How to effectively cover up a cold sore? Discover the best tips and techniques, including using makeup, medicated patches, and topical creams. Get the guidance you need to confidently face the world with a minimized cold sore.

Prepare Your Skin Before Covering a Cold Sore

Before attempting to cover a cold sore, it’s crucial to follow proper hygiene and application steps. The herpes simplex type 1 virus (HSV-1) can cause cold sores to develop on your face, usually on your lips and around your mouth. These painful red blisters go through a five-stage process and typically clear up within 1 to 2 weeks.

Stick to your treatment plan to ease symptoms and speed up healing. If possible, cancel some engagements and take time to rest and recharge your immunity, especially during the initial stages when open cold sores are more susceptible to infection and less conducive to coverage.

Conceal a Cold Sore with Makeup

When you’re ready to cover your cold sore with makeup, consider the following tips:

• Apply a small amount of oil, balm, or moisturizer to prime your skin and prevent cracking, splitting, and bleeding.
• Use a Q-tip to gently remove any flaky skin.
• Allow your skin to dry for at least 1 minute before applying makeup.
• Lightly dab a small amount of cream concealer onto your sore.
• Apply thin layers of thick, creamy foundation to build up coverage, tapping or patting each layer into your skin and blending out the edges.
• Lightly tap a layer of translucent powder or finishing powder over the top.
• Finish with a light spritz of setting spray to lock in your makeup.

Medicated Patches and Topical Treatments

If you want to cover a cold sore without makeup, you can use various gels, creams, and ointments to help retain moisture and promote healing. Some options include:

• Pure aloe vera gel
• Lemon balm ointment
• Tea tree oil
• Petroleum jelly
• Prescription antiviral cream
• Lysine cream

You can also use special Band-Aids or patches to cover a cold sore at the onset of symptoms. These provide a clean, protective layer that improves comfort and acts as a buffer between you and the elements. Some patches are even medicated with ingredients like hydrocolloid, aloe vera, or tea tree oil.

Prevent Contamination and Virus Transmission

When covering a cold sore, it’s important to take precautions to prevent contamination and the spread of the virus. Here are some tips:

• Use a Q-tip, disposable applicator, or your fingertips to apply makeup or products.
• Avoid double-dipping your applicator into the makeup container. Instead, decant a small amount into a separate container.
• Thoroughly sanitize any brushes or tools after use.
• Remove makeup using micellar water and a cotton pad that’s only for the affected area.

Practice and Seek Professional Advice

If you don’t usually wear makeup, practice your coverage technique when you feel relaxed and have some time. This way, you’ll be prepared when you’re rushing off to an important event. You can also ask a friend for assistance or watch an online tutorial.

Once your outbreak fully heals, you can visit a makeup counter to receive application tips and product recommendations tailored to your needs.

Maintain Your Covered Cold Sore

If your cold sore gets too dry while covered, apply a small amount of moisturizer. If it’s a long day, you may need to clean your face and start from scratch with your coverage routine.

Keep your chosen topical treatment or makeup kit with you so you can continually apply it throughout the day to maintain your coverage and promote healing.

The Benefits of Covering a Cold Sore

Covering a cold sore can provide several benefits:

• Reduces the visibility of the blemish, helping you feel more confident and comfortable in social situations.
• Protects the cold sore from further irritation, contamination, and potential infection.
• Helps to retain moisture and promote healing, which may accelerate the recovery process.
• Prevents the spread of the HSV-1 virus to others through direct contact.

By following the tips and techniques outlined in this guide, you can effectively conceal your cold sore and face the world with confidence.

How to Cover Up a Cold Sore

Before you try to cover up a cold sore, there are some pretty important hygiene and application tips to keep in mind.

The herpes simplex type 1 virus (HSV-1) can cause cold sores to develop anywhere on your face, though usually, they appear on your lips and around your mouth. These painful red blisters may occur on their own or in clusters. Cold sores go through a five-stage process and usually clear up within 1 to 2 weeks.

Stick to your treatment plan to ease symptoms and speed up healing. If possible, cancel some of your engagements and take time to rest and recharge your immunity. This is especially beneficial during the initial stages since open cold sores are more susceptible to infection and less conducive to coverage.

Eventually, though, you’ll probably want to put your best face forward and confidently step out into the world. If you decide to cover your cold sore, you have a few options to consider.

Read on to learn how to conceal a cold sore with Band-Aids, medicated patches, and cosmetics such as concealer, foundation, and lipstick. You can also cover cold sores with topical creams and ointments.

Here are some tips to ensure the coverage process goes smoothly:

• To minimize swelling, apply ice or a cold compress to the sore.
• Gently wash your face and hands before starting.
• Wash your hands after touching your face or using them to apply any type of product.
• You may apply a topical cream to your cold sore ahead of time, which may help to speed up the healing process. Allow time for it to dry completely.

If you want to use makeup to cover your cold sore, it must be dry and scabbed over. Open wounds are vulnerable to infection, and it’s possible for makeup and applicators to harbor bacteria.

Research from 2020 detected bacterial contamination in around 79–90% of used cosmetic products, including lipstick, lip gloss, and makeup sponges.

To prevent contamination and spreading of the virus:

• Use a Q-tip, a disposable applicator, or your fingertips to apply makeup.
• Avoid double dipping your applicator into the makeup container.
• Instead, decant a tiny amount of makeup into a small container.
• Thoroughly sanitize any brushes or tools after use.

Makeup tips:

• A thick, creamy consistency will offer the best coverage.
• Choose a hydrating, full coverage, or long-wearing formula.
• Select a shade that is the same as your skin tone.
• Tinted moisturizers are available if you prefer lighter coverage.
• Medicated concealers with ingredients such as zinc oxide, niacinamide, and witch hazel may offer healing benefits.
• Green and yellow color-correcting concealers may minimize redness.
• Keep the area dry and clean.
• Carry a makeup kit to touch up your makeup throughout the day.
• If your cold sore gets too dry, apply a small amount of moisturizer.
• If it’s a long day, you may opt to clean your face and start from scratch.

