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What is shingles?

Shingles (herpes zoster) is an infection that causes a painful rash. It is caused by the varicella-zoster virus (VZV). This is the same virus that causes chickenpox. After you have chickenpox, the virus stays in your body. It may not cause problems for many years. But as you get older, the virus may become active again and cause shingles.

Is shingles contagious?

Shingles is not contagious. You cannot get shingles from someone else. But you can catch chickenpox from someone with shingles if you have direct contact with fluid from their shingles rash.

The risk of spreading the virus is low if the shingles rash is kept covered. People with shingles cannot spread the virus before their rash blisters appear or after the rash crusts.

Who is at risk for shingles?

Anyone who has had chickenpox can get shingles. But the risk of shingles goes up as you get older. Shingles is most common in people over age 50.

People with weakened immune systems are at higher risk of getting shingles. This includes those who:

• Have immune system diseases such as HIV
• Have certain cancers
• Take medicines that weaken their immune system, such as steroids and medicines you take after organ transplant

Your immune system may be weaker when you have an infection or are stressed. This can raise your risk of shingles.

It is rare, but possible, to get shingles more than once.

What are the symptoms of shingles?

Early signs of shingles include burning or shooting pain and tingling or itching. It is usually on one side of the body or face. The pain can be mild to severe.

Up to several days later, you will get a rash. It consists of blisters that typically scab over in 7 to 10 days. The rash is usually a single stripe around either the left or the right side of the body. In other cases, the rash is only on one side of the face. In rare cases (usually among people with weakened immune systems), the rash may be more widespread. It might look similar to a chickenpox rash.

Some people may also have other symptoms:

• Fever
• Headache
• Chills
• Upset stomach

What other problems can shingles cause?

Shingles can cause other problems (complications):

• Postherpetic neuralgia (PHN) is most common complication of shingles. It causes severe pain in the areas where you had the shingles rash. It usually gets better in a few weeks or months. But some people can have pain from PHN for many years, and it can interfere with daily life.
• Vision loss can happen if shingles affects your eye. It may be temporary or permanent.
• Hearing or balance problems are possible if you have shingles within or near your ear. You may also have weakness of the muscles on that side of your face. These problems can be temporary or permanent.

Very rarely, shingles can also lead to pneumonia, brain inflammation (encephalitis), or death.

How is shingles diagnosed?

Usually your health care provider can diagnose shingles by taking your medical history and looking at your rash. In some cases, your provider may scrap off tissue from the rash or swab some fluid from the blisters and send the sample to a lab for testing.

What are the treatments for shingles?

There is no cure for shingles. Antiviral medicines may help to make the attack shorter and less severe. They may also help prevent PHN. The medicines are most effective if you can take them within 3 days after the rash appears. So if you think you might have shingles, contact your provider as soon as possible.

Pain relievers may also help with the pain. A cool washcloth, calamine lotion, and oatmeal baths may help relieve some of the itching.

Can shingles be prevented?

There is a vaccine, called Shingrix, to help prevent shingles and its complications. The Centers for Disease Control and Prevention recommends that healthy adults 50 years and older get the vaccine. Your provider might also recommend the vaccine if you are over 19 and have a weakened immune system. The vaccine is given in two doses.

If you have shingles, you can help prevent spreading the virus to others by:

• Staying away from:
  • People with weakened immune systems
  • People who have not had chickenpox or the chickenpox vaccine, especially if they are pregnant
  • Premature or low birth weight babies
• Keeping the rash covered
• Not touching or scratching the rash
• Washing your hands often

Centers for Disease Control and Prevention

• Shingles

  (National Institute on Aging)

  Also in Spanish

• Shingles (Herpes Zoster)

  (Centers for Disease Control and Prevention)

• Shingles Transmission

  (Centers for Disease Control and Prevention)

  Also in Spanish

• What Everyone Should Know about Shingles Vaccine (Shingrix)

  (Centers for Disease Control and Prevention)

• Herpes Zoster Oticus

  (National Institute of Neurological Disorders and Stroke)

• Postherpetic Neuralgia

  (Mayo Foundation for Medical Education and Research)

  Also in Spanish

• Ramsay Hunt Syndrome

  (Mayo Foundation for Medical Education and Research)

• Photos of Shingles

  (Centers for Disease Control and Prevention)

• Shingles (Zoster)

  (VisualDX)

• Shingles: Signs and Symptoms

  (American Academy of Dermatology)

• ClinicalTrials. gov: Herpes Zoster

  (National Institutes of Health)

• ClinicalTrials.gov: Neuralgia, Postherpetic

  (National Institutes of Health)

• Article: Causal association between inflammatory bowel disease and herpes virus infections: a. ..

