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Don’t shrug off shingles – Harvard Health Blog
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If you had chickenpox as a kid, there is a good chance you may develop shingles later in life. “In fact, one in three is predicted to get shingles during their lifetime,” says Dr. Anne Louise Oaklander, director of the Nerve Unit at Harvard-affiliated Massachusetts General Hospital.
The same varicella-zoster virus that causes chickenpox also causes shingles. After the telltale spots of chickenpox vanish, the virus lies dormant in your nerve cells near the spinal cord and brain. When your immunity weakens from normal aging or from illnesses or medications, the virus can re-emerge. It then travels along a nerve to trigger a rash in the skin connected to that nerve. The rash often appears on only one side of your body. The most common locations are the chest, back, or stomach, or above one eye.
Most cases of shingles cause severe pain and itching, and can leave scars. Fluid-filled blisters develop, break, and crust over during and a few weeks after an outbreak. You also may feel sick or fatigued, with a slight fever or headache. However, it is possible to have rashes that are so mild they’re not even noticed.
Seek treatment right away
Many people have the mistaken impression that, like poison ivy, shingles is a nuisance rash that fades on its own. “But in fact a shingles rash should alert people, especially in middle or old age, to seek immediate medical help,” says Dr. Oaklander.
Rapid treatment with one of three antiviral drugs, acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir), can shorten a shingles attack and reduce the risk of serious damage, such as:
- Long-term pain. Pain that lingers in the area of a healed shingles rash is called postherpetic neuralgia. This often-disabling pain can last several months to a year.
- Prolonged itching. Many people are left with an itchy area from their shingles, which can be as disabling as chronic pain. It is most common on the head or neck.
- Damage to vision and hearing. Pain and rash near an eye can cause permanent eye damage and requires an urgent ophthalmological exam. When the nerve to the ear is affected, it can permanently damage hearing or balance.
- Strokes and heart attacks. A PLOS Medicine study that tracked about 67,000 people ages 65 and older who were newly diagnosed with shingles found that stroke risk more than doubled in the first week after the shingles diagnosis. The same study reported an increased risk for heart attacks in the three months after shingles, but the additional risk dissipated after six months.
Prevent shingles with vaccination
The Centers for Disease Control and Prevention recommends that almost all people ages 60 and older be vaccinated against shingles, whether or not they had chicken pox in their youth or have had shingles before, says Dr. Oaklander.
The vaccination that prevents chickenpox in children was used to develop a similar vaccine (Zostavax) that protects against shingles. “It reduces the risk of getting shingles by about half, and shingles rashes that still develop are slightly less likely to cause postherpetic pain, or other serious complications,” says Dr. Oaklander.
People with especially weak immune systems, such as those with cancer or anyone undergoing immunosuppressive treatments, should avoid Zostavax since the vaccine contains a weakened form of the live virus. Because Zostavax has only been available since 2006, it is still not yet clear if a single vaccination offers lifelong protection, but at this time, no booster is recommended.
A new shingles vaccine called HZ/su also may be helpful for older adults. A study published in The New England Journal of Medicine found that the vaccine was 97.2% effective among those ages 50 and older, and 97.9% effective for those ages 70 and older. And since HZ/su is not made from a live, weakened virus, it is safe to give to people with weak immune systems. This vaccine still needs to undergo further testing before it can be submitted for FDA approval, which may happen as early as this year.
Tips to Treat Shingles Scalp pain and itchy rash
Shingles can form a blistering, itchy, painful rash anywhere on the body, but can be particularly excruciating and challenging if it spreads to the scalp. Shingles blisters can leave you with a sensitive scalp and make grooming very difficult. What’s worse, the infection can result in bald patches if you aren’t careful about how you treat the rash.
Shingles are caused by the reactivation of the virus that causes chickenpox, the varicella zoster virus. After you recover from chickenpox, the virus can travel down into the nerve tissues of the body and lay there dormant for decades. Shingles occurs when the virus reawakens and travels back up the nerve pathways and out to the skin. Anyone who has had chickenpox is at risk for contracting shingles later in life.
Shingles and a Sensitive Scalp
The itching and pain of shingles can leave your scalp incredibly sensitive to even the slightest pressure. That can make running a brush or comb through your hair a terrible ordeal, with the bristles scraping the rash and potentially causing the blisters to burst. At other times, the urge to scratch your itchy scalp may seem irresistible.
However, you must avoid both scratching and combing too hard. The viral infection that causes shingles can result in hair loss through a condition known as cicatricial alopecia or scarring alopecia. Scarring caused by the shingles rash destroys stem cells in hair follicles that create new hair growth. The destruction of these cells prevents hair regeneration, resulting in permanent hair loss. Scratching or scraping at the rash can increase your chances of scarring alopecia.
Note that shingles only affects one side of the body. That means a scalp rash will also be limited to one side of your head.
Scalp Treatment for Shingles
There are some specific scalp treatments and hair care techniques you can use to relieve the pain and itching of a sensitive scalp and help head off permanent damage:
- Apply cool water and cold compresses to the part of your scalp affected by the shingles rash.
- Pat calamine or menthol lotion on your head as a soothing scalp treatment.
- Avoid using harsh soaps or scented shampoos when washing your hair. Try to find a gentle, unscented hair cleanser.
- When washing your hair, use lukewarm or warm water — never hot.
- Avoid scrubbing when washing your hair. Use gentle motions with your fingertips, never the nails.
- Pat your hair dry with a towel after washing, rather than rubbing it dry.
- Comb your hair carefully, trying to scrape your rash as little as possible.
- Do not use any hair care products on a sensitive scalp rash. Avoid hair spray, pomade, mousse, and other products.
- Discuss with your doctor or dermatologist any prescription emollients or creams that might help soothe your shingles rash or decrease itching to prevent scratching.
More general treatments to address your shingles scalp infection and symptoms include:
- Antiviral medications that attack the shingles virus
- Tricyclic antidepressants, which have been shown to interrupt pain signals
- Topical lidocaine patches, which can relieve itching and pain when applied directly to the rash
- Nerve blocks, which are topical anesthetics injected directly into the rash
- Over-the-counter pain relievers such as aspirin or NSAIDs
There are a number of ways to deal with shingles that affects your scalp. By using shingles scalp treatments carefully, you may avoid permanent scarring and hair loss.
Identify signs of shingles | Ada
What is shingles?
Shingles is an infection that usually produces a painful skin rash, but the painful tingling sensations which characterize the condition can also occur when no rash is present. Shingles is caused by the varicella zoster virus (VZV).
VZV is the same virus that causes chickenpox, a very common childhood infection. After a person has had chickenpox, VZV remains dormant in their body for the rest of their lifetime. If the virus reactivates, which can happen decades later, most often due to a weakened immune system, the resulting condition is called shingles. Although anybody who has already had chickenpox can develop shingles, the condition most commonly affects adults, typically those over 60 years of age.
The early signs of shingles are typically sensations of itching, numbness or a burning pain on the skin of the face, chest or back; in most cases this develops into the condition’s characteristic rash.
The rash develops into blisters on one side of the body, most commonly in one the following areas:
A shingles outbreak typically lasts for three to four weeks. Many people experience only one outbreak of shingles in their lifetime, although the condition can recur.
Good to know: Shingles is also known as herpes zoster, but it is important to note that this condition is not caused by the same virus, called herpes simplex, that results in genital or oral herpes.
Read more about Genital Herpes »
Read more about Herpes Labialis »
Symptoms of shingles
The principal symptom of shingles is a painful skin rash. This looks like red or discolored skin at first and eventually features weeping blisters.
Signs of shingles before the rash appears
Before the rash appears, early warning signs of shingles, which may be present, include:
- Itching, burning pain, numbness, tingling in the place where the rash will develop
- Flu-like symptoms such as chills, fever, headache, feeling fatigued or overly tired
- Upset stomach
After the initial skin complaints develop into the shingles rash, the condition typically lasts for two to four weeks. The pain typically worsens as the rash develops and alleviates as it heals.
What does the shingles rash look like?
The varicella zoster virus which causes shingles lies dormant in the nervous system, so the rash will appear in a dermatomal pattern; a band or area of skin on the body corresponding to a particular set of nerves. The shingles rash usually appears on the face, neck or one side of the torso.
Good to know: If the relevant nerves are affected, it is also possible to experience shingles on the leg. It is relatively unusual, but also possible, to develop the shingles rash in more than one area of the body, i.e. in relation to more than one set of nerves. Even more rarely and especially in people with a compromised immune system, three or more dermatomes may be affected. This is a form of the condition known as disseminated zoster.
As the condition progresses, the rash site develops blisters which fill with clear fluid. Because shingles interacts with a person’s nervous system, the rash is often accompanied by an intense, stabbing pain which worsens as it develops. The area affected by the rash may be hypersensitive to touch, which can render it difficult to dress or to sleep in certain positions.