To cover a cold sore with makeup:

1. Use a small amount of oil, balm, or moisturizer to prime your skin and prevent cracking, splitting, and bleeding.
2. Use a Q-tip to gently remove flaky skin.
3. Allow your skin to dry for at least 1 minute.
4. Lightly dab a small amount of cream concealer onto your sore.
5. Apply thin layers of thick, creamy foundation to build up coverage.
6. Tap or pat each layer into your skin, blending out the edges for a seamless finish.
7. Lightly tap a layer of translucent powder or finishing powder over the top.
8. Finish with a light spritz of setting spray to lock in your makeup.
9. Remove makeup using micellar water and a cotton pad that’s only for the affected area.

If you don’t usually wear makeup, practice your coverage technique when you feel relaxed and have some time. This way, you’ll be prepared when you’re rushing off to an important event.

You can also ask a friend for assistance or watch an online tutorial. Once your outbreak fully heals, you can visit a makeup counter to receive application tips and product recommendations.

If you want to keep your cold sore covered without makeup, you can apply various gels, creams, and ointments to help retain moisture and promote healing. Keep your product with you so you can continually apply it throughout the day.

You can cover a cold sore with:

• pure aloe vera gel
• lemon balm ointment
• tea tree oil
• petroleum jelly
• prescription antiviral cream
• lysine cream

You can use special Band-Aids to cover a cold sore at the onset of symptoms. They provide a clean, protective layer that improves comfort and acts as a buffer between you and the elements.

Most covers are invisible or opaque, which helps to hide your sore. Some patches are medicated with hydrocolloid, aloe vera, or tea tree oil. You can add your ointment or essential oils to a regular Band-Aid.

Band-Aids may help to retain moisture, alleviate inflammation, and soothe symptoms, which may accelerate healing.

Patches can reduce contact with your cold sore, which helps to prevent contamination and transmission.

To use a bandage to cover a cold sore:

1. Wash and dry the area.
2. If necessary, trim the cover to make it the correct size.
3. Apply the bandage.
4. Smooth it down.

You can apply makeup over the bandage. Dab foundation, concealer, or lipstick onto the surface and blend it into your skin.

You can wear a Band-Aid for up to 10 hours, including during sleep for overnight protection. You’ll need to change it more often if your sore is weeping. Covers may irritate sensitive skin, so notice how your skin reacts the first few times you use them.

To cover a cold sore on your lip, you can opt for a neutral look that will blend with your concealer and foundation. To do this, follow the makeup directions above.

You can use lip gloss, satin lipstick, or matte lipstick on your lips. Decide if you prefer a neutral tone or want to go a brighter or bolder shade.

Matte lipstick may stay put longer and provide more coverage, but it tends to cake and dry out. If the matte texture is too dry, you can always add a few layers of balm, gloss, or satin lipstick.

Lip gloss and satin lipstick are more moisturizing and offer a glossy, shiny finish. However, they are sheerer and transfer easily, so your sore will be more visible, and you’ll need to touch it up often.

To use lipstick or gloss to cover a cold sore on your lip:

1. Follow the makeup directions above to cover your sore.
2. Hydrate your lips with balm.
3. Use a disposable applicator or a lipstick you’ll use only when the cold sore is present, to apply thin layers of lipstick or gloss to your lips, gradually building up the color.

If you want to make your cold sore more discreet, try some of these coverage methods. While some of the techniques are not suitable during the early stages, be patient as you wait for your sore to heal.

Always practice good personal hygiene to avoid contamination and transmission. If any product causes irritation, inflammation, or worsening symptoms, wash your face and discontinue use.

How to Cover Up a Cold Sore

Before you try to cover up a cold sore, there are some pretty important hygiene and application tips to keep in mind.

The herpes simplex type 1 virus (HSV-1) can cause cold sores to develop anywhere on your face, though usually, they appear on your lips and around your mouth. These painful red blisters may occur on their own or in clusters. Cold sores go through a five-stage process and usually clear up within 1 to 2 weeks.

Stick to your treatment plan to ease symptoms and speed up healing. If possible, cancel some of your engagements and take time to rest and recharge your immunity. This is especially beneficial during the initial stages since open cold sores are more susceptible to infection and less conducive to coverage.

Eventually, though, you’ll probably want to put your best face forward and confidently step out into the world. If you decide to cover your cold sore, you have a few options to consider.

Read on to learn how to conceal a cold sore with Band-Aids, medicated patches, and cosmetics such as concealer, foundation, and lipstick. You can also cover cold sores with topical creams and ointments.

Here are some tips to ensure the coverage process goes smoothly:

• To minimize swelling, apply ice or a cold compress to the sore.
• Gently wash your face and hands before starting.
• Wash your hands after touching your face or using them to apply any type of product.
• You may apply a topical cream to your cold sore ahead of time, which may help to speed up the healing process. Allow time for it to dry completely.

If you want to use makeup to cover your cold sore, it must be dry and scabbed over. Open wounds are vulnerable to infection, and it’s possible for makeup and applicators to harbor bacteria.

Research from 2020 detected bacterial contamination in around 79–90% of used cosmetic products, including lipstick, lip gloss, and makeup sponges.

To prevent contamination and spreading of the virus:

• Use a Q-tip, a disposable applicator, or your fingertips to apply makeup.
• Avoid double dipping your applicator into the makeup container.
• Instead, decant a tiny amount of makeup into a small container.
• Thoroughly sanitize any brushes or tools after use.

Makeup tips:

• A thick, creamy consistency will offer the best coverage.
• Choose a hydrating, full coverage, or long-wearing formula.
• Select a shade that is the same as your skin tone.
• Tinted moisturizers are available if you prefer lighter coverage.
• Medicated concealers with ingredients such as zinc oxide, niacinamide, and witch hazel may offer healing benefits.
• Green and yellow color-correcting concealers may minimize redness.
• Keep the area dry and clean.
• Carry a makeup kit to touch up your makeup throughout the day.
• If your cold sore gets too dry, apply a small amount of moisturizer.
• If it’s a long day, you may opt to clean your face and start from scratch.

