that causes chickenpox starts up again in your body. After you get better from chickenpox, the virus “sleeps” (is dormant) in your nerve roots. In some people, it stays dormant forever. In others, the virus “wakes up” when disease, stress, aging, or some medications weaken the immune system. It is not clear why this happens. But after the virus becomes active again, it can only cause shingles, not chickenpox.

You can’t catch shingles from someone else who has shingles. But there is a small chance that a person with a shingles rash can spread the virus to another person who hasn’t had chickenpox and who hasn’t gotten the chickenpox vaccine.

What are the symptoms?

Shingles symptoms happen in stages. At first you may have a headache or be sensitive to light. You may also feel like you have the flu.

Later, you may feel itching, tingling, or pain in a certain area. That’s where a band, strip, or small area of rash may occur a few days later. The rash turns into clusters of blisters. The blisters fill with fluid and then crust over. It takes 2 to 4 weeks for the blisters to heal, and they may leave scars. Some people only get a mild rash. And some do not get a rash at all.

It’s possible that you could also feel dizzy or weak. Or you could have pain or a rash on your face, changes in your vision, changes in how well you can think, or a rash that spreads. A rash or blisters on your face, especially near an eye or on the tip of your nose, can be a warning of eye problems.

Call your doctor now if you think you may have shingles. It’s best to get early treatment. Medicine can help your symptoms get better sooner. And if you have shingles near your eye or nose, see your doctor right away. Shingles that gets into the eye can cause permanent eye damage.

How is shingles treated?

Shingles is treated with medicines. These medicines include antiviral medicines and medicines for pain.

See your doctor right away if you think you may have shingles. Starting antiviral medicine right away can help your rash heal faster and be less painful. And you may need prescription pain medicine if your case of shingles is very painful.

Good home care also can help you feel better faster. Take care of any skin sores, and keep them clean. Take your medicines as directed. If you are bothered by pain, tell your doctor. Other treatments may help with intense pain.

Who gets shingles?

Anyone who has had chickenpox can get shingles. You have a greater chance of getting shingles if you are older than 50 or if you have a weak immune system.

There are shingles vaccines for adults. They lower your chances of getting shingles and prevent long-term pain that can occur after shingles. And if you do get shingles, being vaccinated makes it more likely that you will have less pain and your rash will clear up more quickly.

Cause

Shingles is a reactivation of the varicella-zoster virus, a type of herpes virus that causes chickenpox. After you have had chickenpox, the virus lies inactive in your nerve roots and remains inactive until, in some people, it flares up again. If the virus becomes active again, you may get a rash that occurs only in the area of the affected nerve. This rash is called shingles.

Anyone who has had even a mild case of chickenpox can get shingles. This includes children.

Transmission

Exposure to shingles will not cause you to get shingles. But if you have not had chickenpox and have not gotten the chickenpox vaccine, you can get chickenpox if you are exposed to shingles. Someone who has shingles can expose you to the virus if you come into contact with the fluid in the shingles blisters.

If you are having an active outbreak of shingles, you can help prevent the spread of the virus to other people. Cover any fluid-filled blisters that are on a part of your body that isn’t covered with clothes. Choose a type of dressing that absorbs fluid and protects the sores.

Symptoms

When the virus that causes chickenpox reactivates, it causes shingles. Early symptoms of shingles include headache, sensitivity to light, and flu-like symptoms without a fever. You may then feel itching, tingling, or pain where a band, strip, or small area of rash may appear several days or weeks later. A rash can appear anywhere on the body but will be on only one side of the body, the left or right. The rash will first form blisters, then scab over, and finally clear up over a few weeks. This band of pain and rash is the clearest sign of shingles.

The rash caused by shingles is more painful than itchy. The nerve roots that supply sensation to your skin run in pathways on each side of your body. When the virus becomes reactivated, it travels up the nerve roots to the area of skin supplied by those specific nerve roots. This is why the rash can wrap around either the left or right side of your body, usually from the middle of your back toward your chest. It can also appear on your face around one eye. It is possible to have more than one area of rash on your body.

Shingles develops in stages:

Prodromal stage (before the rash appears)

• Pain, burning, tickling, tingling, and/or numbness occurs in the area around the affected nerves several days or weeks before a rash appears. The discomfort usually occurs on the chest or back, but it may occur on the belly, head, face, neck, or one arm or leg.
• Flu-like symptoms (usually without a fever), such as chills, stomach ache, or diarrhea, may develop just before or along with the start of the rash.
• Swelling and tenderness of the lymph nodes may occur.

Active stage (rash and blisters appear)

• A band, strip, or small area of rash appears. It can appear anywhere on the body but will be on only one side of the body, the left or right. Blisters will form. Fluid inside the blisters is clear at first but may become cloudy after 3 to 4 days. A few people won’t get a rash, or the rash will be mild.
• A rash may occur on the forehead, cheek, nose, and around one eye (herpes zoster ophthalmicus), which may threaten your sight unless you get prompt treatment.
• Pain, described as “piercing needles in the skin,” may occur along with the skin rash.
• Blisters may break open, ooze, and crust over in about 5 to 10 days. The rash heals in about 2 to 4 weeks, although some scars may remain.

Post-herpetic neuralgia (chronic pain stage)

• Post-herpetic neuralgia (PHN) is the most common complication of shingles. It lasts for at least 30 days and may continue for months or years. Symptoms are:
  • Aching, burning, stabbing pain in the area of the earlier shingles rash.
  • Persistent pain that may linger for years.
  • Extreme sensitivity to touch.
• The pain associated with PHN most commonly affects the forehead or chest. This pain may make it difficult for the person to eat, sleep, and do daily activities. It may also lead to depression.

Shingles may be confused with other conditions that cause similar symptoms. The rash from shingles may be mistaken for an infection from herpes simplex virus (HSV), poison oak or ivy, impetigo, or scabies. The pain from PHN may feel like appendicitis, a heart attack, ulcers, or migraine headaches.

What Happens

Shingles is caused by the same virus that causes chickenpox. After an attack of chickenpox, the virus remains in the tissues in your nerves. As you get older, or if you have an illness or stress that weakens your immune system, the virus may reappear in the form of shingles.

You may first have a headache, flu-like symptoms (usually without a fever), and sensitivity to light, followed by itching, tingling, or pain in the area where a rash may develop . The pain usually occurs several days or weeks before a rash appears on the left or right side of your body. The rash will be in a band, a strip, or a small area. In 3 to 10 days, the rash turns into fluid-filled blisters that ooze and crust over. The rash heals in about 2 to 4 weeks, although you may have long-lasting scars. A few people won’t get a rash, or the rash will be mild.

Most people who get shingles will not get the disease again.

