How is shingles diagnosed. What are the most effective treatments for shingles. Can shingles be prevented with vaccination. How long does a typical shingles outbreak last. What are the potential complications of untreated shingles.

Understanding Shingles: Causes and Symptoms

Shingles, also known as herpes zoster, is a viral infection caused by the varicella-zoster virus, the same virus responsible for chickenpox. After a person recovers from chickenpox, the virus remains dormant in the nervous system and can reactivate years later, causing shingles.

The primary symptom of shingles is a painful rash that typically appears as a stripe of blisters on one side of the body or face. This rash is often accompanied by burning, tingling, or itching sensations. Other symptoms may include fever, headache, fatigue, and sensitivity to light.

Risk Factors for Developing Shingles

• Age (50 years and older)
• Weakened immune system
• Certain medications
• Stress
• Recent illness or surgery

Do all individuals who have had chickenpox develop shingles. No, not everyone who has had chickenpox will develop shingles. However, the risk increases with age and certain health conditions that compromise the immune system.

Diagnosing Shingles: What to Expect

Diagnosing shingles typically involves a physical examination and assessment of symptoms. In most cases, a healthcare provider can diagnose shingles based on the characteristic appearance and distribution of the rash. However, in some instances, additional tests may be necessary to confirm the diagnosis.

Diagnostic Tests for Shingles

1. Viral culture: A sample of fluid from a blister is taken to identify the presence of the varicella-zoster virus.
2. Polymerase chain reaction (PCR) test: This test detects the DNA of the virus in a sample of fluid or tissue from the affected area.
3. Tzanck smear: A scraping of skin cells is examined under a microscope for signs of the virus.

Is early diagnosis crucial for effective shingles treatment. Yes, early diagnosis and prompt treatment can significantly reduce the severity and duration of symptoms, as well as lower the risk of complications.

Effective Treatment Options for Shingles

While there is no cure for shingles, several treatment options can help manage symptoms, reduce pain, and prevent complications. The most effective treatments typically involve a combination of antiviral medications, pain management strategies, and supportive care.

Antiviral Medications

Antiviral drugs are the cornerstone of shingles treatment. These medications work by inhibiting the replication of the varicella-zoster virus, thereby reducing the severity and duration of the outbreak. Common antiviral medications prescribed for shingles include:

• Acyclovir (Zovirax)
• Valacyclovir (Valtrex)
• Famciclovir (Famvir)

When should antiviral treatment be started for maximum effectiveness. Antiviral medications are most effective when started within 72 hours of the rash’s appearance. However, they may still provide some benefit if begun later, especially in severe cases or in patients with compromised immune systems.

Pain Management Strategies

Managing pain is a crucial aspect of shingles treatment, as the condition can cause significant discomfort. Various pain management options are available, including:

• Over-the-counter pain relievers (e.g., acetaminophen, ibuprofen)
• Topical anesthetics or numbing agents
• Prescription pain medications for severe cases
• Nerve blocks or local anesthetics administered by a healthcare provider

Can complementary therapies help alleviate shingles pain. Some patients find relief through complementary therapies such as acupuncture, relaxation techniques, or applying cool compresses to the affected area. However, these should be used in conjunction with, not as a replacement for, conventional medical treatments.

Managing the Shingles Rash: Home Care and Remedies

Proper care of the shingles rash can help promote healing and reduce discomfort. Here are some home care strategies that can be beneficial:

• Keep the rash clean and dry to prevent bacterial infections
• Apply cool, wet compresses to reduce itching and soothe the skin
• Use calamine lotion or other soothing lotions to relieve itching
• Wear loose-fitting, breathable clothing to avoid irritating the rash
• Take lukewarm baths with colloidal oatmeal to soothe the skin

Is it safe to use over-the-counter antihistamines for shingles-related itching. While antihistamines may provide some relief from itching, it’s essential to consult with a healthcare provider before using them, as they may interact with other medications or have side effects in some individuals.