• Article: Prevention of Shingles in Dermatology Patients on Systemic Medications.

• Article: The incidence of herpes zoster in China: A meta-analysis and evidence. ..

• Shingles — see more articles

• Find a Dermatologist

  (American Academy of Dermatology)

• National Institute of Allergy and Infectious Diseases

• National Institute of Neurological Disorders and Stroke

  Also in Spanish

• Shingles (For Parents)

  (Nemours Foundation)

  Also in Spanish

• Get the Shingrix Vaccine if You Are 50 or Older

  (Centers for Disease Control and Prevention)

Shingles: MedlinePlus Medical Encyclopedia

Shingles is a painful, blistering skin rash. It is caused by the varicella-zoster virus, a member of the herpes family of viruses. This is the virus that also causes chickenpox.

After you get chickenpox, your body does not get rid of the virus. Instead, the virus remains in the body but is inactive (becomes dormant) in certain nerves in the body. Shingles occurs after the virus becomes active again in these nerves after many years. Many people had such a mild case of chickenpox that they do not realize they have had the infection.

The reason the virus suddenly becomes active again is not clear. Often only one attack occurs.

Shingles can develop in any age group. You are more likely to develop the condition if:

• You are older than age 60
• You had chickenpox before age 1
• Your immune system is weakened by medicines or disease

If an adult or child has direct contact with the shingles rash and did not have chickenpox as a child or get the chickenpox vaccine, they can develop chickenpox, not shingles.

The first symptom is usually pain, tingling, or burning that occurs on one side of the body. The pain and burning may be severe and are usually present before any rash appears.

Red patches on the skin, followed by small blisters, form in most people:

• The blisters break, forming small sores that begin to dry and form crusts. The crusts fall off in 2 to 3 weeks. Scarring is rare.
• The rash usually involves a narrow area from the spine around to the front of the abdomen or chest.
• The rash may instead involve the face, eyes, mouth, and ears.

Other symptoms may include:

• Fever and chills
• General ill feeling
• Headache
• Joint pain
• Swollen glands (lymph nodes)

You may also have pain, muscle weakness, and a rash involving different parts of your face if shingles affects a nerve in your face. The symptoms may include:

• Difficulty moving some of the muscles in the face
• Drooping eyelid (ptosis)
• Hearing loss
• Loss of eye motion
• Taste problems
• Vision problems

Your health care provider can make the diagnosis by looking at your skin and asking about your medical history.

Tests are rarely needed, but may include taking a skin sample to see if the skin is infected with the virus.

Blood tests may show an increase in white blood cells and antibodies to the chickenpox virus. But the tests cannot confirm that the rash is due to shingles.

Your provider may prescribe a medicine that fights the virus, called an antiviral drug. This drug helps reduce pain, prevent complications, and shorten the course of the disease.

The medicines are most effective when started within 72 hours of when you first feel pain or burning. It is best to start taking them before the blisters appear. The medicines are usually given in pill form. Some people may need to receive the medicine through a vein (by IV).

Strong anti-inflammatory medicines called corticosteroids, such as prednisone, may be used to reduce swelling and pain. These medicines do not work in all people.

Other medicines may include:

• Antihistamines to reduce itching (taken by mouth or applied to the skin)

• Pain medicines

• Zostrix, a cream containing capsaicin (an extract of pepper) to reduce pain

Follow your provider’s instructions about how to care for yourself at home.

Other measures may include:

• Caring for your skin by applying cool, wet compresses to reduce pain, and taking soothing baths
• Resting in bed until the fever goes down

Stay away from people while your sores are oozing to avoid infecting those who have never had chickenpox — especially pregnant women.

Herpes zoster usually clears in 2 to 3 weeks and rarely returns. If the virus affects the nerves that control movement (the motor nerves), you may have temporary or permanent weakness or paralysis.

Sometimes the pain in the area where the shingles occurred may last from months to years. This pain is called postherpetic neuralgia.

It occurs when the nerves have been damaged after an outbreak of shingles. Pain ranges from mild to very severe. Postherpetic neuralgia is more likely to occur in people age 60 or over.