A person with shingles is contagious to others in the period when their rash is blistering. During this period, a person should avoid physical contact with others, in particular, certain population groups, including:
- Elderly people
- Pregnant people
- People with a weakened immune system
- People who have not had chickenpox in the past
The blistering phase of the rash usually lasts for seven to ten days, and the lesions should then reduce in size as they heal, eventually disappearing.
Subtypes of shingles
Although the painful shingles rash on one side of the face, neck or torso is present in most cases of shingles, the condition can take various other forms.
Less common forms of shingles include:
- Zoster sine herpete; shingles with pronounced pain, but without the rash
- Internal shingles; shingles affecting the internal organs
- Herpes zoster ophthalmicus; shingles affecting the nerve in the eye
- Herpes zoster oticus; shingles which invades the facial nerve
Zoster sine herpete (ZSH): shingles without the rash
It is possible for a person to develop shingles without being affected by the rash, although this is rare. When shingles occurs without the rash being present, this is called zoster sine herpete (ZSH).
When shingles occurs without a rash, the first symptoms of the condition may involve:
- A feeling of numbness in a certain area
- An itchy, burning sensation
- A painful sensation
- Generalized aches
- Hypersensitivity to touch
When shingles is present, even without the rash, sensations will be concentrated in a specific area of the body – commonly the face, neck, one side of the torso or the eyes. However, in the absence of the shingles rash, zoster sine herpete may still rarely lead toneurological and visceral diseases, such as inflammation of the brain (encephalitis), Varizella pneumonia, paralysis of the facial nerves and problems related to keeping one’s balance or problems with hearing.
Because shingles shares characteristics with many other conditions, including herpes simplex, impetigo, dermatitis herpetiformis and contact dermatitis, it can easily be confused with these conditions. In cases where a rash is not present, a laboratory test will usually be necessary to establish the presence of the varicella zoster virus in the body.
In rare cases, shingles can invade the lungs, nervous system and brain instead of – or as well as – the external areas of the body. This is more likely to happen in cases where a person has a weakened immune system, for example as caused by human immunodeficiency virus (HIV) or by undergoing a course of chemotherapy.
It is rarely possible to have internal shingles without a rash if it only affects internal parts of the body. People, who have a weakened immune system and suspect they may have shingles even though the typical rash is not present, should make their healthcare professional aware of their medical history immediately in order to prevent shingles developing internally.
Symptoms of internal shingles are related to the affected internal organ. If a person has internal shingles affecting the lungs, for example, developing pneumonia is a possible symptom.
Herpes zoster ophthalmicus
Also called ophthalmic herpes zoster, this form of the condition involves shingles invading the nerve in the eye. The first indicator that shingles has spread to the eye is the development of the shingles rash and/or associated sensations in the tip of the nose.
If shingles is suspected in the nasal area, it is advisable to consult an ophthalmologist, a doctor specializing in conditions which affect the eyes, without delay, as this form of shingles can cause visual distortions and even blindness.
Good to know: In some cases of herpes zoster ophthalmicus, Hutchinson’s sign may be present. This involves vesicles (fluid-filled sacs) developing on the tip or side of the nose, due to shingles affecting the nasociliary branch of the trigeminal nerve, which is connected to parts of the nose as well as the cornea in the eye.
Read more about Herpes Zoster Ophthalmicus »
Herpes zoster oticus (HZO)
This type of shingles occurs when shingles affects the facial nerves. Symptoms may vary, depending on which of the cranial nerves in the head is affected. The cranial nerve VII (nervus facialis) is affected in around 90 percent of cases of herpes zoster oticus, resulting in shingles on the face, neck, ear and/or mouth.
The other, less common, forms of herpes zoster oticus are:
- Ramsay Hunt Syndrome; a peripheral facial palsy, characterized by acute pain in one ear and the face. Vesicles may be present in the external ear canal, as well as additional auditory symptoms in some cases.
- HZO affecting cranial nerve VIII; or nervus vestibulocochlearis, which produces vestibular (balance system) symptoms such as dizziness and vertigo in addition to the shingles rash.
If a person suspects they may be affected by herpes zoster oticus, they should consult a healthcare professional immediately, as shingles which affects the facial nerves, indicates a likelihood of developing internal shingles.
Causes of shingles
All people who have been affected by chickenpox and, rarely, people who have been vaccinated against chickenpox and thereby carry VZV ‒ the virus which causes herpes zoster/shingles ‒ in their body, are at risk of developing shingles.
Good to know: If a person who has been vaccinated against chickenpox develops shingles, the infection tends to be significantly less severe than the condition can be when it affects people who do not carry any form of VZV in their body. It is therefore, in general, worthwhile for a person, who has not experienced chickenpox, to be vaccinated against it, even though this is an attenuated vaccine (containing a weakened version of the virus that does not cause the illness), and therefore does not offer total protection against related conditions such as shingles.
Shingles will affect around one in three people in the U.S. during their lifetime. After a person has recovered from chickenpox, VZV remains dormant in their body. It is stored in the nervous system and can reactivate as shingles when a person’s immune system is compromised by aging, illness or stress.
Is shingles (herpes zoster) contagious?
Shingles is only contagious at the point when the rash is blistering. At this time, VZV can be passed from a person with shingles to others via direct bodily contact, passing on traces of infected blister fluids and the sharing of towels, bedding and utensils.
It is only possible to catch the varicella zoster virus, rather than shingles itself: If a person who has never had chickenpox before is infected with VZV by somebody with shingles, they will develop chickenpox ‒ the first infection which VZV causes when it enters the body ‒ as opposed to shingles.
Shingles is most common in adults over 60 years of age. The Centres for Disease Control and Prevention recommend that all people over 60 be vaccinated against shingles. The vaccine reduces the overall risk of contracting the condition by around 50 percent, and lessens the duration and severity of shingles if it occurs.
Shingles can also affect people whose immune systems have been weakened by injury or illnesses, such as human immunodeficiency virus (HIV), cancer or the use of certain medicines or treatments which place a lot of stress on the immune system – such as organ transplants and chemotherapy. People of any age, who have previously had chickenpox and are experiencing a prolonged period of severe stress, are also at risk of shingles.
If a person develops shingles while pregnant, it is usually mild and poses no further risk to the individual or their unborn baby. However, pregnant people who have never had chickenpox, should avoid contact with those affected by chickenpox and those affected by shingles as a precautionary measure.
People with shingles or chickenpox both have the capacity to infect others with VZV, and developing chickenpox whilst pregnant can result in potentially severe health complications for both the pregnant person and the developing fetus.
Because the shingles rash is instantly identifiable due to its dermatomal pattern, the rash and accompanying pain, usually on one side of the body, are generally the only symptoms which need to be present for a shingles diagnosis to be made. The doctor will usually perform a physical examination and may take a swab from a blister, sending a sample of cells from the aggravated area of skin for a laboratory test in order to confirm the diagnosis.
It is recommended that anyone who thinks that they may be developing shingles seek medical attention as soon as possible to get supportive treatment and decrease the chance of infecting others. Although it is not possible to cure shingles, various pharmaceutical products can be prescribed on diagnosis which can help ease the pain and lessen the duration of the condition. These work most effectively when taken as soon as possible after the onset of shingles. If you suspect that you could be experiencing the first signs of shingles, or are unsure, consult the Ada app for a free symptom assessment.
There is no cure for shingles, but by diagnosing the condition early, it is possible to:
- Prevent the spread and severity of shingles
- Reduce associated health complications
- Ease the pain
- Lessen the duration of the outbreak
Following a diagnosis of shingles, a physician will generally advise on a recovery plan designed to alleviate the discomfort associated with the shingles rash.
Activities which are usually recommended for a swift recovery from shingles may include:
- Resting and relaxing
- Wearing loose-fitting clothes
- Keeping the rash clean and dry in order to dry out the blisters
- Keeping the rash uncovered so that the blisters can progress into the scabbing stage as quickly as possible
- Using cool compresses to alleviate the burning sensation on the skin
- Avoiding sharing bedding, clothing or towels, as this can facilitate the spread of infection to others
Medications to aid recovery
Medications which may be prescribed for alleviating the physical discomfort of shingles and combating the flare-up of the varicella zoster virus may include:
- Painkilling medications such as non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol or opioids in cases of severe pain. In some cases, antidepressants or anticonvulsants may be prescribed for their pain-relieving properties, which can work effectively in combination with other painkillers.
- Antiviral medications
Signs of shingles FAQs
Q: Are there further health risks associated with shingles?
A: If left untreated, shingles is more likely to result in post herpetic neuralgia (PHN), a condition in which a burning pain continues to be felt in the areas affected by shingles for more than three months after the rash and blisters themselves have disappeared. Approximately one fifth of people who are affected by shingles will go on to develop PHN. The likelihood of shingles spreading to internal regions of the body likewise increases in the absence of a promptly initiated treatment and recovery plan.
Q: Are the signs of shingles different in adults to those in children?