Preventing Complications: Long-term Management of Shingles

While most cases of shingles resolve within a few weeks, some individuals may experience long-term complications. The most common complication is postherpetic neuralgia (PHN), a condition characterized by persistent pain in the area affected by shingles even after the rash has healed.

Strategies for Preventing and Managing Postherpetic Neuralgia

• Early antiviral treatment to reduce the risk of PHN
• Ongoing pain management techniques
• Topical treatments such as lidocaine patches or capsaicin cream
• Antidepressants or anticonvulsants to manage nerve pain
• Physical therapy or occupational therapy to improve function and quality of life

Are there any long-term effects of shingles on overall health. While most people recover fully from shingles, some may experience long-term effects such as changes in skin sensitivity, scarring, or in rare cases, vision or hearing problems if the rash affects the eyes or ears.

Shingles Vaccination: A Preventive Approach

Vaccination is an effective way to reduce the risk of developing shingles or experiencing severe complications from the condition. The Centers for Disease Control and Prevention (CDC) recommends the shingles vaccine for adults aged 50 and older.

Types of Shingles Vaccines

1. Shingrix: A recombinant zoster vaccine, considered the preferred option due to its higher efficacy
2. Zostavax: An older live vaccine, no longer available for use in the United States as of November 18, 2020

Who should consider getting the shingles vaccine. The CDC recommends that healthy adults 50 years and older get two doses of Shingrix, separated by 2 to 6 months, to prevent shingles and its complications. This includes individuals who have previously had shingles or received the Zostavax vaccine.

Living with Shingles: Coping Strategies and Support

Dealing with a shingles outbreak can be challenging, both physically and emotionally. Implementing effective coping strategies and seeking support can help manage the condition and improve overall well-being.

Practical Tips for Daily Living

• Maintain a healthy lifestyle with a balanced diet and regular exercise
• Practice stress-reduction techniques such as meditation or deep breathing exercises
• Get adequate rest to support the immune system
• Avoid triggers that may exacerbate symptoms, such as extreme temperatures or tight clothing
• Stay connected with friends and family for emotional support

How can individuals with shingles manage work or daily responsibilities. It’s important to communicate with employers or family members about the condition and its impact. Some individuals may need to take time off work or adjust their schedules during the acute phase of the outbreak. Gradually resuming activities as symptoms improve can help maintain a sense of normalcy.

Emerging Treatments and Research in Shingles Management

The field of shingles treatment and prevention continues to evolve, with ongoing research exploring new therapeutic approaches and improving existing ones. Some areas of current interest include:

• Development of more effective antiviral medications
• Novel pain management techniques for acute and chronic shingles-related pain
• Immunomodulatory therapies to enhance the body’s response to the virus
• Improved vaccine formulations for broader protection and longer-lasting immunity

Are there any promising new treatments on the horizon for shingles. While specific treatments are still in various stages of research and development, scientists are exploring targeted antiviral therapies, immune system modulators, and advanced pain management techniques that may offer improved outcomes for shingles patients in the future.

Participating in Clinical Trials

Individuals interested in contributing to shingles research or accessing cutting-edge treatments may consider participating in clinical trials. These studies help advance our understanding of the condition and develop new therapies. Patients can inquire about ongoing trials through their healthcare providers or by visiting reputable clinical trial registries.

In conclusion, managing shingles effectively requires a comprehensive approach that includes prompt diagnosis, appropriate treatment, and ongoing care. By understanding the condition, following prescribed treatments, and implementing self-care strategies, individuals with shingles can minimize discomfort and reduce the risk of complications. As research continues to advance, we can look forward to improved prevention and treatment options for this challenging condition.