Complications may include:

• Another attack of shingles
• Bacterial skin infections
• Blindness (if shingles occurs in the eye)
• Deafness
• Infection, including encephalitis or sepsis (blood infection) in people with a weakened immune system
• Ramsay Hunt syndrome if shingles affects the nerves of the face or ear

Contact your provider if you have symptoms of shingles, particularly if you have a weakened immune system or if your symptoms persist or worsen. Shingles that affects the eye may lead to permanent blindness if you do not receive emergency medical care.

Do not touch the rash and blisters on people with shingles or chickenpox if you have never had chickenpox or the chickenpox vaccine.

The shingles vaccine is different than the chickenpox vaccine. Older adults who receive the shingles vaccine are much less likely to have complications from the condition.

Herpes zoster – shingles

• Herpes zoster (shingles) on the back
• Adult dermatome
• Shingles
• Herpes zoster (shingles) – close-up of lesion
• Herpes zoster (shingles) on the neck and cheek
• Herpes zoster (shingles) on the hand
• Herpes zoster (shingles) disseminated

Dinulos JGH. Warts, herpes simplex, and other viral infections. In: Dinulos JGH, ed. Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 12.

Whitley RJ. Chickenpox and herpes zoster (varicella-zoster virus). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 136.

Updated by: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Shingles (herpes) – causes, symptoms, diagnosis, treatment of lichen in Moscow

• Signs of herpes zoster
• Lichen forms
• Causes
• Incipient disease
• Eruption period
• Crust
• Diagnosis of herpes zoster
• How to treat infection?
• What are antivirals used for?
• Possible consequences of herpes
• Is shingles contagious?
• When lichen is transmitted
• Disease prevention
• Which doctor to contact with herpes zoster

Shingles , also known as herpes zoster or herpes zoster, is a viral disease that occurs as a result of reactivation of the herpes simplex virus type 3. It is characterized by inflammation of the skin, on which a large number of vesicles appear, as well as inflammation of the nervous tissue surrounding the posterior roots of the spinal cord and ganglia of peripheral nerves. This condition usually occurs in a specific area of ​​the skin known as the “dermatome” and has vivid and painful symptoms.

Most often, the disease is detected in the elderly. Unfavorable ecology contributes to the development of infection in young people with weak immunity. Shingles often develops against the background of oncological processes, especially in people with weakened immune systems (after chemotherapy, for example).

Signs of herpes zoster

The onset of the disease is quite pronounced – there is a burning sensation and soreness of a certain area of ​​\u200b\u200bthe skin. Often these areas coincide with the location of the trigeminal facial nerve, affect the forehead, back of the head, neck, and can be located in accordance with the course of the nerves.

Lichen forms

The disease can be typical and atypical.

With an atypical form, the symptoms may be mild:

• In the abortive form, rashes are absent or there is a single focus;
• Bullous form – multiple vesicles with a clear liquid;
• Hemorrhagic form – vesicles with bloody fluid, in place of which scars remain.
• The gangrenous form leaves hard-to-heal ulcers and rough scars.

Causes

Infections that are present in the body in a dormant state are activated. The following factors provoke the development of the process:

• Immunosuppressive drugs;
• Heavy workload, stress;
• Cancer processes;
• Radiation therapy;
• HIV;
• Organ transplant.

Repeated episodes require special attention, as rashes are often localized at the site of the tumor. The development of shingles goes through certain stages.

Early disease

From the incubation to the active period takes about four days. At this time there is:

• Malaise, weakness. chills;
• Pain;
• Temperature increase;
• Burning and itching;
• Enlarged lymph nodes;
• Possible disorders of the organs and systems of the body.

Subsequently, the disturbances subside.

Eruption period

The type of rash depends on the severity of the disease. At the initial stage, the rash looks like small pink spots located on healthy skin.

If the process develops typically, then the next day they are replaced by bubbles with a clear liquid – grouped vesicles. After 3 days, their contents become cloudy. Rashes occur in jerks, with interruptions of several days.

If a severe gangrenous form develops, then the filling of the vesicles may be mixed with blood. It seems that the bubbles move to another place, located around the body.

If the form of inflammation is mild, the manifestation of the disease can only be neurological in nature, when the patient feels pain, but there is no rash. This is herpetic neuralgia.