Complications of shingles

Delaying or not getting medical treatment may increase your risk for complications. Complications of shingles include:

• Post-herpetic neuralgia (PHN), which is pain that does not go away within 1 month. It may last for months or even years after shingles heals. It is more common in people age 50 and older and in people who have a weakened immune system due to another disease, such as diabetes or HIV infection.
• Disseminated zoster, which is a blistery rash that spreads over a large portion of the body and can affect the heart, lungs, liver, pancreas, joints, and intestinal tract. Infection may spread to nerves that control movement, which may cause temporary weakness.
• Cranial nerve complications. If shingles affects the nerves originating in the brain (cranial nerves), complications may include:
  • Inflammation, pain, and loss of feeling in one or both eyes. The infection may threaten your vision. A rash may appear on the side and tip of the nose (Hutchinson’s sign).
  • Intense ear pain, a rash around the ear, mouth, face, neck, and scalp, and loss of movement in facial nerves (Ramsay Hunt syndrome). Other symptoms may include hearing loss, dizziness, and ringing in the ears. Loss of taste and dry mouth and eyes may also occur.
  • Inflammation, and possibly blockage, of blood vessels, which may lead to stroke.
• Scarring and skin discolouration.
• Bacterial infection of the blisters.
• Muscle weakness in the area of the infected skin before, during, or after the episode of shingles.

What Increases Your Risk

Things that increase risk for shingles include:

• Having had chickenpox. You must have had chickenpox to get shingles.
• Being older than 50.
• Having a weakened immune system due to another disease, such as diabetes or HIV infection.
• Experiencing stress or trauma.
• Having cancer or receiving treatment for cancer.
• Taking medicines that affect your immune system, such as steroids or medicines that are taken after having an organ transplant.

If a pregnant woman gets chickenpox, her baby has a high risk for shingles during his or her first 2 years of life. And if a baby gets chickenpox in the first year of life, he or she has a higher risk for shingles during childhood.^{footnote 1}

Post-herpetic neuralgia (PHN) is a common complication of shingles that lasts for at least 30 days and may continue for months or years. You can reduce your risk for getting shingles and developing PHN by getting the shingles vaccine.

When should you call your doctor?

If you think you have shingles, see a doctor as soon as possible. Early treatment with antiviral medicines may help reduce pain and prevent complications of shingles, such as disseminated zoster or post-herpetic neuralgia.

A rash or blisters on your face, especially near an eye or on the tip of your nose, can be a warning of eye problems. Treatment can help prevent permanent eye damage.

If you still feel intense pain for more than 1 month after the skin heals, see your doctor to find out whether you have post-herpetic neuralgia (PHN). Getting your pain under control right away may prevent nerve damage that may cause pain that lasts for months or years.

Who to see

Your family doctor or general practitioner can diagnose and treat shingles. You may be referred to:

Examinations and Tests

Doctors can usually identify shingles when they see an area of rash around the left or right side of your body. If a diagnosis of shingles is not clear, your doctor may order lab tests, most commonly herpes tests, on cells taken from a blister.

If there is reason to think that shingles is present, your doctor may not wait to do tests before treating you with antiviral medicines. Early treatment may help shorten the length of the illness and prevent complications such as post-herpetic neuralgia.

Treatment Overview

There is no cure for shingles, but treatment may shorten the length of illness and prevent complications. Treatment options include:

• Antiviral medicines to reduce the pain and duration of shingles.
• Pain medicines, antidepressants, and topical creams to relieve long-term pain.

Initial treatment

As soon as you are diagnosed with shingles, your doctor probably will start treatment with antiviral medicines. If you begin medicines within the first 3 days of seeing the shingles rash, you have a lower chance of having later problems, such as post-herpetic neuralgia.

The most common treatments for shingles include:

• Antiviral medicines, such as acyclovir, famciclovir, or valacyclovir, to reduce the pain and the duration of shingles.
• Over-the-counter pain medicines, such as acetaminophen or ibuprofen, to help reduce pain during an attack of shingles. Be safe with medicines. Read and follow all instructions on the label.
• Topical antibiotics, applied directly to the skin, to stop infection of the blisters.

For severe cases of shingles, some doctors may have their patients use corticosteroids along with antiviral medicines. But corticosteroids are not used very often for shingles. This is because studies show that taking a corticosteroid along with an antiviral medicine doesn’t help any more than just taking an antiviral medicine by itself.^{footnote 2}

Ongoing treatment

If you have pain that persists longer than a month after your shingles rash heals, your doctor may diagnose post-herpetic neuralgia (PHN), the most common complication of shingles. PHN can cause pain for months or years. It affects 10 to 15 out of 100 people who have had shingles.^{footnote 3} Treatment to reduce the pain of post-herpetic neuralgia includes:

• Antidepressant medicines, such as a tricyclic antidepressant (for example, amitriptyline).
• Topical anesthetics that include benzocaine and lidocaine, which are available in over-the-counter forms that you can apply directly to the skin for pain relief.
• Anticonvulsant medicines, such as gabapentin or pregabalin.
• Opioids, such as codeine.

Topical creams containing capsaicin may provide some relief from pain. Capsaicin may irritate or burn the skin of some people, and it should be used with caution.

Treatment if the condition gets worse

In some cases, shingles causes long-term complications. Treatment depends on the specific complication.

• Post-herpetic neuralgia (PHN) is persistent pain that lasts months or even years after the shingles rash heals. Certain medicines, such as anticonvulsants, antidepressants, and opioids, can relieve pain. Most cases of PHN resolve within a year.
• Disseminated zoster is a blistery rash over a large portion of the body. It may affect the heart, lungs, liver, pancreas, joints, and intestinal tract. Treatment may include both antiviral medicines to prevent the virus from multiplying and antibiotics to stop infection.
• Herpes zoster ophthalmicus is a rash on the forehead, cheek, nose, and around one eye, which could threaten your sight. You should seek prompt treatment from an ophthalmologist for this condition. Treatment may include rest, cool compresses, and antiviral medicines.
• If the shingles virus affects the nerves originating in the brain (cranial nerves), serious complications involving the face, eyes, nose, and brain can occur. Treatment depends on the nature and location of the complication.

Prevention

Anyone who has had chickenpox may get shingles later in life. There are two types of vaccines, Shingrix (RZV) and Zostavax (LZV), that may help prevent shingles or make it less painful if you do get it.

Anyone who has had chickenpox may get shingles later in life. But there are two vaccines (called Zostavax II and Shingrix) that may help prevent shingles or make it less painful if you do get it. Zostavax II is a single dose recommended for adults age 60 and older, whether or not they’ve had shingles before. You can ask your doctor or pharmacist about getting the vaccine at age 50 to 59 instead. Shingrix is a two dose shot approved for use in adults 50 years of age and older. Check with your provincial health plan to see if these shots are covered for you.

• Shingles: Should I Get a Shot to Prevent Shingles?

If you have never had chickenpox, you may avoid getting the virus that causes both chickenpox and later shingles by receiving the varicella vaccine.

If you have never had chickenpox and have never gotten the chickenpox vaccine, avoid contact with people who have shingles or chickenpox. Fluid from shingles blisters is contagious and can cause chickenpox (but not shingles) in people who have never had chickenpox and who have never gotten the chickenpox vaccine.