A: The signs of shingles in children are largely the same as the signs of shingles in adults. However, shingles in children is generally less severe and lasts for a shorter duration than in adults, and most children recover well with no associated health complications. Shingles rarely affects children under three years of age and can only affect children who have already had chickenpox. Shingles are not common in children. However, having a weakened immune system as a result of an autoimmune disease, other chronic or serious disease or because of being overly stressed, however, can increase the likelihood of a child developing shingles.
Does stress cause shingles?
A: Stress itself does not cause shingles. However, it can, in some cases, make an attack of shingles more likely. This is because stress may weaken the immune system, potentially leaving a person more vulnerable to all types of infection, including the varicella zoster virus.
Good to know: People who have a weakened immune system, and who have never been infected by VZV before, will develop chickenpox the first time they catch the virus, rather than its subsequent form, shingles.
Q: Can herpes zoster cause encephalitis?
A: This rare condition occurs when the brain becomes inflamed, which is usually caused by the spread of an infection in the body to the brain. Viral infections, including the herpes simplex virus causing oral and genital herpes and VZV, which causes shingles, are more associated with developing encephalitis than bacterial infections. The possibility of developing encephalitis due to the spread of VZV or another virus is greater in people with a weakened immune system; for example, if a person’s immune system is compromised due to another underlying health condition, such as human immunodeficiency virus (HIV).
Early signs of encephalitis include flu-like symptoms such as headaches, fever, aching muscles and nausea,. More serious symptoms include drowsiness, seizures and difficulty speaking.Immediate medical attention should be sought if encephalitis is suspected, as it can be life-threatening and should be treated as soon as possible. Diagnostic tests for encephalitis will involve an MRI or ct scan to visualize the extent of the inflammation and a lumbar puncture to determine its cause. This will allow doctors to decide on the best course of treatment. If encephalitis is caused by the herpes simplex of VZV virus, treatment will involve a course of antiviral medication.
Q: What are the signs of shingles healing?
A: Normally, the blisters that feature in the shingles rash will burst around five days after they first develop. At this point, the stages of shingles healing are as follows: they will weep, turn into crusty scabs and begin to heal thereafter. From the time they burst, the scabbing and healing process takes approximately two weeks. Signs that shingles is healing as normal during this time include the size of the scabs diminishing, and, correspondingly, the severity of the pain associated with the rash reducing.
Q: Should I get the shingles vaccine?
A: The Centres for Disease Control and Prevention recommend the shingles vaccine for all people over 60 years of age, whether they have had chickenpox or not. The vaccine reduces the overall risk of contracting the condition by around 50 percent, and lessens the duration and severity of shingles if it occurs.
The shingles vaccine is not recommended for certain population groups, including people who are:
- Pregnant. A person who has had the shingles vaccine should wait a minimum of four weeks before trying to become pregnant
- Affected by a condition which weakens the immune system, such as HIV
- Affected by any type of cancer affecting bone marrow or the lymphatic system
- Using immunosuppressive medications such as steroids
- Undergoing radiation therapy or chemotherapy
- Receiving an organ or bone marrow transplant in less than 4 weeks time, just having received it or while being on immunosuppressive medication after receiving one
5 Complications of Shingles
Shingles can cause more than just a painful rash. Sometimes the pain continues after the rash goes away. Other problems can occur when shingles involves the eye, face or ear. Problems also can develop when it involves infections of the skin or the brain’s lining. Learn about five possible complications of shingles.
1. Postherpetic Neuralgia (PHN)
PHN is the most common complication of shingles. The older you are when you get shingles, the more likely you are to have this problem. With PHN, pain can last for months and sometimes years. The pain occurs in the same area as the rash, but it persists after the rash has gone away. The pain may feel like burning or stabbing. PHN also can cause very bad itching. It can make your skin so sensitive that even a light touch hurts.
Getting the shingles vaccine can help prevent PHN. The vaccine makes you about half as likely to get shingles as people who aren’t vaccinated. It also lowers your risk of getting PHN after shingles by more than 60%. If you do get PHN, your doctor can prescribe medicine to ease the pain. Options include painkillers, anti-seizure drugs, antidepressants, and creams to run on your skin.
Although a virus causes shingles, sometimes a bacterial infection develops as a complication. That’s because the skin rash of shingles forms blisters that rupture. An infection can occur if bacteria get into the ruptured blisters. One way this can happen is by scratching the blisters. Your doctor can treat a bacterial infection with an antibiotic. This will help you heal and prevent scarring.
A shingles infection that involves the eye can cause blurred vision or even loss of vision. Early symptoms are pain on one side of the face and blisters on the tip of the nose. Eye symptoms may include:
- Decreased vision
- Eye pain or discomfort
- Redness of the eye
- Swelling around the eye or in the eyelid
- Sensitivity to light
You can prevent complications involving the eye. The first step is to see an eye doctor when you first have symptoms. The doctor can prescribe antiviral medication that can help. If you have a very bad case, you might need to be treated in a hospital. Then you could get an antiviral drug by IV, which puts it right into your blood.
Shingles can attack the facial nerve. This problem is called Ramsay Hunt syndrome. Symptoms include:
- Rash on one side of the face
- Severe ear pain
- Weakness of the facial muscles on one side, causing drooping
Other symptoms may include:
For facial complications, your doctor may treat you with more than one medicine. Often, doctors prescribe an antiviral drug and a steroid to help avoid hearing loss and facial weakness. You also might take a tranquilizer to treat dizziness. In some cases, hearing loss and facial weakness do not go away. However, most people recover without permanent damage.
Shingles of the brain is called herpes zoster encephalitis. It is a rare but serious complication. Besides the shingles rash, other symptoms start quickly. They include headaches, vomiting, fever and confusion. Shingles encephalitis is dangerous because it can cause seizures and swelling of the brain.
Shingles encephalitis requires treatment in a hospital. There, doctors can give antiviral drugs through an IV, as well as other drugs to control seizures and swelling. Giving IV drugs is a very fast way to get the drug into your system. With prompt treatment, shingles encephalitis clears up in about three weeks.
What to know about shingles without a rash
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Shingles is a viral nerve infection that causes a painful rash and blistering on the skin. In some cases, the infection can spread to internal organs and can sometimes appear without a rash. Doctors refer to this as internal shingles.
About 1 in 3 people in the United States will develop shingles during their lifetime.
Shingles, or herpes zoster, usually clears up in 2 to 4 weeks. However, as the infection can spread to other organs, it may lead to serious and potentially life-threatening complications if left untreated.
In this article, we look at the causes, symptoms, and complications of internal shingles, as well as treatment and prevention.
Shingles usually causes a painful, itchy, blistering rash. Shingles with no rash is called zoster sine herpete (ZSH), and may cause the following symptoms:
- muscle aches
- numbness and tingling
- burning under the skin
- swollen lymph nodes
The pain from shingles can vary from mild to severe. People may experience sharp, stabbing pains and the affected skin area can feel very tender.
In rare cases, the shingles virus can spread to the internal organs and cause inflammation. Internal shingles can cause the following complications, depending on the organ it affects:
- pneumonia, if it spreads to the lungs
- hepatitis, if it spreads to the liver
- encephalitis in the membranes of the brain
- transverse myelitis in the spinal cord
- problems with the blood vessels
These conditions are all very serious and potentially life-threatening if left untreated. Neurological symptoms that occur outside the rash area require immediate medical attention.
This rash and any itchiness or burning usually occurs in a single band or stripe on one side of the body. It is often located around the waist, chest, stomach, or back.
However, shingles can occur on almost any part of the body, including the face. It can also spread to more than one area.
Complications from shingles are more likely to occur in older people or people with weakened immune systems. The following are possible shingles complications:
Following shingles, some people continue to experience nerve pain and intense itching in the area where the rash was. This is known as postherpetic neuralgia (PHN). It is the most common complication of shingles and develops in around 10–13 percent of people who have had shingles.
PHN can persist for months or even years after the other symptoms of shingles have cleared. PHN can be severe, and the pain can be constant or intermittent. In some people, very light touch or changes in temperature can trigger the pain.
PHN can interfere with daily life and can cause depression, anxiety, insomnia, and unintended weight loss.
If shingles develops on the face, there is a risk of the eyes being affected. Potential complications involving the eye include:
- inflammation, causing redness and discharge
- permanent scarring of the cornea
- glaucoma or pressure in the eye
- vision problems
People must get prompt treatment if blisters occur in or around the eyes to avoid the risk of vision loss.
Ramsey Hunt syndrome
Shingles infections near or within the ear can cause Ramsey Hunt syndrome, which leads to hearing or balance problems, dizziness, earache, and paralysis of the face.
Around 75 percent of individuals with Ramsey Hunt syndrome will make a full recovery if they receive antiviral medication with 72 hours of the onset of their symptoms. However, some people may be left with long-term hearing loss or facial paralysis.
Share on PinterestA weakened immune system caused by emotional stress may reactivate the chickenpox virus.
The varicella-zoster virus causes shingles, the same virus that is responsible for chickenpox. Anyone who has had chickenpox can develop shingles later in life. Researchers are not sure why shingles may sometimes appear without a rash.