To cover a cold sore with makeup:

1. Use a small amount of oil, balm, or moisturizer to prime your skin and prevent cracking, splitting, and bleeding.
2. Use a Q-tip to gently remove flaky skin.
3. Allow your skin to dry for at least 1 minute.
4. Lightly dab a small amount of cream concealer onto your sore.
5. Apply thin layers of thick, creamy foundation to build up coverage.
6. Tap or pat each layer into your skin, blending out the edges for a seamless finish.
7. Lightly tap a layer of translucent powder or finishing powder over the top.
8. Finish with a light spritz of setting spray to lock in your makeup.
9. Remove makeup using micellar water and a cotton pad that’s only for the affected area.

If you don’t usually wear makeup, practice your coverage technique when you feel relaxed and have some time. This way, you’ll be prepared when you’re rushing off to an important event.

You can also ask a friend for assistance or watch an online tutorial. Once your outbreak fully heals, you can visit a makeup counter to receive application tips and product recommendations.

If you want to keep your cold sore covered without makeup, you can apply various gels, creams, and ointments to help retain moisture and promote healing. Keep your product with you so you can continually apply it throughout the day.

You can cover a cold sore with:

• pure aloe vera gel
• lemon balm ointment
• tea tree oil
• petroleum jelly
• prescription antiviral cream
• lysine cream

You can use special Band-Aids to cover a cold sore at the onset of symptoms. They provide a clean, protective layer that improves comfort and acts as a buffer between you and the elements.

Most covers are invisible or opaque, which helps to hide your sore. Some patches are medicated with hydrocolloid, aloe vera, or tea tree oil. You can add your ointment or essential oils to a regular Band-Aid.

Band-Aids may help to retain moisture, alleviate inflammation, and soothe symptoms, which may accelerate healing.

Patches can reduce contact with your cold sore, which helps to prevent contamination and transmission.

To use a bandage to cover a cold sore:

1. Wash and dry the area.
2. If necessary, trim the cover to make it the correct size.
3. Apply the bandage.
4. Smooth it down.

You can apply makeup over the bandage. Dab foundation, concealer, or lipstick onto the surface and blend it into your skin.

You can wear a Band-Aid for up to 10 hours, including during sleep for overnight protection. You’ll need to change it more often if your sore is weeping. Covers may irritate sensitive skin, so notice how your skin reacts the first few times you use them.

To cover a cold sore on your lip, you can opt for a neutral look that will blend with your concealer and foundation. To do this, follow the makeup directions above.

You can use lip gloss, satin lipstick, or matte lipstick on your lips. Decide if you prefer a neutral tone or want to go a brighter or bolder shade.

Matte lipstick may stay put longer and provide more coverage, but it tends to cake and dry out. If the matte texture is too dry, you can always add a few layers of balm, gloss, or satin lipstick.

Lip gloss and satin lipstick are more moisturizing and offer a glossy, shiny finish. However, they are sheerer and transfer easily, so your sore will be more visible, and you’ll need to touch it up often.

To use lipstick or gloss to cover a cold sore on your lip:

1. Follow the makeup directions above to cover your sore.
2. Hydrate your lips with balm.
3. Use a disposable applicator or a lipstick you’ll use only when the cold sore is present, to apply thin layers of lipstick or gloss to your lips, gradually building up the color.

If you want to make your cold sore more discreet, try some of these coverage methods. While some of the techniques are not suitable during the early stages, be patient as you wait for your sore to heal.

Always practice good personal hygiene to avoid contamination and transmission. If any product causes irritation, inflammation, or worsening symptoms, wash your face and discontinue use.

Eye manifestations of herpes zoster

Approximately a quarter of the world’s population is at risk of developing herpes zoster (Herpes Zoster-HZ) at a certain period of life, in 10-20% of cases the first branch of the trigeminal nerve (Herpes Zoster Ophthalmicus – HZO) is involved in the pathological process . Ophthalmic complications of HZO are dangerous to the eye and can lead to a significant reduction in visual function.

Epidemiology

Varicella zoster virus (VZV), also known as human herpesvirus type 3, is a common virus that causes two distinct clinical conditions, chickenpox and herpes zoster (HZ) [1].

VZV infection markers are present in 95% of the population [2]. Chickenpox is a primary VZV infection. Prior to the introduction of varicella vaccination in 1995, there were approximately 4 million cases (15–16 cases per 1,000 population) of VZV infection in the United States annually, with a peak age of 5 to 9 years, more than 90% of children infected before the age of 15 years From 12,000 to 13,000 patients were hospitalized with 100-150 annual deaths from complications of the disease [3,4].

Late recurrence of VZV infection gets its name from the Greek herpein meaning “to spread” or “crawl” and zoster meaning “belt” or “zone”. It is estimated that the lifetime risk of developing herpes zoster is 10–30% [5].

The reported incidence of HZ before vaccination ranged from 1.2 to 6.5 cases per 1000 population [6]. An increase in the incidence in older age groups is noted everywhere. It is believed that every second person who has reached the age of 85 can develop shingles [7]. In addition to age, provoking factors are intrauterine contact with VZV, chickenpox before the age of 18 months, as well as immunodeficiencies associated with weakened cellular immunity [8,9].

Other predisposing factors may include syphilis, tuberculosis, malaria, emotional and physical trauma. Herpes zoster is a particular problem in patients with HIV. The disease can develop at any age and manifest itself at any stage of HIV infection, especially with the development of immunodeficiency. In some cases, shingles is the earliest manifestation of AIDS. The probability of re-infection within one year is 12% [10]. In HIV-infected individuals, more than one dermatome is often simultaneously involved in the pathological process, which is rare in immunocompetent patients. In addition, they are highly likely to develop complications: postherpetic neuralgia (PHN), chronic skin lesions, CNS and eye lesions [11].

Viral structure and pathogenesis

Humans are the only known natural host of VZV. After a primary infection, VZV is transported retrogradely to the spinal cord roots, sensory ganglia, and autonomic ganglia, remaining inactive for many years – “freezes for a while, then to raise its head again” [12].