If you have shingles, avoid close contact with people until after the rash blisters heal. It is especially important to avoid contact with people who are at special risk from chickenpox, such as:

• Pregnant women, infants, children, or anyone who has never had chickenpox.
• Anyone who is currently ill.
• Anyone with a weak immune system who is unable to fight infection (such as someone with HIV infection or diabetes).

If you cover the shingles sores with a type of dressing that absorbs fluid and protects the sores, you can help prevent the spread of the virus to other people. Guidelines about avoiding other people when you have shingles may vary from province to province. Talk to your doctor about steps you can take to avoid spreading the virus to other people.

Home Treatment

You may reduce the duration and pain of shingles by:

• Taking good care of skin sores.
  • Avoid picking at and scratching blisters. If left alone, blisters will crust over and fall off naturally.
  • Use cool, moist compresses if they help ease discomfort. Lotions, such as calamine, may be applied after wet compresses.
  • Apply cornstarch or baking soda to help dry the sores so that they heal more quickly.
  • Soak crusted sores with tap water to help clean away crusts, decrease oozing, and dry and soothe the skin.
  • Ask your doctor about using topical creams to help relieve the inflammation caused by shingles.
  • If your skin becomes infected, ask your doctor about prescription antibiotic creams or ointments.
• Using medicines as prescribed to treat shingles or post-herpetic neuralgia, which is pain that lasts for at least 30 days after the shingles rash heals.
• Using non-prescription pain medicines, such as acetaminophen or ibuprofen, to help reduce pain during an attack of shingles or pain caused by post-herpetic neuralgia. If you are already taking a prescription pain medicine, talk with your doctor before using any over-the-counter pain medicine. Some prescription pain medicines have acetaminophen (Tylenol), and getting too much acetaminophen can be harmful. Be safe with medicines. Read and follow all instructions on the label.

If home treatment doesn’t help with pain, talk with your doctor. Getting your pain under control right away may prevent nerve damage that may cause pain that lasts for months or years.

Medications

Medicines can help limit the pain and discomfort caused by shingles, shorten the time you have symptoms, and prevent the spread of the disease. Medicines also may reduce your chances of developing shingles complications, such as post-herpetic neuralgia (PHN) or disseminated zoster.

Medicine choices

Medicines to treat shingles when the rash is present (active stage) may include:

• Over-the-counter pain medicines, such as acetaminophen or ibuprofen, to help reduce pain. Be safe with medicines. Read and follow all instructions on the label.
• Antiviral medicines, to reduce the pain and duration of shingles.
• Topical antibiotics, which are applied directly to the skin, to stop infection of the blisters.

Medicines to treat post-herpetic neuralgia pain may include:

What to think about

For some people, non-prescription pain relievers (analgesics) are enough to help control pain caused by shingles or post-herpetic neuralgia. But for others, stronger medicines may be needed. And if prescription medicines don’t help control your pain, you may need to see a pain specialist about other ways to treat PHN.

Other Treatment

Post-herpetic neuralgia (PHN), the most common complication of shingles, is difficult to treat. Your doctor may recommend other treatments, along with medicines, to control the pain of PHN.

Other treatment choices

There are other treatments that may be used for shingles and post-herpetic neuralgia. These treatments may help, but there is no clear evidence from studies that show how well these treatments work. These other treatments include:

Psychological therapies that help you tolerate long-term pain, such as cognitive-behavioural therapy, may be helpful. These methods can include counselling as well as learning techniques that teach you to shift your focus of attention away from the pain, such as relaxation and breathing exercises.

For severe pain from PHN, you may need to see a pain management specialist. These doctors are trained to help with pain that doesn’t respond to medicines or usual treatments.

References

Citations

1. Gershon AA (2009). Varicella zoster virus. In RD Feigin et al., eds., Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 6th ed., vol. 2, pp. 2077–2088. Philadelphia: Saunders Elsevier.
2. Chen N, et al. (2010). Corticosteroids for preventing postherpetic neuralgia (Review). Cochrane Database of Systematic Reviews (12).
3. Dubinsky RM, et al. (2004, reaffirmed 2008). Practice parameter: Treatment of postherpetic neuralgia. An evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 63(6): 959–965.

Other Works Consulted

• Centers for Disease Control and Prevention (2008). Prevention of herpes zoster: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, 57(05): 1–30. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5705a1.htm. [Erratum in MMWR, 57(28): 779. Also available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5728a5.htm.]
• Habif TP (2010). Herpes zoster. In Clinical Dermatology, A Color Guide to Diagnosis and Therapy, 5th ed., pp. 479–490. Philadelphia: Mosby.
• Herpes zoster vaccine (Zostavax) revisited (2010). Medical Letter on Drugs and Therapeutics, 52(1339): 41.
• Wolff K, Johnson RA (2009). Varicella-zoster virus infections. In Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 6th ed., pp. 837–845. New York: McGraw-Hill Medical.

Credits

Adaptation Date: 7/24/2020

Adapted By: HealthLink BC

Adaptation Reviewed By: HealthLink BC

Varicella-Zoster virus, determination of DNA in scraping of skin epithelial cells (Varicella Zoster Virus, DNA, scrape of skin epithelial cells)

Method of determination
PCR with real-time detection.

Study material
Scraping of skin epithelial cells

Home visit available

Online check-in

Detection of DNA of the Varicella-Zoster virus in scraping of skin epithelial cells is used to diagnose typical, atypical and erased forms of VZV infection, to carry out differential diagnostics with other diseases accompanied by vesicular rash in pregnant women, newborns, children and adults, including HIV -infected.

Varicella-Zoster virus or herpesvirus type 3 (Varicella-Zoster virus, VZV or Human Herpesvirus 3, HHV3) is a highly contagious virus of the Herpesviridae family. The virus, upon initial infection, causes chickenpox (chickenpox), upon reactivation, shingles or herpes. It is transmitted from person to person by airborne droplets and contact, and transplantation of the virus from the mother to the fetus is also possible (in the case of chickenpox). The largest number of diseases is recorded during the cold season (autumn-winter seasonality).

Chickenpox is an acute viral disease accompanied by moderate fever and symptoms of intoxication, lesions of the skin and mucous membranes in the form of maculopapular vesicular rash.

The virus enters the human body through the upper respiratory tract, where it is fixed on the cells of the mucous membrane and is introduced into them. In the cells of the mucous membrane of the respiratory tract, the primary multiplication and accumulation of the virus occurs. Then the virus enters the lymphatic system and at the end of the incubation period enters the bloodstream and spreads throughout the body.Viremia occurs. Possessing tropism for the epithelium of the skin and mucous membranes, the pathogen is fixed in the epithelium of the surface layer of the skin.

A patient with chickenpox is contagious a day before the appearance of the rash, the entire period of the rash and 3-5 days after the appearance of the last bubbles.