Crust

As a rule, after 2-3 weeks from the onset of rashes, crusts form. The areas of rashes turn pale and dry up. In place of the fallen crusts, a slight pigmentation remains.

Herpes zoster diagnosis

With a pronounced manifestation of skin forms of the disease, it is not difficult to make a diagnosis. Errors occur at the initial stage, when angina pectoris, pulmonary infarction, pleurisy, acute appendicitis are mistakenly diagnosed.

Laboratory confirm the diagnosis using a microscope or immunofluorescent method. In general practice, laboratory diagnostics is not used.

How to treat an infection?

If young people who do not have chronic diseases are sick, then treatment is not carried out. The disease will completely disappear within a month. To eliminate the pain of herpes, the doctor may prescribe painkillers. With intense pain, painkillers are used along with antiviral drugs. It is possible to use non-steroidal drugs. Assign antiherpetic drugs in tablets, creams, ointments or intramuscular injections.

What are antivirals used for?

The goal is to avoid the development of complications. Antiherpetic treatment helps the rapid healing of ulcers and improves the patient’s condition.

The course of treatment and dosage of drugs is determined by the doctor, taking into account the general condition of the patient. On average, the treatment time does not exceed 10 days.

If a gangrenous form develops with a bacterial infection, antibiotics, immunomodulators, physiotherapy and vitamins are prescribed.

As for the treatment of rashes, there are different opinions about the use of drying agents. In any case, they should be used with caution so as not to worsen the condition of the skin with a burn.

Do not use hormonal drugs, as they suppress the immune system.

Treatment of the disease in elderly patients is not always successful, since antiviral drugs do not justify themselves.

Possible consequences of herpes

• Paralysis of the facial or other nerves.
• Reduced vision.
• Violations of the internal organs.
• Disabling meningoencephalitis.
• For bacterial infections, treatment is delayed for months.

Is shingles contagious?

Most often, cases of the development of the disease are recorded in the off-season. If a person has previously had chickenpox and has good immunity, then the likelihood of contracting infection through contact with a patient is minimal.

If immunity to the herpes virus is weakened or not formed, then there is a chance of getting sick upon contact, including again.

When lichen is transmitted

• A sick person can infect those who have not had chickenpox – adults and children.
• In the presence of strong immunity and good health, the probability of getting infected is zero.
• Most often children get sick.
• Almost anyone can get shingles if their defenses are weakened.
• Viral during the formation of fresh blisters. During the formation of crusts, there is no danger of infection.

Disease prevention

It is necessary to isolate the sick, avoid contact with the sick (applies to those who have not had chickenpox), observe hygiene rules, and take measures to strengthen immunity.

Which doctor to contact with herpes zoster

You should first contact a therapist, then an infectious disease specialist or a dermatologist. If the form of herpes is severe, the help of a neurologist is needed, if the eyes are affected, an ophthalmologist.

We recommend making an appointment at the neurological department of the clinic of the Russian Academy of Sciences (Moscow). You will be examined by the best doctors, they will study the signs of the disease, determine the causative agent of the infection, make a diagnosis, consult, give clinical recommendations and prescribe an effective treatment.

Don’t put off going to a specialist! Specialists of the Neurological Department of the NCC No. 2 (CCH RAS) in Moscow remind you that any symptoms that disturb you are a reason for consulting a neurologist. In this case, the doctor will be able to recognize and stop the disease at an early stage, until the situation worsens and becomes irreversible. You can make an appointment with a neurologist by calling the clinic, as well as using the form on the website.

Herpes zoster – causes, symptoms, treatment in adults

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Effective treatment of herpes zoster and postherpetic neuralgic pains in Hadassah Medical Clinic. All analyzes and consultations in one place for the convenience of patients. The selection of an individual treatment plan and a multidisciplinary approach make it possible to successfully cure the infection even in immunocompromised patients.

Shingles (herpes zoster) is a viral infection that affects the skin and nervous system. It is caused by the causative agent Varicella zoster (VZV) – type 3 herpesvirus. The disease is manifested by blisters along the nerves and burning pains that bother a person for several months. Herpes zoster is dangerous not only with subjective symptoms, but also with complications from the brain and sensory organs.

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Daria Grigoryevna

Allergist-immunologist, Ph.D.