Shingles: Diagnosis and treatment

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Shingles Treatment, Medication, and Prevention: Pain Relief, Antiviral

Written by WebMD Editorial Contributors

• Antiviral Medications for Shingles
• Painkillers for Shingles
• Other Medications for Shingles
• Alternative Treatments for Shingles?
• Self-Care for Shingles
• Can I Prevent Shingles?
• Who Shouldn’t Get the Shingles Vaccine?
• More

The virus that causes chickenpox also causes shingles. It’s called varicella zoster. It can lie quietly in your nerves for decades after causing chickenpox but suddenly wake up and become active.

The main symptom of shingles is a painful rash that comes up on one side of your body or face. See your doctor as soon as you can if you think you might have this condition.

1 million people in the U.S. get shingles each year, according to the CDC. There is a shingles vaccine for prevention.

Your doctor may want to put you on medications to control your infection and speed up healing, cut inflammation, and ease your pain. They include:

These medicines may slow down the progress of the shingles rash, especially if you take them within the first 72 hours of having symptoms.

They can also lower your chance of having complications. Your doctor may prescribe:

• Acyclovir (Sitavig, Zovirax)
• Famciclovir (Famvir)
• Valacyclovir (Valtrex)

Talk with your doctor or pharmacist about side effects to watch for if you take one of these drugs.

Shingles causes inflammation and pain. Your doctor can suggest over-the-counter medicines to relieve milder discomfort. They include:

• Acetaminophen
• Ibuprofen
• Naproxen

These may also help you stave off postherpetic neuralgia, which is a burning pain that some people get after the rash and blisters of shingles go away.

If you have severe pain after the rash clears or an infection during your shingles outbreak, your doctor might prescribe:

Capsaicin cream: Be careful not to get it in your eyes.

A numbing medicine: You might get lidocaine (Lidoderm, Xylocaine) for pain. It can come in a variety of forms, such as creams, lotions, patches, powders, and sprays, among others.

Antibiotics: You might need these medicines if bacteria infect your skin and rash. But if bacteria aren’t involved, then antibiotics won’t help.

Tricyclic antidepressants: These medications might help ease the pain that lingers after your skin has healed, such as amitriptyline, desipramine (Norpramin), and nortriptyline (Pamelor). They may also help you with depression, if you have that in addition to shingles. Your doctor can tell you what the risks and benefits are.

Some studies show that various alternative treatments, from acupuncture to supplements, can offer relief. The research isn’t complete, but some show promise. Check with your doctor before you try any of these: 

TENS (transcutaneous electrical nerve stimulation). This therapy uses tiny electrical pulses to relieve pain. A TENS unit is about the size of a smartphone and comes with small patches called electrodes. You put them over the painful area and turn the unit on and off as your pain comes and goes. 

Traditional Chinese medicine. These treatments aim to restore balance in your body. They include acupuncture, the ancient practice of inserting very thin needles into your skin at specific points. Also, moxibustion and cupping, two types of heat therapy, are supposed to draw out toxins. These treatments may be done in combination.

Creams and other skin treatments. A mixture of liquid dimethyl sulfoxide (DMSO) and idoxuridine, an antiviral drug, may reduce swelling and the number of blisters you have when you put it on your rash. And chlorophyll, the chemical that gives plants their green color, is also used directly on the rash as a cream or saline solution. 

Supplements. You’ll find a long list of herbs, pills, and oils that claim to relieve shingles. Most have no research to back them up, but there are a couple of exceptions. Papain, a protein found in papayas, is sold in capsules. And manuka and clover honeys can be put directly on your skin. Very early studies on both show they might be helpful. 

There aren’t home remedies for shingles. But there are things you can do to help your skin heal.

Keep the affected area clean, dry, and exposed to air as much as possible.

The itching can be maddening at times, but try not to scratch or burst the blisters.

Soothe the rash. Your top priority is to find relief for the pain and itching that the rash causes. You might try:

1. Oatmeal baths. Dip into a cool tub of water. For extra relief, add colloidal oatmeal, which is made of oats that have been ground to a very fine powder. This soothing bath may help calm your itching.