More than 99 percent of Americans aged 40 years old or more have had chickenpox, usually during childhood.
Following chickenpox, the virus settles in the nervous system near the spinal cord or the base of the skull. There it remains for the rest of a person’s life and is usually kept in check by the immune system.
However, the virus can reactivate at any time. When this occurs, it multiplies and travels along the nerve fibers to the skin, causing symptoms of shingles.
Many internal symptoms may occur before the rash and, in rare cases of ZSH, a rash will never appear.
Doctors do not fully understand why the virus reactivates in some people but not others. However, a weakened immune system is thought to be a contributing factor. This may be caused by:
- advanced age
- physical and emotional stress
- conditions that compromise the immune system, such as HIV and AIDS
- medications or treatments that suppress the immune system, such as those used in chemotherapy or organ transplantation
People of any age can get shingles, including young children. However, the risk increases significantly with age, and it mostly occurs in people of more than 50 years old.
Share on PinterestA doctor can prescribe antiviral medications to reduce the symptoms and the risk of developing complications.
A doctor can usually diagnose shingles based on a history of the symptoms and an examination of the rash. In some cases, a skin sample or fluid sample from a blister may be needed.
Shingles without a rash is more difficult to diagnose, and doctors need to do extra tests. One study found that testing a person’s saliva for the virus could diagnose shingles without a rash.
There is no cure for shingles, but antiviral medications can reduce the severity and decrease the risk of developing complications. Antiviral medications should be taken within 72 hours of the rash appearing.
Painkillers available for purchase over the counter or online, such as acetaminophen and ibuprofen, can be used to relieve the pain, but a doctor can prescribe stronger painkillers if necessary.
People with shingles should keep the rash covered, wear loose-fitting clothes, and avoid scratching or picking the blisters. Applying a cool, damp washcloth may help the blisters dry out faster and ease the pain.
People with shingles can ease their discomfort by:
- getting plenty of rest
- trying gentle stretches or walking
- distracting themselves by reading, watching TV, listening to music, or playing games
- avoiding stress
- using calamine lotion or an oatmeal bath to soothe the skin. Calamine lotion is available for purchase over the counter or online.
People cannot catch shingles from another person but it is possible for someone to catch chickenpox from a person with shingles. This can only happen if someone has not had chickenpox or received the chickenpox vaccine.
The varicella-zoster virus present in shingles blisters can be spread if someone comes into direct contact with the fluid. It remains contagious until the last blister has dried up and scabbed over.
The risk of spreading the virus is low if the rash is kept covered. Individuals with shingles should avoid contact with anyone who has not already had chickenpox. This is particularly important in the following cases:
- pregnant women
- babies less than 1 month old
- people living with HIV and AIDS
- people undergoing chemotherapy
- people having bone marrow or organ transplants
People with shingles should also wash their hands often and avoid swimming, contact sports, and sharing towels. If the rash is oozing and cannot be covered, they should also stay home from work or school.
Pain in shingles (postherpetic neuralgia)
What is Herpes Zoster (shingles)?
Herpes Zoster, also known as shingles, is a virus infection of
the nervous system and is accompanied by pain occurring after a
herpes infection (post herpetic).
Herpes zoster occurs when a childhood virus, which at the time
caused chickenpox, becomes active again. After recovery from
chickenpox, the virus settles into a particular part of the nervous
system, such as nerve
knots. As people grow older, resistance to viral
infections decreases, until the moment when the herpes zoster virus
can gain control. Consequently, the virus spreads from the nerve
button(s) to the skin and shingles results, with its characteristic
one-sided skin rash in one or more areas of a nerve(s). The little
blisters contain the virus and are therefore contagious to anyone
who has not built up natural resistance to it. There are cases of
grandparents with shingles giving chickenpox to their
grandchildren. The reverse is not possible. Pain during shingles is
due to inflammation of a sensory nerve in the skin.
Patients with shingles report one-side symptoms in a skin
area(s) corresponding to an infected nerve knot(s). Since nerve
buttons are present all over the body, the pain can occur anywhere
within the skin, e.g., face and trunk. Moreover, outside
pain, pins and needles, changed skin sensation and itching can also
occur. The pain is experienced as burning, pulsating, dull and
itching. Pain after a herpes zoster infection can be continuous,
with shooting sensations in the scar area. Clothes can be
uncomfortable or even painful.
How is the pain diagnosis made?
The diagnosis is based on the pattern of the pain complaints,
together with physical and neurological examination.
Do I need any additional examinations?
At the start of the disease, there is a typical skin rash with
redness, pimples and blisters in the painful area. Healed blisters
are covered in scabs. The skin rash is generally located on one
side of the body and does not cross to the other side. Sensory
disturbances, such as dullness, unpleasant pain after pricking or
touching the infected skin are frequent.
- Diagnostic examination for other non-physical factors important
for your pain, have already been done by yourself trough filling
out your pain questionnaires.
- Blood examination for herpes infection
What are the treatment possibilities?
Depending on the cause of your pain, your pain specialist will
decide on whether or not to embark on physical treatment. Based on
the results of the completed pain questionnaire, additional
examinations can be carried out and, as well as physical treatment,
other methods of treatment will be suggested.
If the results of your pain questionnaire are abnormal, your
pain specialist will suggest one of the non-physical treatments
Interventional Pain Treatments
90,000 causes of the disease, stages, symptoms, diagnosis, treatment of lichen – Experienced neurologists in Moscow – Clinic of the Central Clinical Hospital of the Russian Academy of Sciences
Shingles 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 immunity (after chemotherapy, for example).
Signs of illness
The onset of the disease is quite pronounced – there is a burning sensation and soreness of a certain area of the 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.
Forms of lichen
The disease can be typical or atypical.
In the atypical form, the symptoms may be mild:
- In the abortive form, the rash is 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.
- Gangrenous form leaves difficult healing ulcers and rough scars.
Causes of occurrence
Infections that are present in the body in a dormant state are activated. The following factors provoke the development of the process:
- Preparations that suppress immunity;
- Heavy loads, stresses;
- Cancer processes;
- Radiation therapy;
- Organ transplant.
Repeated episodes require special attention, since the rash is often localized at the site of the tumor. The development of shingles goes through certain stages.
The initial stage of the disease
About four days pass from the incubation to the active period. At this time, there is:
- Malaise, weakness, chills;
- Temperature rise;
- Burning and itching;
- Lymph nodes are enlarged;
- Possible disorders of the organs and systems of the body.
The frustrations subside afterwards.
Period of rashes
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 transparent liquid – grouped vesicles. After 3 days, their contents become cloudy. Rashes occur in fits and starts, with breaks 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 are moving to another place, being 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.
As a rule, after 2-3 weeks from the onset of the rash, crusts form.The areas of the rash turn pale and dry. In place of the fallen off crusts, a slight pigmentation remains.
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 misdiagnosed.
Laboratory confirmation of the diagnosis using a microscope or immunofluorescence method. In general practice, laboratory diagnostics are not used.
How can an infection be treated?
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 rule out pain with herpes, your doctor may prescribe pain relievers. For intense pain, pain relievers are used along with antiviral drugs. The use of non-steroidal drugs is possible. Prescribe antiherpetic drugs in tablets, creams, ointments or intramuscular injections.
What are antiviral drugs used for?
The goal is to exclude the development of complications. Antiherpetic treatment helps in the rapid healing of ulcers and improves the patient’s condition.
The course of treatment and dosage of drugs are 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 with a bacterial infection develops, antibiotics, immunomodulators, physiotherapy procedures and vitamins are prescribed.
With regard to 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 skin condition with a burn.
Hormonal medications should not be used as they suppress the immune system.
Treatment of the disease in elderly patients is not always successful, as antiviral drugs do not justify themselves.
- Paralysis of the facial or other nerves.
- Decreased vision.
- Disorders of the internal organs.
- Meningoencephalitis causing disability.
- With a bacterial infection, 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 becoming infected by contact with the patient is minimal.
If the immunity to the herpes virus is weakened or not formed, then the probability of getting sick on contact exists, including repeatedly.
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 infection is zero.
- Children most often get sick.
- Almost everyone can get shingles if their defense mechanisms are weakened.
- Dangerous during the period of formation of fresh bubbles. During the formation of crusts, there is no danger of infection.
It is necessary to isolate the sick, avoid contact with the sick (for those who have not had chickenpox), observe the rules of hygiene, and take measures to strengthen the immune system.
Which doctor should I contact with this disease
You should first contact a therapist, then an infectious disease specialist or dermatologist.If the form of herpes is severe, the help of a neurologist is needed, in case of eye damage – an ophthalmologist.
We recommend making an appointment at the neurological department of the clinic of the Russian Academy of Sciences (Moscow). The best doctors will examine you, study the signs of the disease, determine the causative agent of the infection, diagnose, consult, issue clinical recommendations and prescribe effective treatment.