Work experience: 14 years

Cost of admission: from 9000 ₽

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Benefits of treatment at the Hadassah Clinic

Rapid diagnostics

Analyzes are carried out in our own laboratory, which is equipped with modern equipment and test systems for all types of research.

Multidisciplinary approach

Herpes zoster will be treated by neurologists, infectious disease specialists, immunologists and other specialists, if the patient’s health condition requires it.

Personalized therapy program

Our doctors follow the principle of “treat the patient, not the disease”, therefore, they are attentive to each situation and take into account the characteristics of a particular person when choosing a therapeutic program.

Evidence-based medicine

In our work, we use only generally recognized clinical protocols, international recommendations, and the results of randomized trials.

Original medicines

The clinic cooperates with leading pharmaceutical companies, which makes it possible to purchase certified and high-quality medicines.

Rehabilitation

We pay great attention to restoring the patient’s full life, eliminating residual pain and other symptoms that interfere with normal activities.

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Symptoms of herpes Zoster

Up to 80% of cases of the disease begin with a prodromal period. Patients experience moderate pain, itching and tingling in the area of ​​one dermatome – where a rash appears after 3-4 days. It is also characterized by fever, malaise, headaches.

Rashes have characteristic features:

• initially pink spots 3-5 cm in diameter with indistinct edges appear;
• a day later, small blisters form in their place, similar to a rash with chickenpox;
• vesicles are usually located on the chest or abdomen, which corresponds to the course of one of the sensory nerves;
• the appearance of signs of herpes on the back, neck, limbs is typical for a generalized form of the disease and is mainly associated with immunodeficiencies;
• rashes gradually shrink into crusts that fall off after a few weeks, leaving behind unstable pigmentation on the skin.

The acute period is always accompanied by intense burning pains in the area of ​​the affected nerve. Pain is aggravated by touch. They can be permanent or paroxysmal in nature, some patients describe the symptoms as “electric shock”.

You can see a photo of what shingles looks like, but do not use the information as a way for self-diagnosis and self-treatment. This is a dangerous disease that should be treated under the supervision of an infectious disease specialist and a neurologist.

Causes

Most people come into contact with the pathogen in childhood, when they fall ill with classic chickenpox or endure it in an erased form. After the initial infection, the virus does not disappear from the body anywhere. It remains in the nerve ganglia and can remain there in a latent state for decades. Under adverse conditions, it again manifests itself, causing shingles.

VZV reactivation occurs when the body’s immune defenses decrease due to the following factors:

• hypothermia or overheating;
• chronic stress;
• excess ultraviolet exposure;
• unbalanced diet, beriberi;
• acute respiratory diseases;
• injuries, surgical operations;
• acute and chronic diseases of internal organs;
• secondary immunodeficiency states;
• receiving immunosuppressive, antibacterial therapy.

One of the most important predisposing factors is HIV infection. When the level of CD4-lymphocytes falls below 500 cells per μl, the body’s resistance to latent infection is sharply reduced, and symptoms of herpes zoster appear.

Diagnostics

Diagnosis of herpes zoster is usually based on pathognomonic lesions and pain. Herpes simplex virus (HSV) can cause nearly identical lesions, but unlike herpes zoster, HSV tends to recur and is not dermatomal (associated with a specific nerve). Before treating herpes zoster, the doctor must be completely sure of the diagnosis, so clarifying examinations are prescribed:

PCR test

to identify the genetic material of the pathogen;

ELISA

for detection of antibodies to herpesvirus;

Clinical blood test

in which the specialist is interested in the level of leukocytes and the ratio of different fractions of white blood cells;

Microscopy of impression smears from affected areas of the skin

to detect multinucleated giant cells.

It is important to clarify what led to the manifestation of the disease. If there are no obvious causes, it is worth looking for a disease that initially does not cause independent symptoms, but reduces immunity (cancer or infection with the human immunodeficiency virus). Exclusion of HIV infection is necessary in all patients under 50 years of age.

Shingles Treatment at Hadassah Clinic

Therapy is carried out in two directions: etiotropic medicines to fight a viral infection and painkillers to alleviate a person’s condition. The best clinical results can be achieved with the start of pharmacotherapy in the first 72 hours from the appearance of rashes. The main drugs for the treatment of herpes zoster in adults are representatives of the acyclovir group, which are used according to an individual scheme.