2. Cold compresses. Run a washcloth under cool water and place it on your blisters for about 20 minutes at a time. Not only can this relieve itching, it also keeps your blisters clean. That can help you avoid a skin infection. If your blisters aren’t oozing anymore, stop using cold compresses. And if you are using any creams or patches on your rash, don’t use compresses at the same time.

3. Loose clothing. You’ll likely find that relaxed fits made from natural fibers, such as cotton or linen, give you more comfort. If you need to cover your blisters, avoid bandages that might stick to your rash.

4. Calamine lotion. Treat your skin with this smooth, cool, and soothing balm. 

Treat your body and mind. You can get worn down mentally when you’re in constant pain. Stress can make it seem even worse. Self-care starts with treating your rash, but don’t stop there. Your mind and emotional state need to be cared for as well.  

Stick with good habits: Your body is working hard to fight the varicella zoster virus that causes shingles. To give it the right support, you can:

• Eat nutritious food and have regular meals. Ask someone to make a run to the grocery store for fresh fruit and such if you’re not up for it.
• Try to get a good night’s sleep and rest anytime you need to.
• Do gentle exercises, such as walking or stretching. Light activity can help take your mind off the pain. Keep it simple though, and check with your doctor if you’re trying something new.

Distract yourself. Sometimes, the best thing you can do is to put your focus elsewhere. Here are a few things to try:

• Call a friend.
• Listen to music that relaxes you.
• Read a book.
• Watch a favorite movie.
• Work on hobbies you enjoy.

Keep calm. Relaxation can be a big help. With a calmer mind, you can better handle your discomfort. You may want to try:

• Meditation
• Tai chi
• Walking (but keep your blisters covered)
• Yoga

Experiment with these strategies as you get through your shingles outbreak. Different things can help depending on how severe your symptoms are and how you feel from day to day.

There are two shingles vaccines. Shingrix is the recommended vaccine. Zostavax is no longer avilable in the U.S.

Who should get it: The CDC recommends that you get this vaccine if you’re a healthy adult age 50 or older, whether or not you remember having had chickenpox, because most people have been exposed to the virus. If you have had the Zostavax vaccine, you can also get Shingrix.

How many shots do you need? You would need two shots for Shingrix: One at first, with a follow-up in 2 to 6 months.

What it does: Shingrix reduces your chance of getting shingles by more than 90%. Even if you still get shingles, the vaccine may help it be less painful.

I never had chickenpox. Do I still need the shingles vaccine? Yes, you do. Shingrix is recommended for everyone age 50 or older, whether or not you remember having had chickenpox.

If I’ve had shingles, can I still get the vaccine? Yes. It may help prevent another bout of shingles later on. If you have shingles right now, you should wait until the rash is gone before you get vaccinated.

What are the side effects? The most common side effects with Shingrix include pain and swelling where the needle went in you skin, muscle pain, tiredness, headache, chills, fever, and stomach troubles. With any vaccine, there is a chance of a severe allergic reaction. 

Don’t get the Shingrix vaccine if:

• You’re allergic to any of the ingredients.
• You’re pregnant or nursing.
• You have tested negative for immunity to the chickenpox virus. Ask your doctor about the chickenpox vaccine instead.
• You have shingles now.

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Shingles (Herpes zoster): causes, symptoms, diagnosis and treatment.

Herpes zoster is an infectious disease whose causative agent (herpesvirus type 3) also causes chicken pox.

Since the virus, penetrating into sensitive nerve endings, is integrated into the genetic apparatus of nerve cells, it is impossible to remove it from the body. In those who have had chickenpox, the virus goes into a latent (inactive) state.

When the immune system is weakened, the virus is activated, affecting the skin. The disease often develops in the elderly and in immunocompromised individuals.