Do not postpone your visit to a specialist! Specialists of the neurological department of the Central Clinical Hospital of the Russian Academy of Sciences in Moscow remind: 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 (shingles) | Memorial Sloan Kettering Cancer Center
This information tells about herpes zoster (shingles), including how it spreads and how to treat it.
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What is herpes zoster?
Herpes zoster, also called herpes zoster, is an infectious disease caused by the varicella-zoster virus.This is the same virus that causes chickenpox. Herpes zoster occurs only in those individuals who have previously had chickenpox. When the chickenpox is gone, the chickenpox virus remains inactive in the body. This means that you may not feel symptoms, but the virus is still present in your body. When the varicella-zoster virus becomes active again, it causes herpes zoster.
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What are the symptoms of herpes zoster?
People with herpes zoster develop a rash similar to that of chickenpox.It can cause itching, burning, and pain.
In localized herpes zoster, the rash usually appears as a wide band on one side of the body. With disseminated (more widespread) herpes zoster, the rash covers a larger area of the body.
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How is herpes zoster spread?
Herpes zoster can be spread by touching an infected person’s blisters. Disseminated herpes zoster can spread through contact with droplets of liquid from the nose and throat of an infected person.Droplets containing the virus are released into the air when an infected person coughs or sneezes. They are easy to breathe in and get infected.
If you have had chickenpox before, your virus will not become active as a result of contact with a person who has herpes zoster. However, if you have not had chickenpox, you may get it after contact with someone who has herpes zoster.
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Who is at risk of contracting herpes zoster?
Herpes zoster usually develops in people with serious medical conditions or weak immune systems.
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How is herpes zoster treated?
For the treatment of herpes zoster, antiviral drugs, skin creams and, if necessary, pain relievers are used.
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What precautions are taken in the hospital if I have herpes zoster?
Isolation measures are activities we take to prevent the spread of infection among patients.If you were diagnosed with chickenpox during your hospital stay or at risk of contracting the disease:
- You will be placed in a separate room.
- The door to your room must always be closed.
- A sign will be posted on your door informing all staff and visitors to wash their hands with soap and water or rub them with alcohol-based hand sanitizer before entering and after leaving your room.
- Isolation measures for localized and disseminated herpes zoster are different.
- For localized herpes zoster, all visitors and staff should wear a yellow gown and gloves while in your room. They are issued outside of your room and can be disposed of in your room.
- For disseminated herpes zoster, visitors and staff should wear a yellow gown, gloves, and respiratory mask when in your room.
- Subject to these isolation measures, you are prohibited from walking in the ward.
- For any type of herpes zoster, you are not allowed to walk around the ward or access the following areas of the hospital:
- pantry for groceries in your department;
- recreation center at M15;
- children’s recreation areas in the M9;
- main lobby;
- any other common areas of the hospital.
- You may have art therapy or massage sessions in your room.
- You should wear a yellow coat and gloves when leaving your room for diagnostic tests. If you have disseminated herpes zoster, you will also need to wear a mask.
You can stop following these precautions when all the blisters are dry and crusty.
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What are the ways to prevent herpes zoster?
For the prevention of herpes zoster, the vaccine Zostavax ® is used.This vaccine is recommended for people over 60 years of age, but should not be used if the immune system is weakened. Your doctor can provide more information about this vaccine.
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Where can I get more information about herpes zoster?
If you have questions, talk to your doctor or nurse. Alternatively, for more information, you can visit the websites:
Center for Disease Control and Prevention
New York State Department of Health
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Complex treatment of herpetic lesions of the peripheral nervous system | Igonina I.A., Kolokolov O.V., Bakulev A.L., Kravchenya S.S., Kolokolova A.M., Sitkali I.V.
Shingles (herpes zoster) is a disease caused by the type 3 herpes virus, which is based on the reactivation of a latent ganglion-associated viral infection with damage to the skin and nervous system.Typically, herpes zoster presents with fever, pain, and blistering skin eruptions along the nerves [10, 14, 16].
The incidence of shingles varies from 0.4 to 1.6 cases per 1000 people under the age of 20 and from 4.5 to 11.8 cases per 1000 people in the older age group. Men and women get sick with the same frequency. Important risk factors for the development of herpes zoster include stress, hypothermia, and physical injury. Complications of the disease are more likely in old age, in the presence of concomitant autoimmune, oncological and hematological pathology, diabetes mellitus, taking immunosuppressive drugs (corticosteroids, cytostatics).HIV infection adversely affects both the risk of developing and the severity of dermatosis. So, the incidence of shingles at the age of 20 to 50 years in HIV-infected people is almost 8 times higher than in immunocompetent individuals. Relapses of the disease occur in less than 5% of those who have been ill [14, 45].
A distinctive feature of the causative agent of chickenpox and herpes zoster – Varicella zoster virus (VZV) of the Alphaherpesvirinae subfamily of the Herpesviridae family – is the ability to persist for a long time in the sensory ganglia of the nervous system and reactivate under the influence of any unfavorable endogenous and (or) exogenous factors.In fact, we are talking about two clinical forms of the disease caused by the same etiotropic agent. Dermatosis manifests itself with a primary infection – chickenpox, then enters a latent phase with localization in the ganglia of the posterior roots of the spinal cord and ganglia of the cranial nerves, subsequently recurring with shingles [10, 12, 14].
The route of transmission of Varicella zoster virus is airborne. After replication of viruses on the mucous membranes of the respiratory tract, they migrate to the lymph nodes and CD4 + lymphocytes, as well as to epithelial cells.Infection of sensory nerve endings is mediated by an extracellular virus, which is present in large numbers in vesicles on the skin. Further spread of VZV in a macroorganism can occur by hematogenous, lymphogenous and neurogenic (along the axons of the sensory nerves) pathways. The virus infects the sensory ganglia of the nervous system, which ensures its lifelong persistence in the human body. The products of activation of a number of viral genes lead to blockade of interferon, a decrease in the expression of a number of receptors on immunocompetent cells, as a result of which VZV acquires the ability to “escape” from the defense mechanisms of the human immune system.
A decrease in the tension of cellular reactions leads to the reactivation of the virus, which is accompanied by damage not only to the skin, but also to the nerve endings. Histologically, when the virus is reactivated in the ganglia, hemorrhages, edema and lymphocytic infiltration are revealed throughout the sensory nerve. The nature of these changes determines the presence and severity of the pain syndrome.
Most dermatovenerologists propose to distinguish the following clinical forms of herpes zoster: vesicular, without rash (zoster sine herpete), generalized, disseminated, mucous membranes, ophthalmic herpes, Hunt’s syndrome, as well as atypical (bullous, hemorrhagic, ulcerative-necrotic, and ganglionic) [14 ].
By localization, lesions of the trigeminal (Gasser) and geniculate nodes, cervical, thoracic and lumbosacral ganglia are isolated. According to the majority of experts, the areas of the skin innervated by the spinal and trigeminal nerves are most often affected, and thoracic dermatomes are most often involved in the pathological process. According to a number of other authors, herpetic lesions of the Gasser’s node are more common than spinal ganglionitis .
Usually the disease manifests itself as pain syndrome.About 70–80% of patients with shingles in the prodromal period complain of pain in the affected dermatome, in the area of which skin rashes subsequently appear.
In the prodromal period, pain can be constant or paroxysmal. The pain is most often described as burning, shooting, stabbing, or throbbing. Some people feel pain only when touched. In other patients, severe pruritus is the leading clinical symptom. The prodromal period usually lasts 2-3 days, but sometimes reaches a week.
There are frequent paresthesias in the affected areas. The intensity of the pain syndrome is determined by the degree of involvement of peripheral nerves in the pathological process. After 2-7 days, the rashes typical of shingles begin to appear on the skin. In the case of the classic course of herpes zoster, it is ephemeral erythema, edema, then multiple papules, rapidly transforming into vesicles within 2-3 days. Efflorescences tend to cluster and merge with each other. Due to the addition of a secondary pyococcal infection, pustulization in the foci is noted.
Severe general infectious manifestations (fever, cephalgia, myalgia, fatigue, general malaise), as well as an increase in regional lymph nodes are observed in less than 20% of patients.
According to a number of authors, in the study of cerebrospinal fluid in herpes zoster, lymphocytic pleocytosis is determined .
After 3-5 days, erosions appear on the site of the vesicles and crusts are formed, which disappear by 3-4 weeks. At the site of resolved rashes, hypo- or hyperpigmentation usually persists for a long time.If the period for the appearance of new vesicles lasts more than 1 week, this indicates a high probability of the patient being immunodeficient. On the mucous membranes, instead of crusts, shallow erosion is formed. Rashes on the mucous membranes can generally go unnoticed.
It is important that with herpes zoster, the spread of the pathological process corresponds to a certain dermatome on one side of the body (left or right) and does not cross the anatomical midline of the trunk, with the exception of areas of mixed innervation. In immunocompetent patients, one dermatome is usually affected, however, due to individual variability of innervation, neighboring dermatomes may be involved in the process.