Mostly children of preschool age, usually attending preschool institutions, are ill. Despite the fact that the incidence of chickenpox in adults is less than in children, adults more often develop complications such as pneumonia, encephalitis, hepatitis; the mortality rate is low.When infected in the first half of pregnancy, intrauterine damage to the fetus and the occurrence of malformations are possible. With chickenpox disease immediately before childbirth (4 days or less), a severe form of chickenpox may develop in a newborn, since he does not have transplacental maternal antibodies. In case of chickenpox disease more than 4 days before delivery, the maternal antibodies formed and passed through the placenta, although they do not protect the child from infection, prevent its severe course.In the absence of immunity in the mother and in contact with a patient with chickenpox, newborn children can also get sick. Usually, by the age of 14-15 years of life, 70 to 90% of the population already has chickenpox. After the transferred disease, lifelong immunity remains. Recurrent chickenpox infections are rare.

Herpes zoster (shingles) is a sporadic viral disease of the skin and nervous tissue, characterized by inflammation of the skin (with the appearance of predominantly vesicular rashes against the background of erythema in the dermatome) and nerve tissue (posterior roots of the spinal cord and peripheral nerve ganglia).

The Varicella-Zoster virus remains in the human body in a latent state, localizing mainly in the trigeminal ganglia and spinal ganglia of the sensory roots of the thoracic spinal cord. In some cases, when the body is weakened (stress, trauma, intoxication, chronic diseases, etc.), after many years, the activation of the virus with manifestations of herpes zoster may occur, and the presence of IgG antibodies in the blood does not protect against reactivation of the infection.

The clinical picture of herpes zoster consists of cutaneous manifestations and neurological disorders. In typical cases, it begins as an infectious process – with symptoms of general intoxication, malaise, weakness, fatigue, fever, nausea, vomiting, lymphadenopathy, changes in the cerebrospinal fluid (in the form of lymphocytosis and monocytosis). Further, there are pronounced pains of a neuralgic nature in the area of ​​the affected dermatome, in which the appearance of rashes is then noted.

At risk are people: 1) who have had chickenpox in childhood; 2) infected with HIV; 3) who have had a bone marrow transplant; 4) having leukemia or lymphoma; 4) after chemotherapy and treatment with systemic glucocorticosteroid drugs; 5) the elderly.

A number of patients may have an atypical course of herpes zoster, manifested either by the absence of bubbles (abortive form), or by the appearance of bubbles in the form of bubbles (bullous form) with hemorrhagic contents (hemorrhagic form) or with the formation of a dark scab after opening (gangrenous, necrotic form) ). Herpes zoster in a pregnant woman does not pose a danger to the fetus.

In accordance with clinical guidelines, the diagnosis of chickenpox and herpes zoster is most often based on the clinical picture of the disease.Laboratory research methods in medical organizations are used to diagnose atypical and erased forms of the disease, for differential diagnosis with other diseases accompanied by vesicular rash (for example, an infection caused by the herpes simplex virus, foot and mouth disease, enterovirus infection, streptoderma).

According to international recommendations, laboratory confirmation of chickenpox or herpes zoster occurs by detecting VZV DNA by polymerase chain reaction (PCR) or by isolating VZV in cell culture in biological material.Detection of VZV-specific serum IgM (test # 257) is less sensitive than PCR and is not the method of choice for confirming chickenpox. Serum IgG serum screening (Test # 256) can be used to assess immunity or susceptibility to chickenpox in unvaccinated individuals.

Analytical indicators

• determined fragment – a specific region of the DNA of the Varicella-Zoster virus;
• determination specificity – 100%;
• detection sensitivity – 100 copies of the pathogen DNA in the sample.

90,000 Caution, VEGETABLE! / Articles

Most of the population considers chickenpox (chickenpox) a harmless disease that occurs in young children, proceeds easily and without complications. Far from it. Some cases of the disease can be complicated by superinfection on the skin, when the patient scratches the elements of the rash and bacteria enter them, causing an inflammatory process. This leads to scarring of the skin. In immunocompromised patients, pneumonia, acute otitis media (inflammation of the middle ear), meningitis and meningoencephalitis (inflammation of the brain and its membranes) can be a frequent complication.In some cases, there is a risk of death.

The older the patient is, the greater the risk of complications after chickenpox. Thus, the risk of developing a severe course of chickenpox in patients under one year old and over 15 years old. The risk of a severe course of the disease exists in children and adults with an immunodeficiency state, with atopic dermatitis, diabetes mellitus. Pregnant women are at risk of severe course. On the one hand, their disease can be very difficult, but on the other hand, it is not safe for her unborn child.

The next aspect of this problem is that the virus that causes chickenpox, even if the disease was mild, does not disappear from the body, but moves along the nerve fibers to the spinal cord and “falls asleep” there for a certain time. In the future, in children who had been ill with “harmless” chickenpox under the influence of adverse factors (hypothermia, stress, etc.), the virus “wakes up” and causes such a disease as shingles. This is a painful disease in which rashes and intense pain occur along the course of the nerves on the body.

How can you protect yourself and your child from such a “mild” disease as chickenpox? Vaccination is the only method of preventing chickenpox.

The world experience in the use of vaccines for the prevention of varicella has more than 30 years. Countries such as the United States, Canada, Germany, Australia and many others have included chickenpox vaccination on the National Vaccination Schedule. This made it possible to quickly reduce the incidence of this infection among the population.In our calendar of preventive vaccinations, vaccination against chickenpox is not yet provided. Therefore, everyone must decide for himself whether he needs immunization against such a disease as chickenpox or not.

Our medical center is ready to offer you specific prophylaxis of chickenpox with the VARILRIX vaccine

To form protection in children aged 12 months to 13 years with the help of the VARILRIX vaccine, it is necessary to administer 1 dose of the vaccine (0 , 5 ml.). For persons aged 13 years and older, two vaccinations of the VARILRIX vaccine, 1 dose (0.5 ml), are required with an interval between injections of 6-8 weeks.

Research shows that out of 100 people vaccinated, 90-94 people do not get chickenpox. In this case, the risk of subsequent shingles is reduced to zero. The duration of the protection is 20 years or more.

Chickenpox (chickenpox) in a child – World Health Clinic

Chickenpox, which is commonly called chickenpox, causes the herpes virus and is transmitted by airborne droplets.It spreads very quickly indoors. The causative agent of the disease after the transferred chickenpox remains in the spinal cord, in a “dormant state.” And when exposed to factors such as stress, decreased immunity, it can cause shingles in an adult. In childhood, chickenpox is transferred … Read more

Chickenpox, which the common people call chickenpox, causes the herpes virus and is transmitted by airborne droplets. It spreads very quickly indoors.

World of Health 2016-10-04

Chickenpox, which the common people call chickenpox, is caused by the herpes virus and is transmitted by airborne droplets. It spreads very quickly indoors.

The causative agent of the disease after the transferred chickenpox remains in the spinal cord, in a “dormant state. And when exposed to factors such as stress, decreased immunity, it can cause shingles in an adult.

In childhood, chickenpox is tolerated much easier, in adults it is much more difficult.

A child infected with chickenpox is contagious within 1-2 days (the incubation period of the disease) and until the 5th day after the appearance of the last elements of the rash.