Causes of disease

The virus is transmitted from a patient with chicken pox or herpes zoster by contact or airborne droplets. The person who becomes infected primarily (most often a child) gets chickenpox. Penetrating through the mucous membranes into the blood and lymph, the virus reaches the nerve cells, where it begins to multiply. After recovery, the virus remains in the body for life, often being in an inactive state. The awakening of the infection is associated with weakened immunity caused by hypothermia, long-term use of steroid hormones, immunosuppression (after transplantation), chemotherapy and radiation therapy, as well as a general decrease in immunity in patients with blood diseases, oncological and viral diseases. Shingles is very severe in HIV-infected patients.

Classification of herpes zoster

The clinical picture of herpes zoster consists of skin manifestations and neurological disorders. There are typical and atypical forms of the disease. With an atypical form, an erased course of the disease is possible, in which papules develop in the foci of hyperemia, which do not transform into vesicles.

In herpes zoster, the spread of the pathological process corresponds to a certain area of ​​the skin and does not cross the anatomical midline of the trunk. In most patients, the rash is preceded by a burning or itching sensation in a specific area of ​​the skin, as well as pain, which can be stabbing, throbbing, shooting, paroxysmal or constant. In a number of patients, the pain syndrome is accompanied by general systemic inflammatory manifestations: fever, malaise, myalgia, and headache.

Infection of the central nervous system and involvement of the meninges can produce meningeal, encephalic (symptoms suggest virus involvement of the brain and/or spinal cord and meninges), or mixed forms of herpes zoster. If the infection spreads along the optic nerve, ophthalmic herpes develops.

When a rash appears over the entire surface of the skin and on parenchymal organs (eg, liver, kidneys), a generalized form of herpes zoster develops. Another type of shingles is hemorrhagic. A characteristic feature is the bloody fluid inside the vesicles.

Symptoms of herpes zoster

The onset of the disease is accompanied by general intoxication, malaise and fever. Nausea and vomiting are possible. Lymph nodes are enlarged.

There are pronounced pains along the affected nerve, which can be permanent, but more often they are paroxysmal itchy in nature, intensifying at night.

As a rule, they are provoked by any irritants: touching the skin, cold, movement. Some patients complain of loss of sensation in certain areas of the skin, which may be combined with increased pain response. Sometimes the pain syndrome in the absence of skin rashes can resemble angina pectoris, myocardial infarction, renal colic, or pancreatitis. The period of neuralgia preceding the rash lasts up to 7 days. Then nodules appear on one side of the body, from which bubbles form with transparent contents, which gradually become cloudy. After 3-7 days, most of the bubbles dry up with the formation of yellow-brown crusts. When the bubbles are injured, bright red sores are exposed. After the sores heal, small scabs or scars remain on the skin.

Most often, rash and pain are noted in the region of the ribs, lower back and sacrum, less often along the branches of the trigeminal, facial and ear nerve and on the extremities.

In rare cases, the mucous membranes are affected.

Herpes zoster diagnostics

It is possible to make a diagnosis after examining and questioning the patient. The doctor pays attention to the nature of the rash (localized and unilateral), the type of vesicles and complaints of itchy burning pain. It is more difficult to identify the atypical form of herpes zoster. With an erased form, pain and other neurological symptoms may be absent. In case of neurogenic disorders before the appearance of rashes, the diagnosis can be made on the basis of the results of laboratory tests. In this case, a histological examination is used, and the virus is isolated in cell culture. The Zanck test helps to quickly confirm the herpetic nature of the rashes: giant multinucleated cells are found in the scraping of the material taken from the base of the vesicle. However, this test does not make it possible to determine the type of herpes. The methods of enzyme immunoassay and indirect immunofluorescent reaction are also used. Recently, the diagnosis of viral infections is carried out using the polymerase chain reaction (PCR).

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Synonyms: Blood test for antibodies to the chickenpox virus; Chicken pox; Human herpes virus type 3; HBV-3 type; varicellae-zoster virus; Herpes zoster.