The rash is usually accompanied by the same painful sensations as in the prodromal period. However, in some cases, pain syndrome may appear only in the acute period of the disease.
In the abortive form of herpes zoster, skin rashes are limited to erythema and papules, without transformation into cavity elements.With the hemorrhagic form of herpes zoster, the contents of the vesicles are mostly hemorrhagic, the pathological process captures not only the epidermis, but also the dermis, after the resolution of the rash, scarring is possible. Of the most severe varieties of herpes zoster, the necrotic and disseminated form of herpes zoster is distinguished .
The pain during the entire period of the rash, as a rule, has an intense burning character, the zone of its distribution corresponds to the roots of the affected ganglion. Usually, the pain intensifies at night and when exposed to various stimuli (tactile, temperature, etc.).
An objective examination can reveal sensory disorders in the form of hyperesthesia, hypoesthesia or anesthesia, including anesthesia dolorosa, and others. Sensory disorders are usually limited to the area of the rash, but are highly variable in form and intensity.
The severity of the pain syndrome does not always correlate with the severity of the skin manifestations. In a number of patients, despite the severe gangrenous form of skin lesions, the pain remains insignificant and short-term.At the same time, other patients have long-term intense pain syndrome with minimal skin manifestations.
With ganglionitis of the gasser’s node, excruciating pains, sensory disturbances and rashes are observed in the innervation zone of one (I, II or III), two or (rarely) all branches of the trigeminal nerve. With ophthalmic herpes, keratitis, episcleritis, iridocyclitis are possible, in rare cases – damage to the retina of the eye, optic neuritis with an outcome in optic nerve atrophy, as well as glaucoma. Perhaps the defeat of the III, IV, VI cranial nerves, which is manifested by oculomotor disorders and ptosis.
Infection with VZV and Herpes simplex virus (HSV) is the most common cause of Bell’s palsy, skin manifestations may be absent, and the etiological role of VZV or HSV can be determined using laboratory tests. Often, herpetic lesion of the VII cranial nerve is manifested not only by peripheral prosoparesis, but also, in the case of lesions of the geniculate node, by hyperacusis and hypogeusia (Hunt’s syndrome) .The defeat of the VIII cranial nerve usually debuts with tinnitus. Hypoacusion can occur not only when the auditory nerve is damaged, but also when the middle ear apparatus is involved. Vestibular disorders usually develop slowly and range from mild dizziness to severe vestibular ataxia.
With the localization of rashes in the area of innervation of the IX cranial nerve, pain and impaired sensitivity are observed in the soft palate, palatine arch, tongue, posterior pharyngeal wall.
Due to the development of herpetic radiculitis and neuritis, movement disorders are sometimes observed, usually corresponding to the zone of sensory disturbances.
The defeat of the cervical nodes is accompanied by rashes on the skin of the neck and scalp. With ganglionitis of the lower cervical and upper thoracic localization, Steinbrocker syndrome can be observed (pain in the hand is accompanied by swelling of the hand, trophic disorders in the form of cyanosis and thinning of the skin, hyperhidrosis, brittle nails) . Thoracic ganglionitis often simulates the clinical picture of angina pectoris, myocardial infarction, which leads to errors in diagnosis. With herpetic lesions of the ganglia of the lumbosacral region, pain occurs that simulates pancreatitis, cholecystitis, renal colic, appendicitis.In connection with the development of ganglioradiculitis, the symptoms of Neri, Lassegh, Matskevich, Wasserman are caused.
A neurogenic bladder with peripheral urination disorders may be associated with herpes zoster of S2 – S4 sacral dermatomes. Acute and chronic herpetic encephalitis and myelitis are serious complications, often leading to death or disability [10, 33, 36].
Pain syndrome is the most painful manifestation of herpes zoster when the peripheral nervous system is affected.In some patients, the rash and pain have a relatively short duration, in 10–20% of patients postherpetic neuralgia occurs, which can last for months or even years. Significantly reducing the quality of life, it can lead to long-term temporary disability and is accompanied by significant financial costs. This is why the effective treatment of pain associated with herpes zoster is an important clinical challenge.
According to modern concepts, the pain syndrome in herpes zoster has three phases: acute, subacute and chronic .
Acute herpetic neuralgia usually occurs in the prodromal period and lasts up to 30 days. In most patients, the onset of pain and rash is preceded by a burning or itching sensation in a specific dermatome. The pain can be stabbing, throbbing, shooting, paroxysmal, or persistent. In a number of patients, the pain syndrome is accompanied by general systemic inflammatory manifestations: fever, malaise, myalgia, headache. It is extremely difficult to determine the cause of the pain at this stage.Depending on its localization, the differential diagnosis should be carried out with angina pectoris, myocardial infarction, an acute attack of cholecystitis, pancreatitis, appendicitis, pleurisy, intestinal colic, vertebral radiculopathy and other conditions. The cause of the pain syndrome usually becomes apparent after the appearance of characteristic rashes. The immediate cause of prodromal pain is subclinical reactivation and replication of VZV in neural tissue. The presence of severe pain in the prodromal period increases the risk of more severe acute herpetic neuralgia during the rash and the likelihood of developing postherpetic neuralgia later.
In the majority (60–90%) of immunocompetent patients, the appearance of skin rashes is accompanied by acute severe pain. The severity of acute pain syndrome increases with age. A common feature of acute herpetic neuralgia is allodynia, pain caused by exposure to a non-painful stimulus such as the touch of clothing. It is believed that acute allodynia is a predictor of postherpetic neuralgia.
The subacute phase of herpetic neuralgia begins at the end of the acute phase (after 30 days from the onset of the prodromal period).Against the background of adequate treatment, it can be stopped or lasts more than 120 days, turning into postherpetic neuralgia. Factors predisposing to the persistence of pain include: old age, female sex, the presence of a prolonged prodromal period, massive skin rashes, localization of rashes in the area of innervation of the trigeminal nerve (especially the eye area) or brachial plexus, severe acute pain, the presence of immunodeficiency.
In postherpetic neuralgia, patients describe three types of pain:
1) constant, deep, dull, pressing or burning pain;
2) spontaneous, periodic, stabbing, shooting pain, similar to an electric shock;
3) pain when putting on or light touch (in 90% of patients).
According to the definition of the International Herpes Forum, postherpetic neuralgia is defined as pain that lasts more than 4 months. (120 days) after the onset of the prodromal period of herpes zoster [33–35].
Pain syndrome, as a rule, is accompanied by sleep disturbances, loss of appetite and weight loss, chronic fatigue, depression, which leads to social maladjustment of patients.
If in the acute phase the pain syndrome is of a mixed (inflammatory and neuropathic) nature, then in the chronic phase it is typical neuropathic pain.Each of these phases has its own treatment characteristics based on the pathogenetic mechanisms of pain syndrome and confirmed by controlled clinical trials.
Treatment of herpes zoster is currently an urgent interdisciplinary problem, in the solution of which not only dermatovenerologists and neurologists are involved, but also infectious disease specialists, ophthalmologists, otorhinolaryngologists, as well as doctors of other specialties.
The drugs of choice for etiotropic therapy for herpes zoster currently remain synthetic acyclic nucleosides (acyclovir and its analogues – famciclovir and valciclovir).Acyclovir is currently the most well studied. The mechanism of action of acyclovir is based on the interaction of synthetic nucleosides with replication enzymes of herpes viruses. Herpesvirus thymidine kinase is much faster than the cellular one, binds to acyclovir, as a result of which the drug accumulates mainly in infected cells. Acyclovir line up in a chain of DNA under construction for “daughter” viral particles, interrupting the pathological process and stopping the reproduction of the virus. Valacyclovir is distinguished by its high bioavailability, which can significantly reduce the dose and frequency of administration of the drug.Famciclovir, due to the higher affinity for herpesvirus thymidine kinase than for acyclovir, is more effective in the treatment of shingles.
The main schemes of antiviral therapy for herpes zoster in adult patients are: valacyclovir 1000 mg 3 times / day. orally for 7 days or famciclovir 500 mg 3 times / day. orally for 7 days, or 800 mg acyclovir 5 times / day. orally for 7-10 days. It should be remembered that acyclic nucleosides should be prescribed as early as possible – in the first 72 hours after the onset of skin rashes.
As noted above, pathogenetic treatment in different phases of the disease has its own characteristics. In the prodromal and acute phases, it is advisable to prescribe anti-inflammatory drugs (NSAIDs), decongestant, desensitizing therapy.
As you know, the “gold standard” of the effectiveness of NSAIDs, the standard in the study of the therapeutic potential and safety of new and “old” drugs in this group is diclofenac sodium. Diclofenac has been tested in all areas of clinical use of NSAIDs; its effectiveness has been proven in the course of randomized clinical trials both in urgent conditions and in chronic pain.At the same time, in the course of numerous studies, it has been shown that none of the existing NSAIDs is superior in effectiveness to diclofenac, while the latter may be inferior to some of them in safety. According to a number of authors, in the Russian Federation, diclofenac remains the most popular NSAID, which is primarily due to the financial availability of generics of this drug. According to a survey of 3 thousand patients in Moscow and other 6 regions of Russia who regularly receive NSAIDs, this drug was used by 72% of respondents .However, it is cheap generics that have not been subjected to large clinical trials for their efficacy and safety , which cannot be said about the original drug diclofenac and its analogues.