The main symptoms of chickenpox

• Rash – localized on the face, scalp, trunk, limbs. It can also be on the oral mucosa. Rash at first in the form of pale pink spots. Then in the form of bubbles with a transparent liquid. Around the vesicles there is a corolla of reddened skin. On the second day of the appearance of the rash, the bubbles wrinkle and become covered with brown crusts;
• Increase in body temperature – the temperature rises to 38-39C, the child becomes lethargic, capricious, appetite decreases;
• Itchy skin.

Treatment of chickenpox

• It is imperative to cut the child’s nails, as scratching damages the elements of the rash and may become infected or then, if roughly scratched, scars may remain;
• Do not let your child sweat, as sweating will cause increased itching;
• It is necessary to lubricate the bubbles, by choice: a weak solution of potassium permanganate (1-2%), a solution of brilliant green (1-2%). This will speed up the drying of the bubbles;
• Rash in the mouth – rinsing with a weak furacillin solution;
• With severe itching, of course, after consulting a pediatrician, you can give your child antihistamines;
• Drink plenty of fluids;
• Balanced diet with an abundance of vitamins.

“Rehabilitation after coronavirus is necessary for everyone” | Articles

People who have had coronavirus do not leave hospitals completely healthy, the head of the Center for Rehabilitation and Rehabilitation of the Central Clinical Hospital, Doctor of Medical Sciences, Professor Elena Gusakova told Izvestia . In her practice, there were cases when young, previously healthy people recovered from COVID-19 for four weeks. The effects of this virus can range from sleep disturbances and depression to stroke and pulmonary fibrosis .At the same time, we do not yet know the distant manifestations that may occur in a year, five or ten years. Recovery needs to start as early as possible – even on mechanical ventilation. But it is better not to rush to go to work after an illness, the rehabilitation therapist believes.

Postcoid Syndrome

– Does everyone who has had coronavirus need rehabilitation?

– I don’t know a single person who, after being discharged from the hospital after being treated for a new coronavirus infection, would feel absolutely healthy .Even those who have been ill in a mild form require at least psychological rehabilitation. After the illness, all patients have asthenia, weakness, headache, shortness of breath, increased sweating and depressed mood. We have given this symptom complex the conditional name “postcoid syndrome”.

Rehabilitation after coronavirus is necessary for everyone who has recovered, regardless of the severity of the disease . Patients who have suffered moderate and severe forms of coronavirus pneumonia require compulsory comprehensive rehabilitation.

Photo: Izvestia / Dmitry Korotaev

– What are the consequences of covid even in its mildest forms?

– In fact, we still have to study the long-term consequences of the transferred new coronavirus infection – how it will affect people’s health in a year, five, ten years . For example, the hepatitis C virus is called the affectionate killer. It leads to the slow development of liver cancer.Human papillomavirus causes cervical cancer. The Ebola virus, discovered many months later in the eye fluid of surviving patients, subsequently causes blindness. The herpes virus, in a person who had chickenpox many years ago, can provoke the development of painful shingles.

It is already known that in people suffering from chronic diseases of the lungs, heart, kidneys and blood, the disease is more severe and is often complicated by decompensation of organ functions, the development of myocarditis (inflammation of the heart muscle), arrhythmias, strokes and heart attacks.Moreover, irreversible changes can develop in the heart muscle.

It has already been proven that the new virus has pronounced neurotropicity and neurotoxicity with the development of anosmia – sudden loss of smell, headache, sleep disturbances, as well as cognitive impairments in the form of decreased memory and mental performance . Moreover, during the rehabilitation of patients, we observe all these manifestations in patients who have undergone a new coronavirus infection in a mild form.

– Why is this happening?

– The nervous and immune systems are closely interconnected and form a single control system of the body.This connection is carried out through cytokines and neuropeptides. Scientific studies have shown that the administration of cytokines (even for medicinal purposes) is accompanied by depression of the central nervous system and muscle weakness. This is what we see with coronavirus infection and “cytokine storm”. In turn, depression triggers the release of the stress hormone cortisol, which suppresses the immune system, as well as the release of adrenaline and norepinephrine, which suppress lymphocyte activity. There is evidence that at the peak of stress in athletes and students there is a decrease in immunoglobulins of all classes, that is, a person experiences immunodeficiency.

Gymnastics with mechanical ventilation

– When should you start rehabilitation?

– In the midst of the disease. And first of all, in the wards of intensive care and intensive care for the prevention of pressure ulcers, thrombosis, muscle atony. Professionals try to start rehabilitation as early as possible, even when the patient is on mechanical ventilation .

The patient is treated with medical, respiratory gymnastics, positioning of the patient – changing the position.Now in the arsenal of rehabilitation therapists there is a large number of various equipment for early rehabilitation – bedside simulators, motorized medical devices, verticalizers for the gradual transfer of a severe patient from a supine position to an upright position, apparatus physiotherapy for stimulating the respiratory muscles and diaphragm to accelerate the transfer from mechanical ventilation to breathing.

Photo: Izvestia / Zurab Javakhadze

In addition to respiratory and physical rehabilitation, psychological rehabilitation is no less important: it is necessary not only to reassure the patient, but also to motivate him to the need for therapeutic and respiratory gymnastics.Indeed, with a severe course of covid, a vicious circle is formed – the patient is weakened, it is difficult for him to deal with a rehabilitation therapist, therefore, muscular hypo- and atony develops, which further aggravates his condition and the patient loses his physical shape even more.

In many patients, against the background of hypoxia (lack of oxygen) and the direct neurotoxic effect of coronavirus infection on the central nervous system, the brain deteriorates memory, attention and thinking speed . To reduce these manifestations, it is necessary not only to solve puzzles and crosswords, but also to work with a neuropsychologist, as well as physical activity with a kinesiotherapist or physical therapy instructor.Asthenia and depression are also very well treated by physical activity.

From sleep disorders to stroke

– What are the consequences of covid for people who have had it?

– The most diverse. If the disease is severe, the functions of absolutely any organ or system of the body can be disrupted – nervous, cardiovascular, kidney, liver. Sleep disorders, psycho-emotional disorders are very common.

In patients admitted to us for rehabilitation, we saw that focal infiltrative changes in the lungs persist, despite negative tests and the absence of the virus in the body . This is manifested by shortness of breath with little physical exertion, walking at a slow pace. If you do not carry out rehabilitation measures, then there is a risk of developing pulmonary fibrosis, which is based on the proliferation of connective tissue as a result of inflammation of the alveolar wall.

Patients with severe covid can suffer lung damage so severe that it will take more than 10 years to recover, according to the FICM, a British professional medical organization that trains critical care physicians.

Photo: Izvestia / Pavel Bednyakov

– Can covid cause disability?

– Young men came to us for rehabilitation who, against the background of covid and disorders of the blood coagulation system, developed an acute violation of cerebral circulation, that is, a stroke with paresis (movement disorders) of the upper and lower extremities, serious speech impairments, cognitive disorders. The patients were so severe that they were admitted on gurneys.