After reactivation, the virus multiplies in the sensitive ganglia of the Gasser ganglion, the virions move to the skin or mucous membrane by axonal transport. A decrease in specific cellular immunity with age, stress factors, traumas (including surgical ones) contribute to endogenous intraganglionic reactivation of a latent virus with damage to the corresponding nerve trunks and skin areas (dermatomes) and the development of HZ syndrome [12]. Involvement of the cranial nerves occurs in 13–20% of cases, with the trigeminal nerve being involved most frequently [13]. Involvement of the ophthalmic branch of the trigeminal nerve in the process leads to the manifestation of HZO with inflammatory and neurological lesions of the eye, often combined with each other [14]. As neurological complications of HZO, palsies of the III and VI pairs of cranial nerves (cranial nerves) most often occur [8, 15].

Clinical manifestations HZO

Acute herpes zoster begins with prodromal symptoms (1-4 days) including fever, malaise, headaches, and hypoesthesia, with pain, burning, itching, erythema, and swelling in the affected dermatome. The first symptoms of HZO are severe neurological pain and subsequent herpetic eruptions against the background of edematous hyperemic skin of the upper eyelid, forehead and scalp, limited by the midline of the face. Release of the virus from sensory nerve endings results in a macular rash that becomes papular and then vesicular within 24 hours. Clustered vesicles usually include a single dermatome, but may include up to three adjacent dermatomes. New vesicles continue to appear for about 4 days and may persist for weeks in immunocompromised patients. Hemorrhagic necrosis of deeper skin tissues may occur, with a tendency to permanent pigmentation and residual scarring. Less commonly, an attack occurs without skin rash [16]. Hematogenous dissemination of the virus is possible, resulting in the appearance of distant clustered vesicles. Visceral dissemination is a more serious complication of herpes zoster: the lungs and gastrointestinal tract are most often affected [17]. After 2-3 weeks, the acute phase subsides, the rash crusts and disappears, but pain can persist in the affected dermatome for a long time. This condition is known as postherpetic neuralgia (PHN). The severity of pain in PHN can reach a high degree, accompanied by the development of chronic fatigue, depression, and loss of social functions [18].

In 50% of patients with HZ orbital localization, a viral lesion of the eye occurs after 1-2 weeks. J. Hutchinson was the first to describe the signs and symptoms of HZO in 1865 [19]. Of the three branches of the trigeminal nerve, the first, ophthalmic branch is most often affected by herpes zoster – in 8-56% of cases [12, 20-22]. Vesicles at the tip of the nose are known as Hutchinson’s sign and are symptoms of a possible intraocular lesion [14, 19].

Periorbital area and eyelids. Eyelid edema is usually the first sign of HZO, accompanied by itching, hypesthesia, or pain. After this, a maculopapular rash develops and further progresses to a vesicular rash.

Conjunctiva. Conjunctival changes in HZO may include papillary or follicular hyperplasia, chronic hyperemia, and pseudomembrane formation. There may be a vesicular rash with possible rupture of the vesicle and hemorrhagic changes. In severe cases, there is extensive scarring of the conjunctiva and the formation of symblefarone.

Episclera/sclera. HZO may cause episcleritis, anterior or posterior scleritis. Both episclera and sclera can be affected during the acute stages of HZO or even months after the vesicles have disappeared. Episcleritis usually appears in the early stages of HZO and may persist for up to 3 months or more in a significant number of patients [23]. The scleritis may be diffuse or nodular and progress towards the limbus leading to peripheral limbal vasculitis [24]. As a result of chronic scleritis, thinning of the sclera and the formation of staphyllomas may occur [25]. Posterior scleritis is less common and is usually the result of an infiltrative process involving perivascular and perineural tissue.

Cornea. Corneal lesions occur in about two-thirds of patients with eye disease in HZO. Chronologically, they manifest as punctate epithelial keratitis, early pseudodendritic keratitis, anterior stromal infiltrates, sclerokeratitis, keratouveitis, endotheliitis, neurotrophic keratitis, and exposure keratopathy [26, 27–29].

Pitted epithelial keratitis. The initial corneal lesion is usually chiseled epithelial keratitis. It is characterized by the appearance of a few grayish-white plaques on the surface of the thickened epithelium with clear linear or branched boundaries; their size, shape and number are constantly changing. It is not uncommon to observe how clinically insignificant keratitis is combined with severe iridocyclitis with hypertension [1].

Pseudodendritic keratitis . Multiple dendritic or stellate lesions occur over several days. As a rule, they are found on the periphery of the cornea and probably represent the fusion of previous foci of punctate epithelial keratitis.

Anterior stromal infiltrates. Approximately 10 days later, single or multiple patchy infiltrates appear, located directly under the Bowman’s membrane. They represent a stromal reaction to a soluble viral antigen diffusing into the anterior stroma, or direct virus damage.

Tree keratitis. This type of keratitis is characterized by small, delicate, dendritic and stellate epithelial lesions predominantly on the periphery of the cornea. Unlike keratitis caused by the herpes simplex virus, it is characterized by discontinuous branching and less pronounced inflammatory infiltration [1].

Discoid keratitis. A few weeks or months after the acute phase of HZO, a deep central or peripheral discoid infiltrate with stromal edema may develop in a relatively calm eye. Unlike discoid corneal lesions caused by the herpes simplex virus, keratouveitis with HZO lesions is accompanied by more pronounced neuralgic pain, trophic disorders, decreased sensitivity of the cornea, a tendency to disintegrate the infiltrate with the formation of a deep corneal ulcer and subsequent gross scarring.

Sclerokeratitis. The spread of scleritis to the cornea can occur approximately 1 month after the onset of HZO in the form of marginal keratitis with vascularization. The underlying mechanism is probably vasculitis or immune complex deposition [26].

Neurotrophic keratitis. Neurotrophic keratitis develops as a result of a decrease in the sensitivity of the cornea with loss of epithelial integrity and subsequent destruction of the epithelium and stroma. The first signs of neurotrophic keratitis are: lack of corneal luster and irregular surface of the cornea or epithelium with punctate erosions. Over time, grayish opacity and edema of the epithelium develop with the visualization of small intraepithelial vesicles. Serious complications such as corneal ulceration, perforation, and fibrovascular scarring may occur. The etiology of this disorder is complex and includes a decrease in the concentration of neurotransmitters, a delay in epithelial regeneration, a decrease in the frequency of blinking, dysfunction of the meibomian glands, a violation of the composition and a decrease in the amount of tear fluid [28, 30].