The positive qualities of diclofenac are primarily due to the optimal physicochemical and structural characteristics of the drug, its ability to penetrate and accumulate in the foci of inflammation, as well as good compatibility with many other drugs. The anti-inflammatory effect of diclofenac is due to the inhibition of the activity of cyclooxygenase 1 and 2 (COX-1 and COX-2).COX-1 is considered structural, and COX-2 is an induced form of a key enzyme in the metabolism of arachidonic acid. COX-1 provides the synthesis of prostaglandins (PG) involved in the secretion of gastric mucus, has bronchodilating properties. Prostacyclin has vasodilating and disaggregating properties, improving microcirculation in the kidneys, lungs and liver. COX-2 provides the synthesis of PGs involved in the inflammatory process, and is found only in the focus of inflammation. The anti-inflammatory activity of NSAIDs is due to the inhibition of COX-2.Most non-selective NSAIDs inhibit COX-1 to a greater extent than COX-2. Diclofenac inhibits both isoenzymes to approximately the same extent, therefore, less likely to cause damage to the gastrointestinal tract (GIT). The drug disrupts the metabolism of arachidonic acid and reduces the amount of PG both in the focus of inflammation and in healthy tissues, suppresses the exudative and proliferative phases of inflammation. The greatest efficiency of its action is noted for inflammatory pains, which is important in the treatment of acute herpetic neuralgia .
Like all NSAIDs, diclofenac has antiplatelet activity. However, it does not compete with acetylsalicylic acid for binding to the active center of COX-1 and does not affect its antiplatelet effect.
Diclofenac reduces capillary permeability, stabilizes lysosomal membranes, reduces the production of ATP in the processes of oxidative phosphorylation, suppresses the synthesis of inflammatory mediators (PG, histamine, bradykinins, lymphokinins, complement factors, and others). The drug blocks the interaction of bradykinin with tissue receptors, restores disturbed microcirculation and reduces pain sensitivity in the inflammation focus.The analgesic effect is due to a decrease in the concentration of biogenic amines with algogenic properties, and an increase in the pain sensitivity threshold of the receptor apparatus. With prolonged use, it can have a desensitizing effect.
With regard to the risk of serious complications, the safety of diclofenac in relation to the gastrointestinal tract is generally higher than that of other non-selective NSAIDs, and in patients with a relatively low risk of complications it is comparable to selective NSAIDs .
However, the total incidence of gastrointestinal complications, primarily dyspepsia while taking diclofenac, is significantly higher than with etoricoxib, celecoxib, nimesulide and meloxicam.The use of diclofenac is associated with an increased risk of destabilization of arterial hypertension and heart failure, as well as the development of cardiovascular accidents. Diclofenac is capable of causing serious hepatotoxic complications, although clinically expressed liver pathology is rare.
Nevertheless, according to many researchers, taking into account the ratio of efficacy, tolerability and low cost, diclofenac can be considered the drug of choice for the treatment of acute and chronic pain in patients who do not have serious risk factors for the development of NSAID gastropathy, who do not suffer from cardiovascular and hepatobiliary diseases. systems.At moderate risk – in elderly people without serious comorbid pathology or in patients with a history of ulcers (without serious complications) – diclofenac can be used in combination with gastroprotectors, but in the absence of cardiovascular pathology or its effective drug correction.
In postherpetic neuralgia, which is a chronic neuropathic pain, drugs that suppress peripheral and central sensitization and activate the antinociceptive system come to the fore in the treatment of patients.These drugs include antidepressants (selective serotonin and norepinephrine reuptake inhibitors are preferred) and anticonvulsants [1, 3, 22]. The appointment of neuroprotective drugs is shown.
In the complex treatment of both acute and chronic pain, B vitamins are used . The metabolic and neurotrophic effect of vitamin B1 (thiamine), the most important component of the physiological system of nerve impulse conduction, is described. It has been established that vitamins B6 and B12 (pyridoxine and cyanocobalamin) play an important role in the processes of myelination of nerve fibers.Pyridoxine is involved in the synthesis of mediators not only in the peripheral, but also in the central nervous system [2, 5, 26, 40]. A number of works emphasize that both the combination and the separate use of vitamins B1, B6, B12 have an analgesic effect [20, 24, 27-29, 38, 41, 42]. It has been proven that the combination of B vitamins in pain inhibits nociceptive responses that do not change after administration of naloxone , enhances the action of norepinephrine and serotonin, the main “antinociceptive” neurotransmitters .
A number of experimental studies have revealed a distinct antinociceptive effect of certain vitamins and their complexes in neuropathic pain [15, 21, 25, 44]. When treated with a complex of B vitamins for 3 weeks. 1149 patients with pain syndromes and paresthesias caused by polyneuropathies, neuralgias, radiculopathies, mononeuropathies, there was a significant decrease in the intensity of pain and paresthesias in 69% of cases . In a review of works on the study of the antinociceptive action of the vitamin B complex I.Jurna in 1998, having analyzed the experimental and clinical studies available by that time, came to the conclusion that their use can reduce both musculoskeletal and radicular back pain .
There is evidence of a synergistic effect in reducing tactile allodynia with the simultaneous use of vitamins B12, B1 and the anticonvulsant carbamazepine or gabapentin [37, 41], which is important for the implementation of the mechanisms of action of drugs when used simultaneously in patients with neuropathic pain.
One of the preparations containing a complex of B vitamins is Neuromultivitis, the treatment of which is continued at a dose of 1-3 tablets per day for 1-2 months. depending on the effectiveness of therapy. The inclusion of Neuromultivitis in the complex therapy of pain syndrome allows to achieve a more pronounced effect when used simultaneously with NSAIDs, to reduce the duration of the pain episode and the duration of therapy, and to reduce the frequency of relapse.
Particularly noteworthy is the drug Neurodiclovit, which contains 50 mg of diclofenac sodium, 50 mg of thiamine hydrochloride, 50 mg of pyridoxine hydrochloride and 250 μg of cyanocobalamin in 1 capsule with a modified release.The drug is prescribed in a dose of 1-3 capsules per day for 1-2 weeks.
The use of a combination of vitamins B1, B6, B12 and diclofenac allows achieving a more pronounced analgesic effect, while the duration of therapy can be reduced, which is confirmed by the data of a number of clinical studies [7, 11, 18, 30, 43], including multicenter double-blind randomized trials [ 37]. With combined therapy, the pain severity according to the subjective feeling of patients significantly decreases earlier than with monotherapy with NSAIDs.Combination of NSAIDs with B vitamins can reduce the dose of NSAIDs [4, 6, 18, 30, 43]. In several clinical studies using a complex of B vitamins as an adjuvant therapy when prescribing diclofenac [37, 39, 43], the analgesic effect was confirmed not only by a decrease in the intensity of pain on a visual analogue scale, but also by the normalization of night sleep in patients and an improvement in the quality of life.
Thus, the most adequate and optimal therapy for herpetic lesions of the peripheral nervous system, in addition to antiviral drugs, is the appointment from the first days of the disease of the complex: NSAIDs + vitamins B1, B6, B12 (Neurodiclovitis), and when neuropathic pain appears, the use of the complex: antidepressant or anticonvulsant + vitamins B1, B6, B12 (Neuromultivitis), as well as neuroprotective agents.
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POST-HERPETIC NEURALGY leads to significant social and economic losses mainly due to patients’ disability, limitations in daily activity due to severe neuropathic pain, which is of a long, persistent nature.So, of patients diagnosed with herpes zoster, or shingles, 45% report pain they experience every day, 23% – about pain all day, and 42% – about “terrible”, “excruciating”, “debilitating” pain. which is often the reason for hospitalization.
POST-HERPETIC NEURALGY – CAUSES Herpes zoster is caused by the Varicella zoster virus, which causes chickenpox in childhood. The disease is characterized by vesicular rash and neuropathic pain.An episode of chickenpox in childhood gives immune protection against a recurrent outbreak of herpes infection for 40-50 years. But all these years, viruses can remain in the body. After primary infection, the virus spreads through sensory nerves to the spinal or cranial ganglia, where it is in a latent (inactive) state. During this time, it does not multiply, therefore, it is not pathogenic. A decrease in immune control leads to reactivation of the virus, viral replication (reproduction), which at the clinical level is manifested by herpes zoster.The main risk factors for the occurrence of postherpetic neuralgia include age, female sex, the presence of pain during the prodrome, the severity of acute skin rashes, and the severity of pain in the acute period. All these factors are interrelated, so more patients aged 50 years and older experience severe, intolerable pain and have more significant skin rashes of Herpes zoster, which is much more likely to lead to postherpetic neuralgia.