– Are there cases when children need rehabilitation after covid?

– It is known that in children, coronavirus infection can lead to the development of Kawasaki syndrome with the development of systemic vasculitis , damage to the arterial bed, skin, eyes, heart, as well as the development of infectious-toxic shock. If a child has been on bed rest for a long time and has developed functional disorders of organs or body systems, he is also shown a course of rehabilitation treatment.

No unique technology

– What traditional physiotherapy methods are successful in helping to recover from covid?

– Classic programs of pulmonary rehabilitation after severe acute respiratory infections, including after coronavirus pneumonia, are based on three pillars: dosed physical activity under the supervision of a specialist, apparatus physiotherapy and respiratory rehabilitation methods, when the effect occurs directly on the mucous membrane of the respiratory system …

Despite the powerful development of technology in the world in the last decade, no unique technology for the rehabilitation of the consequences of coronavirus infection exists, just as there is no secret pill for a quick recovery . We restore not just one problem, but the entire human body as a whole. The multidisciplinary team develops an individual plan for a rehabilitation program, which includes a set of procedures: therapeutic exercises, breathing exercises using respiratory trainers, massage, psycho and diet therapy, physiotherapy, including inhalation, electro and magnetic therapy, vibration therapy, hyperbaric oxygenation, reflexology, etc.

Unlike classical breathing exercises, the main set of exercises after covid should not be aimed at working with resistance on exhalation, but at improving the ventilation function of the lungs by increasing the mobility of the chest , excursions of the diaphragm, strengthening the respiratory muscles, therefore traditional breathing techniques (for example, inflating balloons) aimed at inflating the volume of the lungs cannot be considered basic.

Photo: Izvestia / Zurab Javakhadze

– Is sanatorium treatment indicated after covid?

– Our country has extensive experience in treating patients with respiratory diseases using climatotherapy .The climate of the forest enhances the anti-inflammatory, antibacterial and antiviral effects of the treatment.

Climatotherapy in the mountains helps after pneumonia complicated by pulmonary fibrosis, as well as with concomitant diseases of the cardiovascular system.

The maritime climate with a high content of mineral salts and air ions is indicated for patients with impaired bronchial drainage function.

But if the patient had a severe course of covid, it is best to recover in local sanatoriums, since when moving to another climatic zone, adaptation can fail and exacerbation of chronic diseases .

Work will wait

– Is it possible to fully recover from a badly suffered coronavirus?

– It depends on what we consider a complete recovery. We had young patients undergoing rehabilitation who did not have any chronic diseases before coronavirus infection. They had a high rehabilitation potential, but despite this, it took them about four weeks to fully recover, and some of them continued to have weakness and symptoms of asthenia. It is clear that the younger the patient and the more correct his lifestyle was before the illness, the faster and more efficiently the rehabilitation proceeds.

Nothing happens by itself in life. Therefore, even if you are recovering from an illness at home, try to do daily therapeutic breathing exercises, a small set of exercises for the lower extremities and upper shoulder girdle, start leading a healthy lifestyle – quit smoking, give up alcohol, start eating right and control blood pressure, saturation, blood glucose and cholesterol.

It is necessary to start rehabilitation as early as possible, since the pulmonary fibrosis that appears after the disease does not develop back. This is a slow, irreversible process of replacing the lung, alveolar tissue with dense, connective tissue. Clinically, it is manifested by progressive dyspnea.

Photo: Izvestia / Zurab Javakhadze

– What are the risks for people who have undergone covid when they quickly return to intensive work?

– We must not forget that we live in the era of Evidence Based Medicine, or in the era of evidence-based medicine, and covid is a young pathology.One of the main features of covid, which many people forget about, is the lack of a sufficient amount of confirmed scientific information. For a detailed answer to the question, it should also be emphasized that polymorphism of clinical symptoms is characteristic of covid and its manifestations can be very individual. It is necessary to take into account the form of the transferred disease. Despite the fact that the pathology proceeds so “personally” and depends on many circumstances, all cases are characterized by disorders of the immune response, after which a picture of “polydisease” may appear, that is, the attachment of another pathology.Only taking into account all the above facts, it is possible to objectively assess the danger of a quick return to work.

TOGBUZ “Nikiforovskaya CRH” – Chickenpox

The causative agent, varicella zoster virus (VZV), is transmitted by airborne droplets or by direct contact, and patients are usually contagious a few days before the onset of the rash and until the moment when the rash covered with a crust. Transmission of infection through third parties and household items is impossible.

VZV is a double-stranded DNA virus belonging to the herpesvirus family.Only one serotype is known, and man is its only reservoir.

The varicella-zoster virus VZV enters the human body through the mucous membrane of the nasopharynx and almost without exception causes clinical manifestations of the disease in susceptible individuals. After infection, the virus remains latent in the nerve nodes and, as a result of VZV activation, can cause shingles (or herpes zoster – Herpeszoster), a disease that mainly affects the elderly and those with weakened immune systems.

PROBABILITY TO BE SICK

The contagiousness of the varicella-zoster virus is truly unique – it is 100%. Chickenpox affects all age groups. However, this infection most often affects children. About half of childhood diseases occur at the age of 5 to 9 years, less often children 1–4 and 10–14 years old are ill. About 10% of the cases are people 14 years and older. Among this age group, over the past 5 years, the incidence of chickenpox has increased from 28 to 58 per 100 thousand.population. Children in the first months of life are most often resistant to this infection. However, children who are premature and weakened by other diseases can be seriously ill with chickenpox.

The maximum incidence of chickenpox is observed in the autumn-winter months. Epidemic outbreaks are observed mainly in organized groups among preschool children. Children attending kindergartens and nurseries have chickenpox 7 times more often than unorganized children.

The risk group also includes patients with immunodeficiencies, including HIV infection.Severe cases of chickenpox in children who received hormonal therapy with steroid drugs have been described. Also described are cases of congenital chickenpox in children whose mothers had chickenpox in the first half of pregnancy; perinatal infection occurs in children whose mothers become ill 5 days before and 48 hours after the birth of the child.

In persons with severe immunodeficiency of various etiologies (in a rare case with HIV infection and in patients after organ transplantation; often during acclimatization, decreased immunity caused by severe stress), repeated illness is possible.

SYMPTOMS

The incubation period is usually 14-16 (10-21) days. After chickenpox, the virus remains in sensory ganglia, where it can later reactivate and cause herpes zoster. Symptoms of chickenpox appear as an itchy vesicular rash that usually begins on the face and upper torso and is initially accompanied by fever and general malaise. The presence of a vesicular rash on the scalp is a characteristic symptom of chickenpox.The elements of the rash look like small (several millimeters in diameter) bubbles rising above the reddened surface of the skin, filled with a clear liquid (which contains the varicella-zoster virus). As the rash gradually spreads to the body and limbs, the first bubbles (vesicles) dry out. Usually all crusts disappear after 7-10 days.