Exposure keratopathy. Exposure keratopathy is caused by eyelid changes resulting from HZO. Several factors contribute to corneal damage: poor mobility of the upper eyelid, thickening and unevenness of the eyelids, inversion and eversion, dysfunction of the meibomian glands, and trichiasis [28, 31].

Interstitial keratitis/lipid keratopathy. Interstitial diffuse kerato-iridocyclitis is the most severe form of HZO-induced keratitis, characterized by diffuse infiltration and foci of necrosis in deep stromal layers, usually localized paracentrally or at the periphery of the cornea and subsequently leads to severe scarring with vascularization and lipid deposition.

Post-inflammatory bullous keratopathy. The outcome of severe HZO-keratoiridocyclitis is temporary or permanent corneal edema. The likely mechanism is destruction of the endothelium by VZV or an immune response. Long-term corneal endothelial insufficiency leads to chronic corneal edema, clouding, scarring and vascularization.

Uveitis is a very common lesion in VZ infection. The disease proceeds for a long time, often combined with keratitis and a persistent increase in the level of intraocular pressure. A significant role in the pathogenesis of iridocyclitis belongs to vaso-occlusive processes, which are associated with the formation of areas of atrophy of the iris and ciliary body. Due to ischemia and massive necrosis of the ciliary body, hypotension and phthisis may develop. A retrospective study showed that secondary glaucoma occurs in 56% of patients with uveitis [32].

Retinal necrosis. A special and most dramatic form of sudden VZV activation is acute retinal necrosis (ANN) [33]. The ANS syndrome includes the sequential rapid development of necrotic foci on the periphery of the retina, which later merge into “annular” necrosis outside the vascular arcades and optic neuritis, as well as anterior uveitis and vitreitis. Funnel retinal detachment is a common outcome of ANS.

Neurological manifestations

Acute neuralgia is one of the most common manifestations of herpes zoster and occurs in about 93% of cases [34]. It is characterized by bouts of pain in the zone of innervation of the affected nerve. Post-zoster (post-herpetic) neuralgia (PHN) occurs in approximately 10-15% of patients with herpes zoster (Gobel, 1997; Malin, 1996). The development of PHN is preceded by both general insensitivity of the affected dermatome and severe pain in the initial phase of herpes zoster. PHN is characterized by constant, excruciating, burning pain of varying intensity, sometimes accompanied by sudden, brief bouts of dysesthesia, such as tingling and piercing pain. The pain syndrome has a pronounced vegetative coloration in the form of burning, paroxysmal, sharp pains, aggravated at night. In the future, the pains recur and disturb the patient for many months and years, causing disability, disturbing sleep, changing his mental and emotional status, forming a permanent PHN syndrome. The protracted severe nature of the disease with a prolonged pronounced pain syndrome contributes to the formation of mental personality disorders.

In HZO, the process can spread from the trigeminal (Gasser) node along the ophthalmic branch of the trigeminal nerve. A characteristic pain syndrome and vesicle eruptions develop along branches of the ophthalmic nerve, including the supraorbital and supratrochlear nerves. In the acute stage of rashes or after their healing, as a postherpetic complication, optic neuritis may develop. Rarely, the central visual pathways are involved in the process. Of the other complications, ophthalmoplegia is possible. Of the nerves innervating the external eye muscles, the oculomotor and abducens are more often involved in the process. Combinations of ophthalmoplegia with damage to the optic nerve, the syndrome of the apex of the orbit, have been described [1].

Tholos-Hunt syndrome (CTH), or painful ophthalmoplegia syndrome, develops with a nonspecific inflammatory process in the walls of the cavernous sinus and in the membranes of the intracavernous part of the carotid artery. Manifested by constant boring pain of peri- and retroorbital localization, unilateral lesion of the first branch of the trigeminal nerve, oculomotor, abducens, trochlear cranial nerves, exophthalmos and chemosis in various combinations [35]. In some cases, the disease proceeds with alternating remissions and exacerbations. Typical for CTX is a combination of neuropathic pain in the upper part of the face and ophthalmoplegia, which develop simultaneously or follow each other after several days or weeks. In some patients, there is a violation of the sympathetic innervation of the pupil. In this syndrome, visual loss may occur due to damage to the optic nerve [11].

Ramsey-Hunt syndrome. In 1907, the American neurologist J. Hunt described an HZ lesion of the geniculate ganglion (knee ganglion). The manifestations of the disease begin acutely, with general symptoms of intoxication and fever. Herpetic eruptions are localized in the external auditory canal, auricle, mastoid process and on the tympanic membrane and are often accompanied by excruciating dizziness. There is a lesion or lack of taste in the anterior region ² / ₃ the back of the tongue, decreased tear and salivation and the absence of a corneal reflex on this half of the face, horizontal nystagmus [36, 37]. When the maxillary and ophthalmic branches of the trigeminal nerve are involved in the inflammatory process, the disease is aggravated by neutrophic keratitis [38].

Pathomorphology. Tissue damage by VZV infection results from a combination of factors including necrosis, vasculitis, and chronic inflammation in response to direct viral attack. Reactivation of VZV in the ganglion causes a chronic inflammatory response with associated hemorrhagic necrosis in the dorsal root ganglion and adjacent perineural tissues [39]. With peripheral spread of the virus, VZV travels along sensory axons, causing demyelination, cellular infiltration, and subsequent scarring with peripheral nerve fibrosis. A granulomatous inflammatory response is also seen in peripheral nerves. Fluorescent antibody and electron microscopy studies revealed VZV and its associated antigen in neuronal and glial cells, as well as in their corresponding sensory nerves, before the appearance of a characteristic skin rash [40].