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Which doctors to contact

Depending on the primary symptoms, patients with herpes zoster may see different specialists. However, first of all, you should go to
therapist for examination and referrals for tests. If limited, localized skin rashes appear and there are no pain symptoms, it is necessary to contact a dermatologist for differential diagnosis of erysipelas (caused by bacteria), eczema, etc. In case of severe pain syndrome, movement disorders, consultation is necessary
neurologist. In case of damage to the eyes, pain when moving the eyeballs, an ophthalmologist’s consultation is required. The generalized form of herpes often requires hospitalization and the combined efforts of an immunologist, a neurologist, and a dermatologist.

Herpes zoster treatment

With any localization of rashes, antiviral agents are first prescribed (the drug, the frequency of administration and dosage are determined by the attending physician!).

Their action is especially effective in the first 72 hours from the onset of clinical manifestations.

In the presence of a strong pain syndrome, the doctor may recommend anti-inflammatory therapy. However, contraindications must be taken into account (for example, chronic diseases such as arterial hypertension, diabetes mellitus, erosive lesions of the intestine, peptic ulcer of the stomach and duodenum). If analgesics don’t work, your doctor may prescribe central analgesics (often prescription drugs) and nerve blocks. External (topical) treatment is necessary to eliminate inflammation and prevent infection of the skin by other agents (eg, bacteria). With erosive forms of herpes zoster, creams and ointments with antibacterial action are applied to the affected areas.

Your doctor may also recommend treatments to improve immunity, such as taking vitamins (particularly B vitamins).

Complications

When the vesicles open, a secondary infection (bacterial infection of the skin) is possible, which is accompanied by fever and general intoxication.

Typical complications of herpes zoster include neuritis, paresis and paralysis of sensory and motor nerves.

Postherpetic neuralgia is difficult to treat.

The ocular form of herpes can lead to keratitis (inflammation of the cornea), less often to iritis (inflammation of the iris) or glaucoma (increased intraocular pressure). In addition, the development of optic neuritis is possible, sometimes with its subsequent atrophy and blindness. With the defeat of the branch of the oculomotor nerve, ptosis develops (drooping of the upper eyelid). Sometimes patients complain of hearing loss, damage to the vestibular apparatus, in severe cases – paralysis and paresis of the oral cavity. In addition, patients may report tinnitus or increased sensitivity to sounds. Damage to the lumbosacral nerve nodes sometimes leads to urinary retention, constipation or diarrhea. In patients with significantly weakened immunity (with HIV infection, oncological diseases), herpes zoster often occurs in a generalized form and is complicated by meningitis, encephalitis, or meningoencephalitis.

Shingles prevention

Since shingles is caused by the same pathogen as varicella, prevention of the disease will be based on the same measures as with chickenpox.

To prevent the spread of infection, isolation of the patient is necessary, which lasts up to 5 days from the moment the last element of the rash appears.

Persons who have been in contact with a patient with chickenpox are observed for 21 days. Active (vaccination) and passive (immunoglobulin administration) immunization are used as emergency prophylaxis. Vaccination is carried out for children older than 12 months and adults with no contraindications in the first 72-96 hours after probable contact with a person with chickenpox or shingles. Passive immunization with anti-varicella immunoglobulin is indicated for people with low immunity who have contraindications to vaccinations, pregnant women, children under 12 months of age and newborns whose mothers fell ill with chicken pox within 5 days before the birth of the child. The introduction of immunoglobulin is also carried out within 72-96 hours after contact with a patient with chicken pox or herpes zoster.

References

1. Herpes zoster: Clinical guidelines. Ministry of Health of the Russian Federation. 2016.
2. Decree of the Chief State Sanitary Doctor of the Russian Federation dated February 5, 2018 No. 12 on the approval of SP 3.1.3525-18 “Chickenpox and Shingles Prevention”. 2018.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

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main causes, symptoms, treatment

Dermatological diseases are distinguished by a specific clinical picture. However, it is not always possible to accurately verify the virus, based only on anamnestic and clinical data. Modern methods of diagnostics are offered for identification. For treatment, groups of effective and safe antiviral drugs are used.