COMPLICATIONS AFTER A POSSIBLE DISEASE

Although varicella (chickenpox) is a relatively benign childhood disease and is rarely considered a significant public health problem, the course of the disease can sometimes be complicated by pneumonia or encephalitis caused by the VZV virus, which can be permanent or fatal.The most dangerous are bullous, hemorrhagic or gangrenous forms of chickenpox. Disfiguring scars can form as a result of secondary infection of the vesicles; in addition, necrotizing fasciitis or sepsis may result from such infection.

Complications of chickenpox are recorded with a frequency of 5-6%, they are the reason for hospitalization in 0.3-0.5% of patients. Of the total number of cases, this is several thousand per year. 30% of complications are neurological, 20% are pneumonia and bronchitis, 45% are local complications (for example, streptaderma), accompanied by the formation of scars on the skin.

Other serious manifestations include pneumonia (more often in adults), rarely – congenital chickenpox syndrome (caused by chickenpox transferred during the first 20 weeks of pregnancy) and perinatal chickenpox of newborns whose mothers develop chickenpox in the period 5 days before and 48 hours after childbirth. In patients with immunodeficiencies, including HIV infection, chickenpox is severe. Severe chickenpox and deaths can also occur in children taking steroid hormones for asthma.In general, complications and deaths from chickenpox are more common in adults than in children.

In 10-20% of those who have recovered, the varicella-zoster virus remains for life in the nerve ganglia and subsequently causes another disease that can manifest itself at an older age – shingles or herpes (Herpes zoster). Herpes zoster is characterized by lingering and excruciating neuralgic pain, and also has a number of complications in the form of lesions of the nervous system and internal organs – paralysis, visual impairment.People with herpes zoster can be a source of chickenpox infection.

MORTALITY

The mortality rate (deaths per 100,000 cases) among healthy adults is 30-40 times higher than among children aged 5-9 years. The mortality rate is 1 in 60,000 cases.

TREATMENT

Treatment of chickenpox is mainly reduced to the prevention of bacterial complications. To avoid the spread of the virus, good hygiene must be followed, including daily showers and nail clipping in young children (to prevent scratching and rupture of the rash blisters).

The use of antiviral agents during treatment, such as acyclovir, is justified only for premature infants, patients with impaired immune systems and adults (due to the greater severity of the infection). The traditional remedy for the “treatment” of chickenpox – “brilliant green” – is not at all effective, much more effective than baths and trays with a small addition of soda, antihistamines and pain relieving ointments to relieve itching.

EFFICIENCY OF VACCINATION

Apart from vaccination, there are no countermeasures to control the spread of chickenpox or the incidence of shingles in a susceptible population.Varicella zoster immunoglobulin and herpes medicines are very expensive and are mainly used for prophylaxis after contact with an infection or for the treatment of chickenpox in people at high risk of developing a severe form of the disease. Due to the extreme contagiousness of chickenpox in the world, almost all children or young adults get sick. Every year from 1990 to 1994, before the chickenpox vaccine was introduced, there were about 4 million cases of the disease in the United States. Of this number, approximately 10,000 patients required hospitalization and 100 patients died.

Chickenpox vaccines obtained using the Oka strain of the VZV virus have been on the market since 1994. The positive results in terms of safety, efficacy and cost-benefit analysis have confirmed the validity of their implementation in childhood immunization programs in a number of industrialized countries. After observing study populations for 20 years in Japan and 10 years in the United States, more than 90% of immunocompetent individuals vaccinated during childhood still had protection against chickenpox.

In response to vaccination, about 95% of children develop antibodies, and 70-90% will be protected from infection for at least 7-10 years after vaccination. According to Japanese researchers (Japan is the first country in which a vaccine was registered), immunity against chickenpox lasts 10-20 years. It is safe to say that the circulating virus contributes to the “revaccination” of the vaccinated, increasing the duration of immunity.

Research indicates that emergency vaccination can be effective – when the vaccine is given within 96 hours (preferably 72 hours) of exposure to VZV, at least 90% protective efficacy can be expected.Treatment for chickenpox is much easier for people who have received the vaccine than for those who have not been vaccinated.

VACCINES

The chickenpox vaccines currently available on the market are obtained using the so-called VZV Oka strain, which has been modified by sequential reproduction in various cell cultures. The various formulations of these live, attenuated vaccines have been extensively tested and approved for use in Japan, the Republic of Korea, the United States, and several European countries.Some vaccines are approved for use by ages 9 months or older.

From a logistical and epidemiological point of view, the optimal age for varicella vaccination is 12-24 months. In Japan and several other countries, one dose of the vaccine is considered sufficient, regardless of age. In the United States, 2 doses of the vaccine given 4-8 weeks apart are recommended for adolescents and adults, of whom 78% seroconverted after the first dose and 99% after the second dose.

According to the current US vaccination schedule, children receive 2 doses of the vaccine (1st dose at 12 months, 2nd at 6 years old).

RECENT EPIDEMICS

The incidence of chickenpox is widespread throughout the world. In Russia, there is an annual increase in the number of diseases of this infection. From 1998 to 2007, the incidence of chickenpox increased 1.8 times annually, each year 500-700 thousand cases of chickenpox are recorded.

An interesting fact: the chickenpox vaccine became available in the Russian Federation in 2009.From the end of 2013 to 2015, there was a break in the supply of vaccines to our country. According to Rospotrebnadzor, in 2015 there was an increase in the incidence of chickenpox compared to 2014 by 16%.

HISTORICAL INFORMATION AND INTERESTING FACTS

Chickenpox was first described in Italy in the middle of the 16th century by the physicians Vidus-Vidius and Ingranus. For a long time, chickenpox was not recognized as an independent disease and was considered a type of natural smallpox. After in 1911the causative agent of chickenpox was found in the contents of the chickenpox vesicles, the disease began to be considered a separate nosological form. The virus itself was isolated only in 1958. The varicella-zoster virus infects only humans; humans are also the only reservoir of infection.

Herpes test ᐈ donate blood, plasma for (Varicella Zoster) type 3, by PCR | MedLab

Description of the analysis:

Herpes type 3 (blood plasma, saliva, PCR method) – an analysis that determines whether there is genetic material of the varicella zoster virus (Varicella Zoster Virus) in the patient’s blood.This virus causes chickenpox (chickenpox) and shingles (herpes zoster).

The virus enters the body by airborne droplets, infection most often occurs in childhood. Chickenpox infection in adulthood causes more severe disease.

The incubation period lasts from 10 to 21 days (on average – 2 weeks), after which the disease manifests itself with the first symptoms: fever and malaise. After 1-2 days, an itchy rash in the form of vesicles (vesicles) appears, which becomes covered with a crust within 2 weeks and disappears.If they are not combed, the rashes will not leave behind scars.

During illness, the body produces antibodies, some of which (IgG) remain in the blood for life, forming a strong immunity.

After recovery, the virus goes into a latent existence in the body, causing, if reactivated, herpes zoster. For the reactivation of the virus, a strong weakening of the immune system is necessary, which can occur due to severe stress, after a sharp and prolonged hypothermia, or in the case of the development of oncological pathology.