A combination of factors leads to various ocular complications of HZO, including direct cytopathogenic effects of the virus, as well as inflammatory, immune and vascular responses. In the early stages of HZO, non-granulomatous (lymphocytes and plasma cells) infiltration of the iris, trabecular meshwork, ciliary body, retinal vasculature, and optic nerve is initiated [41]. Lymphocytic and plasmatic infiltration of the posterior ciliary artery and nerves in the retrobulbar region appears to be unique to HZO [42]. This early inflammatory reaction is reversible, but with more severe inflammation, necrosis of the ciliary body and choroid may develop, with the onset of granulomatous infiltration by epithelioid and giant cells [41]. Focal ischemic necrosis, which can occur in the iris and retina, may be associated with damage by immune complexes to a bundle of VZV-affected nerve fibers with the penetration of antibodies from neighboring blood vessels. The necrotizing retinitis seen in acute retinal necrosis is likely the result of a direct infection of the retina [43]. Damage to the optic nerve may be due to vasculitis followed by ischemia and chronic inflammation.

Diagnosis of HZO

In HZO with characteristic dermatomal distribution of lesions and typical lesion morphology, the diagnosis is based on clinical presentation and laboratory confirmation is not required. However, sometimes HZO can mimic other diseases, such as herpes simplex virus or impetigo, requiring laboratory testing for rapid diagnosis. Laboratory testing for VZV includes morphological and immunomorphological tests, viral isolation, serological tests, and cellular immunity tests. The polymerase chain reaction method also makes it possible to timely detect viral particles from skin vesicles with extreme sensitivity, but it is difficult to determine the activity of the infectious process [42, 44]. The final identification technique is the direct isolation of VZV from a culture of vesicular fluid.

Therapy of VZV infection

Drug therapy

Drug therapy should be complex and include both etiotropic and pathogenetic, symptomatic agents, immunotherapy and immunocorrection agents, vitamins, adaptogens.

Treatment of herpetic eye disease is based on antiviral therapy. Currently, there are three of its directions: 1) chemotherapy; 2) nonspecific immunotherapy; 3) specific immunotherapy.

The 3 most commonly used chemotherapeutic drugs from the group of nucleoside analogs are acyclovir, valaciclovir and famciclovir. Aciclovir has a low toxicity index, its disadvantages are moderate activity against VZV in vitro and low bioavailability after oral administration [45]. Topical treatment with acyclovir for HZO vesicular rash usually has minimal effect. After the lesions have dried, an antibiotic ointment can be applied to prevent a secondary bacterial infection.

The polyA:polyU complex (Poludan) is the first domestic highly effective non-toxic biosynthetic interferonogen developed in cooperation with VNIIGB and the Institute of Virology. Ivanovsky. A.A. Kasparov was the first to develop rational methods for using poludan, successfully applied it in the clinic and introduced the drug into ophthalmological practice. The drug has a pronounced inhibitory effect on herpesviruses in the absence of a toxic effect, which has been proven in tissue culture on experimental models of superficial and deep herpetic keratitis, iridocyclitis, and in more than 40 years of clinical practice [1].

A.A. Kasparov proposed subcutaneous injection of fresh skin rashes with a solution of polyA:polyU with novocaine (200 μg of poludan in 5-10 ml of a 0.5% solution of novocaine), which leads to their rapid regression and significantly reduces the severity and duration of the pain syndrome caused by neuralgia. Poludan is used prophylactically in the form of instillation in the absence of eye lesions [1, 46].

In superficial herpetic lesions of the anterior eye, it is advisable to use interferonogens (polyA:polyU, para-aminobenzoic acid) mainly in the form of frequent instillations [46-48].

In case of stromal keratitis, keratoiridocyclitis and intraocular ophthalmic herpes, success can be achieved only with the injection of the Poludan solution. In this case, it is preferable to use the periocular route of administration of interferonogens, in which, along with the general one, local interferonogen formation also occurs in the tissues of the eye [1, 46]. Additionally, immunoglobulins are used, including specific VariZig and immunomodulators [49, 50].

Another area of ​​immunotherapy for conjunctivitis and keratitis in herpes zoster is the use of interferon preparations, in particular, recombinant interferon alfa-2b [51].

Treatment of neurotrophic keratitis includes continuous use of tear replacement and cytoprotective therapy (autologous serum) [52, 53]. Topical antibiotic ointment may also be used to prevent and treat secondary bacterial infections.

Topical treatment of rash elements with a 1% alcohol solution of brilliant green or a concentrated solution of potassium permanganate.

Corticosteroids, due to a pronounced immunosuppressive effect, aggravate the severity of the course of herpetic keratitis and contribute to the recurrence of infection. The appointment of GCS in combination with antiviral drugs is possible in cases of complete corneal epithelialization in the regressive period of the disease to relieve residual inflammation and suppress corneal vascularization. The negative effect in the treatment of patients with herpetic keratitis with steroids is explained by the suppression of the formation of interferon and antibodies in the tissues of the eye, the activation of this pathogen as a result, and the slowing down of regenerative processes in the cornea [1]. Many severe complications have been described that occur with the local use of corticosteroids in herpetic eye disease. These include chronically flowing “steroid-complicated forms” of herpetic keratitis, as well as rapidly progressing “necrotic” lesions of the cornea and keratoiridocyclitis associated with superinfection layering.

Physiotherapy has been successfully used to relieve pain. After resolution of skin rashes, treatment is carried out by neuropathologists until the disappearance of neurological symptoms, including using non-pharmacological therapy methods: magnetotherapy, reflexology, acupuncture, pulsed diadynamic currents, transcutaneous neuroelectric stimulation, regional sympathetic nerve blockade, hyperbaric oxygenation, ultrasound, ultraviolet irradiation (1-2 procedures). In reflexology, both points of general action and points corresponding to the affected ganglion are usually used, the course is 10-12 sessions [1].

Surgical treatment

Surgical treatment is necessary for some corneal complications, including long-term non-healing defects of the corneal epithelium, melting and perforation, corneal scarring. Partial or complete transplantation of the conjunctival flap, amniotic membrane or therapeutic corneoscleral coating according to Puchkovskaya promotes the healing of extensive defects in the corneal epithelium [54]. In the presence of neurotrophic and exposure keratopathy, corneal erosion or ulcer, eyelid surgery may be indicated: tarsorrhaphy or botulinum-induced ptosis. In cases of severe corneal scarring, deep anterior lamellar keratoplasty or penetrating keratoplasty [55] or keratoprosthesis combined with tarsorrhaphy [56] are indicated.