Herpes zoster (herpes zoster) is a dermatological disease characterized by lesions of the skin and nervous system. It occurs more often in adults, older people with a weakened immune system. In severe cases and the absence of medical treatment, it can lead to transverse myelitis.

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Causes of

Herpes zoster is caused by the Varicella Zoster virus. It causes 2 diseases. With primary contact at a young age, chicken pox develops, which has a benign course. However, after recovery, it does not eliminate from the body, it remains in the regional nerve ganglia. You can find the herpes virus in the branch of the trigeminal nerve or near the spinal cord. Due to a decrease in immunity, it is reactivated.

Predisposing factors may be overheating or hypothermia. Quite often reactivation of the virus can be caused by traumatization of the corresponding dermatome.

Epidemiology

Pathology is rare in dermatological practice. The frequency averages about 5-10%. With a pronounced immunodeficiency state, re-infection is possible. Children who have not previously been ill develop a classic version of chickenpox with vesicles on the skin of the whole body upon contact.

Clinical manifestations

Herpes zoster has several clinical stages that follow each other. The first is incubation. The second is the period of prodromal phenomena, the third is the peak. The final one is the restoration of the body.

In clinical practice, there are several forms of herpes zoster in adults: mild, severe, and hemorrhagic. The first is also called abortive. It is characterized by a mild clinical picture, but the virus can be identified using laboratory tests. The abortive form does not lead to rashes on the skin, there is no pain.

The severe form of herpes zoster has a characteristic localization, while the lesion develops near the trigeminal nerve. Inflammation affects the skin of the forehead, eyelids and nose area. With involvement in the pathological process of the eye, conjunctivitis develops. A patient with a severe form of herpes zoster will complain of pain and burning, increased lacrimation. Eyelid edema develops. The pain is burning. In the hemorrhagic form, profuse rashes appear on the skin, the vesicles are filled with bloody contents.

The incubation period for herpes zoster in adults is on average about 12-14 days. The prodromal stage of herpes zoster is characterized by the appearance of the following symptoms:

• severe pain in the region of the spinal column and on the face;

• pain accompanied by burning;

• increase in body temperature;

• skin redness;

• headache;

• weakness;

• decrease in performance.

The immediate cause of the onset of pain during the period of prodromal phenomena is considered to be the multiplication of the virus in the nervous tissue.

During the height of herpes zoster, fuzzy pink spots first appear on the skin. Then, in their place, several grouped bubbles form. More often they are located near the intercostal nerves or on the face. Localized on one side.

Pain in herpes zoster is paroxysmal in nature. When pressed, it does not increase. The nature of the pain can be dull or pressing.

At first, the contents of the vesicles are serous, after a few days they become pink due to the accumulation of blood. After 2-3 weeks, the rashes gradually disappear, leaving no scars on the skin. A herpes infection can progress to a generalized form with severe symptoms or end in recovery with proper treatment.

Diagnostic criteria

In mild cases of herpes zoster, the diagnosis is made on clinical grounds. Typical symptoms of the disease:

• pain along the nerves near the spine;

• unilateral asymmetric rashes;

• pain does not tend to increase with pressure;

• rashes under the influence of therapy dry up and disappear.

Modern laboratory tests can confirm the diagnosis of herpes zoster. Among them are the following methods:

• virological;

• viroscopy;

• serological.

Molecular genetic studies can also be used to establish the diagnosis.

If there are complaints of pain, rashes along the nerves, it is recommended to perform viroscopy. This is one of the main methods for detecting and identifying viral agents using microscopy. The method of staining the prepared smears is according to Romanovsky-Giemsa.