Herpes zoster is characterized by general malaise, fever and the appearance of severe painful sensations (possibly itching, tingling or irritation) in certain areas of the trunk or face. After 1-3 days, a rash appears on the painful areas of the place, which disappears within three to four weeks. Painful sensations disappear after about a month.

Reactivation of the virus can cause the appearance of special forms of herpes zoster: ophthalmic herpes zoster (possible damage to the cornea), Ramsey-Hunt syndrome (temporary hearing loss is not excluded), motor herpes zoster (muscle weakness is observed in the area of ​​the affected areas).

Indications for appointment

The analysis can be ordered by an infectious disease specialist, general practitioner, pediatrician, neurologist or dermatologist in the following cases:

90,030 90,031 symptoms of chickenpox;

90,031 symptoms of herpes zoster.

Result value

Qualitative research – intended only to determine the presence or absence of the varicella-zoster virus in a patient. Accordingly, only two values ​​are possible:

• “detected” – the analysis is positive, the DNA of the virus was found in the patient’s body;
• “not detected” – the analysis is negative, the genetic material of the varicella-zoster virus was not detected.

Preparation for examination: not required.

Material for research: blood from a vein, saliva.

Research method: ELISA (enzyme-linked immunosorbent assay).

Period: 3 working days.

Registration for analyzes

90,000 ᐈ How to treat lichen? ~ 【Types, treatment in Kiev】

Clinical manifestations of lichen

Signs of lichen depend on its variety.The main manifestation of these diseases is a rash in the form of small blisters, which usually itch, merge into spots, have an even outline and flake off. The symptoms of shingles cause the patient both physical and psychological inconvenience due to the appearance of a cosmetic defect.

Shingles

Manifestations can range from mild to severe. Approximately 3-4 days before the onset of the rash, the patient feels pain along the nerves. Then on the body, usually in the intercostal region, bubbles of fluid appear, which merge into pinkish itchy patches.After opening the elements of the rash, a crust appears, sometimes peeling.

In addition to external manifestations, signs of shingles will be supplemented by a deterioration in well-being. In mild cases, only symptoms of general intoxication (fever, weakness, etc.) are observed, with a complicated course – manifestations of CNS damage.

Ringworm (trichophytosis, microsporia)

This lichen in humans can appear on any part of the smooth skin or scalp, less often on the nails.On the affected area, pinkish spots with even outlines appear, which consist of small bubbles. Initially, they do not cause itching, and sometimes it only appears over time.

The vital activity of fungi leads to hair loss in the spot area. When localized on the scalp, noticeable bald patches are formed, on which “hemp of hair” are visible. The infection can spread by self-infection throughout the body. Sometimes the foci of lichen fester.

Black lichen

Small and dark lesions appear on the palms, feet and fingers, or on the forearms and trunk.Over time, they grow, brighten in the center, grow together and form polycyclic areas. Outwardly, they may resemble melanoma. When viewed through a magnifying glass, small scales are visible on the surface.

Pityriasis versicolor

Symptoms of shingles of this variety are multiple, slightly protruding above the skin, rounded spots up to 1 cm in diameter. The color of the rash varies and can be coffee, yellow, pink-brown or brown. The edges of the lichen are uneven. Over time, the spots flake off and itch a little.Under the influence of the sun, rashes often regress. Once removed, the affected area does not tan and remains white.

Pink lichen (Gibert’s disease)

Approximately 50–80% of patients initially have only one (sometimes 2–3) maternal plaque of bright pink color with signs of desquamation and about 3–5 cm in size. More often it is localized on the chest.

After 7–10 days, new lesions appear on the skin of the arms, legs and trunk in the form of smaller pink spots of a round or oval shape.Over the course of 2 days, the spots increase to 2 cm or more. They are not prone to draining.

Over time, the center of the spots turns yellow, becomes covered with small scales and flakes. The appearance of the spot resembles a medallion. Itching is present in half of the patients, in 25% it is severe. After 6-8 weeks, the rash disappears. Pigmented or depigmented areas remain on the skin, which are eliminated over time. There are usually no relapses.

Lichen planus (skin and mouth)

On the skin, the rash looks like multiple red-violet or crimson papules (2-5 mm) with a retracted middle and a waxy sheen.The peeling is usually mild, sometimes similar to psoriasis. The rash appears in clusters of rings, garlands, or lines. Itching can be expressed in varying degrees. After the rash is eliminated, persistent hyperpigmentation remains.

In case of damage to the oral cavity, lichen occurs in different forms:

• typical – gray-white nodules (up to 2 mm) appear on the mucous membrane, when they merge, they resemble a lace pattern;
• exudative-hyperemic – grayish papules appear on the reddened and edematous mucosa;
• hyperkeratolytic – gray plaques appear, which over time coarse, rise and cause a feeling of roughness and dryness in the mouth;
• erosive and ulcerative – the mucous membrane is covered with bleeding ulcers and erosions with fibrinous bloom;
• bullous – there are bullous blisters (up to 1.5 cm) with bloody exudate, which open up and form erosion with fibrinous bloom;
• atypical – rash occurs on the gums and upper lip.

One patient can have signs of several forms. In 1% of patients (usually elderly), the rash is malignant.

Scaly lichen (psoriasis)

The rash is usually located on the extensor (less often – on the flexor) surface of the limbs. Occasionally appears on the scalp, soles, palms, and genitals. Elements of the rash are represented by papules in the form of a rounded spot with clear contours. They are covered with dense silvery-white scales. After regression, the spots remain areas of depigmentation.

White (solar) versicolor

It appears as small, white, rounded spots that appear in spring and summer. They protrude above the surface of the skin, itch, inflame and flake off. Melanin does not enter them and burns occur when exposed to ultraviolet radiation. White lichen can become chronic.

Moist lichen (eczema)

The disease is chronic. It manifests itself as a rash in the form of clusters of bubbles in the area of ​​redness of the skin. After the exudate is released, erosions with a soft crust are formed.The rash is intensely itchy and the constant itching can cause insomnia.

Lichen sclerosus

The rash is located near the armpits, on the chest, neck, thighs, pubis and genitals. Most often occur in women 35-50 years old. The elements look like white papules, which transform into light or pink plaques that rise above the skin. They are flaky and itchy. Over time, the plaques atrophy and can lead to skin and genital cancers.

Linear lichen

The rash appears very quickly and looks like papular-squamous elements (about 2-3 mm) protruding above the skin of pink or bright red color.They are arranged in straight, wavy or curly stripes with a width of 1–2 cm and a length of 5–30 cm. The rash usually does not itch, gradually brightens and leaves self-eliminating foci of depigmentation.

Shiny lichen

More common in boys under 6 years of age. The rash almost never affects the face, head, palms and soles. Usually located on the head of the penis, the skin of the lower abdomen, knees and elbows. The rash looks like shiny, dense pearlescent flat nodules that are close to each other, but do not merge or flake off.After a few weeks or years, the rash will heal itself.