Therapy for neuralgia

Immediate antiviral treatment may prevent or reduce PHN [57]. In all controlled clinical trials on antiviral therapy, it is recommended to start such therapy within the first 72 hours after the onset of rashes. However, observational studies have shown that treatment started even 3 days after the onset of rashes can be effective. The intensity of pain in the acute period of Herpes zoster is an important predictor of the development of PHN. Pain treatment at this stage can influence the further course and formation of PHN. Mild pain is controlled with aspirin, paracetamol, non-steroidal anti-inflammatory drugs, or a short course of combination therapy including tramadol. For moderate to severe pain, opioids are a priority. In the absence or delay of the analgesic effect of opioids, anticonvulsants (pregabalin, gabapentin) are additionally prescribed [58].

Tricyclic antidepressants, gabapentin, pregabalin, and 5% lidocaine patch are suggested as first-line drugs. Opioids, tramadol, capsaicin cream and 8% capsaicin patch are only recommended as second or third line drugs in different guidelines. Treatment with drugs such as serotonin and norepinephrine reuptake inhibitors, carbamazepine, valproic acid, and botulinum toxin is also discussed [59].

VZV vaccination

VZV vaccination reduces the incidence of herpes zoster by 51.3%, the severity of the condition by 61.1% and the development of postherpetic neuralgia by 66.5% [60]. The Advisory Committee on Immunization Practices (ACIP) recommends HZ vaccination for individuals 60 years of age and older with chronic herpes infection. Vaccination is not indicated in the acute period of herpes zoster, for the prevention and treatment of postherpetic neuralgia in persons younger than 60 years of age and at any age after the introduction of the Varicella zoster vaccine. Contraindications are allergy to vaccine components, primary or acquired immunodeficiency, pregnancy, acute illness.

VZV infection in lesions of the first branch of the trigeminal nerve can be a source of various ophthalmic complications – the most common eye lesions in HZ are keratitis and iridocyclitis. The clinical picture of lesions of the cornea is polymorphic. Among superficial keratitis, the most common are punctate and dendritic, and among deep ones, discoid. Other corneal lesions also include sclerokeratitis, peripheral corneal ulcers, uveakeratitis, neurotrophic keratitis, exposure keratitis. Keratouveitis with HZO lesions is accompanied by more pronounced neuralgic pain, trophic disorders, decreased sensitivity of the cornea, a tendency to disintegration of the infiltrate with the formation of a deep corneal ulcer and subsequent coarse scarring. Possible lesions of the eyelids, uveal tract, retina, as well as the development of postherpetic neuralgia. In most cases, the disease is diagnosed clinically based on the detection of characteristic skin rashes, but in atypical cases, additional laboratory and morphological confirmation may be required. The main principles of HZO treatment is the combined use of interferonogens (locally and systemically) and nucleoside analogs, which can also be supplemented with interferon preparations if necessary. In some cases, surgical treatment is required.

The authors declare no conflicts of interest.

The authors declare no conflicts of interest .

Herpes zoster in children: causes, symptoms and treatment

Contents

• 1 Symptoms, treatment and prevention of herpes zoster in children
  • 1.1 Herpes zoster in children: causes, symptoms and treatment
    90 181 1.1.1 What is herpes zoster ?
  • 1.2 Herpes zoster in children: causes, symptoms and treatment
    • 1.2.1 Causes
  • 1.3 How does herpes zoster manifest in children?
  • 1.4 Complications of herpes zoster in children
  • 1.5 Diagnosis of herpes zoster in children
  • 1. 6 Treatment of herpes zoster in children
  • 1.7 Folk remedies for the treatment of herpes zoster in children
  • 1.8 Prevention of herpes zoster in children
  • 1.9 How to protect others from herpes zoster?
  • 1.10 Related videos:
  • 1.11 Q&A:
    • • 1.11.0.1 What is herpes zoster?
      • 1.11.0.2 How can you get infected with herpes zoster?
      • 1.11.0.3 What are the symptoms in children with herpes zoster?
      • 1.11.0.4 How to treat herpes zoster in children?
      • 1.11.0.5 How can I prevent getting herpes zoster in children?
      • 1.11.0.6 Can I play sports if my child has herpes zoster?

More about herpes zoster in children: what are the causes, symptoms, methods of diagnosis and treatment? Our recommendations will help you better protect your child from this virus.

Herpes zoster is a disease caused by the Varicella zoster virus that lives in the nerve ganglion. It is activated when the immune system is weakened, and manifests itself in the form of a disease. This disease is very common and can occur in children of all ages.

Symptoms of herpes zoster in children include burning, itching, and sometimes even pain in the area of ​​the rash. They can appear on any part of the body, but are most common on the head, neck, and torso. Herpes zoster can be especially dangerous for children whose immune systems are weakened, such as newborns and children with heart, lung, or kidney problems.

Herpes zoster in children can be treated with a variety of treatments, including antiviral drugs, anti-inflammatory drugs, and antibiotics. In addition, children can be given medication to relieve pain and itching. In the most severe cases, hospitalization and additional treatment may be required.

It is important to remember that herpes zoster in children is a serious disease that can lead to complications. Parents should seek medical attention if they notice signs of this disease in their child.

Herpes zoster in children: causes, symptoms and treatment

What is herpes zoster?

Herpes zoster is a viral disease caused by the herpes simplex virus. It is characterized by acute pain syndrome and skin rashes. The basis of the disease is the activation of the herpes simplex virus, which was in the body in a dormant state.

Herpes zoster can appear on any part of the body, but most often on the lateral surface of the trunk and chest. It can affect the nerves that are under the skin, resulting in a burning sensation and numbness at the site of the rash.

According to statistics, herpes zoster is less common in children than in adults, but its presence in children means a more serious condition than in adults.

Herpes zoster in children: causes, symptoms and treatment

Causes

Herpes zoster is a disease caused by the Varicella-zoster virus, which also causes chicken pox. During the initial infection with chickenpox, the virus settles in the nervous system and can remain there for decades.

In some cases, inflammation of the nerve cells associated with the virus can cause herpes zoster in children. Factors that can trigger virus activation include cramped living conditions, stress, and changes in the immune system.