Viroscopy evaluates the presence or absence of syncytium and intracellular inclusions. The first smears include Tzank’s acantholytic cells. They are widely investigated for suspected blistering dermatoses, which have characteristic external symptoms. Outwardly, the cells are rounded formations of large sizes. They contain large nuclei.

With herpes zoster, Lipshütz bodies are also found in smears-imprints. These are inclusions that are found inside the nucleus.

The virological method is not widely used. This is due to the fact that the study takes a long time. In virology, a biological fluid containing a virus is taken for analysis. It can be blood, swabs from the nasopharynx and other secrets of the body. With herpes zoster and other herpes infections, saliva is used as the main substrate.

Then they are cultivated on specially prepared tissues. The final step is the detection and identification of the virus using modern serological testing. To do this, use the reaction of immunofluorescence and other methods.

Cultivation on biological models is not always available, which is why the virological method is not widely used in clinics, hospitals and other medical institutions.

Serological methods of laboratory diagnostics are distinguished by high information content. However, they are rarely used to detect herpes zoster virus. In most cases, they are used for controversial issues for differential diagnosis.

Among the serological studies are the following:

• linked immunosorbent assay;

• complement fixation reaction;

• neutralization reaction.

These laboratory tests can detect viral antigen. If atypical symptoms appear in a patient, they are recommended. Patients are scheduled for examination after 1-2 weeks.

In the presence of pain and other characteristic symptoms of pathology, it is necessary to conduct a molecular genetic study. The polymerase chain reaction identifies the DNA of the shingles virus.

Basic treatments

Herpes zoster requires the appointment of a complex drug treatment. The following groups of drugs are used:

The main treatment is the use of antiviral agents. The duration of therapy depends on the form of pathology. However, on average, treatment is carried out for 7-10 days. Dosage forms may be presented as tablets for oral administration or ointments for external use. However, combined treatment of shingles is more often recommended. Tablet forms can be taken several times a day.

Antiviral agents can be used not only during treatment, but also to prevent relapses. Duration of administration and dosage is determined by a specialist. The concentration of the substance in pregnant women and nursing mothers is different.

The next group is painkillers. The attending physician prescribes them in order to relieve pain in the region of the intercostal and facial nerves. Preference is given to non-narcotic analgesics, which rarely cause side effects from the nervous system.

Herpes zoster treatment also includes the use of synthetic dyes. A classic example is a solution of brilliant green and potassium permanganate. They are applied locally to vesicles to prevent infection. Otherwise, bacterial complications may join.

Corticosteroids have an anti-inflammatory effect. In addition, they also reduce the severity of itchy skin. Preference in treatment is given to local ointments.

Surgical methods of therapy are not currently used. Ultraviolet irradiation and other physiotherapeutic procedures are prescribed during the recovery period.

Indications for treatment

It is recommended to carry out even with a mild pathology. Antiviral, painkillers and other drugs for treatment can not only stop the symptoms, but also alleviate the patient’s condition.

Contraindications to treatment

In what cases should you refuse to take medications. The first is the development of an acute allergic reaction. This should be reported to the doctor who is involved in the treatment in order to select the optimal remedy. The second is pregnancy and lactation. In this case, consultation of related specialists is required to determine the correct dosage and select a safe drug. In other cases, interrupting therapy is not recommended.

Possible side effects of therapy

When taking antiviral drugs, patients may complain of a rash, severe itching, or other allergic reactions. When using synthetic dyes, local irritation on the skin may occur.

Among the side effects that occur when taking non-narcotic analgesics, there are:

• dyspeptic disorders;

• dizziness;

• allergic reactions;

• dry eyes and others.

When taking topical corticosteroids, the development of erythema on the skin is possible.

Possible complications

To prevent the development of complications from the nervous and other systems of the body, therapy should be started in a timely manner. However, in some cases, even properly selected therapy does not exclude the development of postherpetic changes.

Most often, complications affect the nervous tissue.