All patients are prescribed analgesics in tablets and injections; local anesthetics are also used for postherpetic pain. With intense pain syndrome, the treatment of herpes Zoster is supplemented with centrally acting medicines: antidepressants, tranquilizers, anticonvulsants. According to indications, methods of physiotherapy are used.

Blisters on the skin contain a large number of viral particles that pose an epidemiological hazard to others. Herpes zoster itself is not transmitted because it is associated with the reactivation of an existing infection, but the patient can become a source of chickenpox for children and previously healthy adults. Since a person with skin manifestations of shingles is contagious to others, it is recommended to limit close contact with family members and others who have not yet encountered chickenpox.

Why the disease is dangerous

One of the main problems is post-herpetic neuralgia, which can occur even with the right drugs for the treatment of herpes zoster in adults. The frequency of complications increases in direct proportion to age – more than 50% of patients over 60 suffer from this disease. Pain phenomena at the site of the rash persist for several months, in 10-15% of cases the symptoms last for six months.

Other negative effects of the infection are much less common, but are a serious health hazard. These include:

• transverse myelitis – inflammation of the segments of the spinal cord located close to the affected dermatome;
• meningitis, encephalitis – inflammation of the membranes and substance of the brain;
• ophthalmic herpes – damage to the eyeball, which is fraught with decreased vision and the development of glaucoma;
• pyoderma – suppuration of rash areas due to the addition of a secondary bacterial infection.

Such manifestations are more common in elderly patients, people with weakened immune systems, patients who have recently undergone serious illness or surgery.

To reduce the risk of dangerous complications from the nervous system, it is necessary to consult a doctor in a timely manner, who knows how to treat herpes zoster according to modern protocols from the standpoint of evidence-based medicine.

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Disease prevention

In people who have recovered from chickenpox, preventive measures are aimed at preventing VZV reactivation in regional nerve structures. For this purpose, it is recommended to strengthen the immune system and health-improving procedures, which include:

• balanced and fortified nutrition;
• prolonged sleep;
• avoidance of mental and physical overwork;
• timely treatment of somatic diseases, metabolic disorders;
• practicing safe sex to prevent HIV infection.

The only way to specifically protect against the Varicella Zoster virus is timely vaccination before the person has come into contact with the virus. Children are usually vaccinated to protect them from infection. However, immunization according to strict indications is also carried out for the elderly and debilitated people who are at high risk of developing symptoms of herpes zoster. Vaccination helps build immunity against infection and prevent it from reactivating.

For effective and evidence-based treatment of herpes zoster in adults, contact the Hadassah clinic in Moscow. Our doctors will conduct a comprehensive diagnosis and select a personal treatment plan. Specialists also treat postherpetic neuralgia and other complications, helping the patient return to a full life after illness.

Text verified by an expert doctor

Zhukova
Daria Grigorievna

Allergist-immunologist, Ph.D.

Work experience: 14 years

Published: June 27, 2022

Updated: June 27, 2022

Internal consultation of the expert is necessary.

SOURCES

• Herpes zoster. Clinical recommendations of the All-Russian public organization “Russian Society of Dermatovenerologists and Cosmetologists”. – 2020.
• Isakov DV, Isakov VA Herpes simplex and herpes zoster (clinic, treatment and prevention). – 2021.
• Cairo A. N., Lavrov V. F. Herpes zoster: epidemiological features of incidence in 2019 // Epidemiology and vaccine prevention. – 2020. – T. 19. – No. 5. – S. 93-97.
• Ryumin AM et al. Neurological manifestations of herpes zoster virus reactivation // Journal of Infectology. – 2022. – T. 14. – No. 1. – S. 31-42.
• Ignatovsky AV Herpes zoster – modern approaches to diagnosis and treatment //Doctor/Vrach. – 2022. – T. 33. – No. 10.
• Avdeeva M.G., Alikeeva G.K., Antonova M.V. etc. Infectious diseases. National leadership. Ed. N.D. Yushchuk, Yu.Ya. Vengerov. M.; GOETAR; 2018.
• Polyakova D.M., Nikiforov V.V., Shakhmardanov M.Z. Immunity and vaccination in adults with infection caused by the Varicella zoster virus. Epidemiology and infectious diseases. 2019; 24(2): 84-7.
• Dooling K.L., Guo A., Patel M., Lee G.M., et al. Recommendations of the advisory committee on immunization practices for use of herpes zoster vaccines // Centers for disease control and prevention.