Also, children can become infected with the virus through contact with other sick children or adults who carry the virus but do not have symptoms of the disease. The risk of infection increases when the immune system is weakened, for example, in diseases that reduce its performance.

How does herpes zoster manifest itself in children?

Herpes zoster in children manifests itself through various symptoms. One of the most common symptoms is a burning sensation at the back of the head, temples, or around the ear. Then a red rash and blisters appear on the skin. The blisters can be small or large and can be very painful, especially when touched and rubbed.

Other symptoms that may accompany herpes zoster in children include headache, fever, weakness, nausea, and abdominal pain. Children may also have problems with vision and hearing.

It should be noted that the symptoms of herpes zoster may worsen as the infection continues to progress. Symptoms usually persist for several weeks, but may continue for a longer period of time in some children.

• Burning, stinging or itching on the skin
• Red rash and blisters on the scalp, face and neck
• Headache, fever, weakness, nausea and abdominal pain

Complications of herpes zoster in children

Shingles herpes in children can lead to a number of complications, especially if they have a severe disease or have a weakened immune system.

• Postherpetic neuralgia is a condition characterized by painful sensations in the affected area that can last for many months after recovery.
• Tumors and deformities of the eyes – when herpes affects the eye, tumors, enlargement and deformation of the eyeball can occur, which can lead to visual impairment.
• Meningitis is an inflammation of the meninges that can occur when a herpes infection occurs in the head. Accompanied by headache, nausea, vomiting, convulsions.

In the event of these complications, it is necessary to consult a doctor and receive special treatment.

Diagnosis of herpes zoster in children

Diagnosis of herpes zoster in children is based on the characteristic symptoms and clinical picture of the disease.

The first sign of herpes zoster in children is the appearance of painful blisters on the skin. They are located along one of the branches of the sympathetic nerve and may be accompanied by burning, numbness or soreness in the affected area of ​​the skin.

Diagnosis of herpes zoster in children may also include laboratory tests – a complete blood count, a test for the presence of the herpes virus. Differential diagnosis with other skin diseases can also be carried out.

It is important to see a doctor immediately if a child develops the characteristic symptoms of herpes zoster, as timely treatment helps to reduce the risk of complications and speed up the healing process.

Treatment of herpes zoster in children

Herpes zoster in children is a serious disease that must be treated immediately. Various methods are used for this.

• Antivirals is the primary treatment for herpes zoster. They help eliminate the virus from the child’s body and cure the disease faster.
• Painkillers and anti-inflammatory drugs – help reduce pain and inflammation at the site of the lesion.
• Antiseptics and ointments – help speed up wound healing and prevent possible complications.

However, before starting the treatment of herpes zoster in a child, it is imperative to consult a pediatrician or dermatologist so as not to harm the health of the baby.

Folk remedies for the treatment of herpes zoster in children

Herpes zoster in children is a common disease that can cause a lot of discomfort. Instead of seeking medical help, some parents choose to use folk remedies to fight this infection.

Aloe leaves is one of the most popular folk remedies in the treatment of herpes zoster in children. They can help soften the skin and reduce itching and inflammation. To use aloe leaves, they must be cut in half and applied to skin rashes.

Lemon balm and calendula leaves can also help relieve itching and irritation associated with herpes zoster. Just pour a small amount of leaves into boiling water, leave for a few minutes, and then use to wipe the affected areas of the skin.

Garlic is another folk remedy that can help reduce the symptoms of herpes zoster. Phytoncides contained in garlic contribute to the killing of the virus. To use, crush garlic teeth and apply to skin rashes.

Cherry cuttings can also help reduce the painful symptoms of herpes zoster. To use, grate half-dried cherry cuttings and apply the paste to skin rashes.

Such folk remedies can help relieve the symptoms of herpes zoster in children. But, as with any other medical problem, if symptoms persist or worsen, seek medical attention.

Prevention of herpes zoster in children

Herpes zoster in children is an infectious disease caused by the herpes virus. To prevent its occurrence, it is necessary to take preventive measures:

• Strengthening immunity – helps the child fight the infection and prevent its development. To do this, you should eat right, including in the diet of vegetables, fruits and foods rich in vitamins, as well as ensure that you get enough sleep and physical activity.
• Avoid contact with infected people – Herpes zoster is transmitted through contact with other people, so close contact with infected people should be avoided and personal hygiene should be monitored.
• Take preventive measures – these measures include washing hands regularly, disinfecting surfaces that may come into contact with the child, and using sun protection on exposed skin, as direct exposure to ultraviolet rays can reduce immunity and cause herpes.

Also, if the child is at high risk of contracting herpes, there is the possibility of vaccination, which reduces the risk of the disease and reduces the severity of symptoms.

How to protect others from herpes zoster?

• Avoid kissing, touching and close contact with people who have herpes zoster.
• Use personal hygiene items (eg, towels, toothbrushes, eating utensils) to avoid getting infected from those who are infected.
• Temporarily avoid hospitals and crowded places to avoid being infected by carriers of the virus.
• Call your doctor if you have symptoms of herpes zoster to avoid infecting others.
• Enjoy a healthy lifestyle, eat right, keep your immune system in good shape and avoid stress to reduce your chances of developing herpes zoster.

Related videos:

Q&A:

What is herpes zoster?

Herpes zoster is an infectious disease caused by the Varicella-Zoster virus. It causes an itchy, reddened, and painful skin rash that covers an area of ​​the body that corresponds to a single nerve. Shingles is less common in children than in adults, but their illness can be more severe.

How can you get infected with herpes zoster?

Herpes zoster is spread by droplets: through the air when an infected person coughs or sneezes. Usually this virus is not transmitted by contact through objects, but stainless steel surfaces, ceramic coatings (such as cups or plates), sometimes less dense materials, there is a small risk of transmission of the virus.

What are the symptoms of herpes zoster in children?

Symptoms of herpes zoster in children may include skin rashes in the form of blisters that freeze into crusts and then disappear after a few weeks. Children may also experience pain and discomfort on the affected skin and persistent burning, stinging, or itching that may occur even before the rashes.

How to treat herpes zoster in children?

Herpes zoster cannot be completely cured, but its symptoms can be alleviated.