Postherpetic neuralgia treatment program
According to the latest recommendations of the International Society of Pain (IASP):
1.Treatment of any kind of neuropathic pain should be based on pain phenotype
2. 8% capsaicin patch “Qutenza” (Kutenza) is included in the list of drugs in the treatment of postherpetic neuralgia, with proven efficacy;
3. In the treatment of neuropathic pain, it is possible to use interventional methods.
The pain treatment clinic “MEDIKA” is the only medical institution in St. Petersburg, where the above recommendations are implemented in the program for the treatment of POST-HERPETIC NEURALGY.
ALGORITHM for PHN treatment in the MEDIKA blade:
The pain specialist will determine the phenotype of pain, and it is possible to use the QST technique – quantitative sensory testing. Determination of the phenotype of pain is carried out using the TSA II apparatus (Medoc), which makes it possible to assess the involvement of various types of nerve fibers in the conduct of pain, as well as the presence of central sensitization.
After determining the phenotype, the following treatments are used:
one.Selection of drug therapy. Appointment of drugs of various classes according to the identified mechanism of damage.
2. Patch “Qutenza” (Kutenza) Today, the only institution in the city, ready to work with 8% capsaicin patch “Qutenza”, which is associated with the peculiarities of the use of the drug.
3. Interventional techniques If the effectiveness of conservative treatment is low, it is possible to carry out various types of intervention, also focused on the mechanism of damage:
– o paravertebral and transforaminal blockade – delivery of glucocorticosteroids as close as possible to the dorsal ganglion;
– o RFA – pulsed radiofrequency ablation – exposure directly to the spinal root and dorsal ganglion in order to reduce the flow of pain impulses;
– o Implantation of a stimulator.If the interventional methods are ineffective, the patient is considered to have passed the selection for the implantation of an electroneurostimulator and will be referred for the placement of a test epidural electrode.
Botulinum therapy for postherpetic neuralgia.
The use of botulinum toxin in postherpetic neuralgia has become more and more widely used. There is sufficient experience in the use of BTA injections in the treatment of pain disorders in the face and head and also in the projection of the ribs in patients with postherpetic neuralgia (PHN).
When examining a patient, the doctor marks the zones on the skin of the forehead, head or projection of the ribs, and then marks the diameter of pain sensations, then injects botulinum toxin (BTA) into this area in the form of intradermal injections (like “mesotechnics”), doses are determined individually the nature of the pattern of pain. With postherpetic neuralgia of the head and face, 1 zone accounts for 10-25 U of Botox, Lantox, Xeomin or 50-100 U of Dysport. As a rule, one course of treatment is sufficient. The expected effect in the form of a decrease in the intensity of pain and sensory disturbances occurs by the end of the 1st week.On average, 7-10 days after treatment, the intensity of pain on the VAS scale decreases, and the manifestations of sensory disorders decrease. Pain syndrome regression occurs 14 days after injection. On the 10-12th day, hyperalgesia decreases, on the 11-14th day, hyperesthesia, on the 14-18th day, allodynia. In the case of injection of the frontal muscle, relaxation occurs on the side of the injections, in addition, correction of facial asymmetry is carried out against the background of relaxation of the facial muscles of those who underwent botulinum therapy on the day of injection and then 1 week after the treatment procedure, after 5-7 days the asymmetry is corrected, additionally there is a cosmetic effect.
The effect of botulinum therapy lasts for several months.
For botulinum toxin therapy for postherpetic neuralgia (PHN), an examination by a neurologist at the Pain Treatment Clinic is required to assess the pain pattern and calculate the exact amount of botulinum toxin injected. Reducing pain in PHN reduces the pharmaco-load (pharmacoeconomic effect) of drugs, because after BTA, the consumption of drugs taken by the patient with PHN is reduced until they are canceled.
The article was prepared by a neurologist, highest category Samorukova E.M.
The MEDICA Pain Treatment Clinic provides outpatient medical care from Monday to Saturday from 9:00 to 21:00 inclusive. Registration by phone 458-00-00 or 955-05-85.
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Herpes / Diseases / Clinic EXPERT
Herpes is a common viral disease caused by the herpes simplex virus (HSV) and is characterized by the appearance of a blistering rash on the skin and mucous membranes of various organs.
Almost all people in the world are carriers of HSV, but only 20% of them are infected.
Usually herpes is manifested by damage to the following organs and structures of the body:
- mucous membranes of the face and genitals
- central nervous system.
The causes of herpes
The development of herpes can be influenced by such factors as:
- weakened immunity
- the presence of certain diseases
- overheating or hypothermia of the body
- surgical procedures and other medical interventions (for example, the installation of an intrauterine device, abortion, etc.
- some psychological conditions and other factors.
Infection with this disease occurs from a person already sick with herpes, in whom the rash is localized on the outer layer of the mucous membrane.
Types of herpes
In total, there are about two hundred varieties of the herpes virus. Of these, only eight types are distinguished that pose a danger to the human body:
- herpes 1 type: manifested by a rash in the face
- herpes 2 types: localized in the genital area
- herpes 3 types: provokes shingles and chickenpox
- herpes 4 types (Epstein-Barr virus): causes the development of infectious mononucleosis
- herpes type 5 (cytomegalovirus): provokes cytomegalia.
Herpes virus types 6, 7 and 8 are currently not fully understood. They are thought to cause chronic fatigue and manifest as a blistering rash.
Symptoms of herpes
Herpes can manifest itself in different ways depending on the type of disease and the type of virus that caused it. The general symptoms of herpes are as follows:
- itching and redness of the skin area
- The appearance of neoplasms on the skin (blisters, crusts, ulcers)
- General weakness of the body, pain in joints and muscles.
Diagnostics of herpes
For the diagnosis of herpes in the EXPERT Clinic, the following laboratory tests are carried out:
- virological method for the determination of herpes simplex virus
- polymerase chain reaction (PCR)
- determination of herpes antigens
- test for an immune response to the simple virus herpes
- cytomorphological method
- enzyme immunoassay
- other analyzes.
Treatment of herpes
Since the herpes virus cannot be completely cured, treatment for this disease is aimed at reducing the number of relapses and alleviating symptoms.Treatment of herpes at the EXPERT Clinic is planned by an experienced immunologist after a thorough diagnosis and implies therapy with antiviral drugs according to various schemes. The dosage of the drug is calculated individually for each patient.
Antiherpes therapy can be shown to the patient not only with exacerbation of herpes, but also during periods of remission of the disease for preventive purposes.
Primary local herpes in a patient in the absence of concomitant pathologies, as a rule, goes away on its own in 7-14 days.A high risk of death is observed in newborns with disseminated herpes and in infants with severely impaired immune system functions. In the absence of adequate treatment, complications may appear: herpetic eye disease can lead to scarring of the cornea and even complete loss of vision. An exacerbation of herpes with low immunity can also lead to serious complications.
Timely diagnosis and treatment of herpes significantly improve the prognosis of the disease.
Prevention of herpes
In order to avoid contracting herpes, immunologists advise adhering to the following recommendations:
- Limit contact with a person already sick with herpes
- Use only personal hygiene items
- Avoid promiscuous and unprotected sex in order to avoid infection genital herpes
- use public toilets carefully, if possible, treat sitting with antiseptic agents
- avoid overheating and hypothermia
- adhere to a healthy lifestyle.
In order to avoid negative consequences for your health, at the first signs of herpes, make an appointment with an immunologist. Your doctor will provide you with quality medical care and help reduce the likelihood of further exacerbations of herpes.
Diseases of the peripheral nervous system
Diseases of the peripheral nervous system (neuritis, polyneuritis, neuropathy).
Among the most frequently diagnosed diseases of the human peripheral nervous system, several forms of neuritis, plaxitis, neuralgia are distinguished, as well as all kinds of these pathologies, which have different topography and are manifested most often by sharp and sometimes mild pains of a permanent nature.By the way, such a widespread radiculitis is also a peripheral lesion.
Diseases of the peripheral nervous system are the most common in the neurological clinic and account for up to 50% of outpatients. Not representing, as a rule, a threat to the life of patients, they are the main cause of disability.
The causes of damage to the peripheral nervous system can be acute and chronic infections, trauma, intoxication, hypovitaminosis, ischemia, hypothermia, compression, degenerative changes in the spine.
Pathomorphologically, when a peripheral nerve is damaged, first there is swelling and disintegration of the myelin sheath, proliferation of Schwann cells, and then structural changes occur in the nerve fibers themselves. At the same time, vasodilatation, exudation, perivascular edema, hemorrhages are noted in the connective tissue sheaths of the nerve.
If inflammatory phenomena predominate in etiopathogenesis, then peripheral pathology is designated with the ending “it”, if metabolic – then “Iya”.If the cause of the disease is degenerative changes in the spine, then the diagnosis is supplemented with the words “vertebrogenic”, “spondylogenic”.
Pathology of the peripheral nervous system at the site of localization
Depending on the place of localization and pathogenesis, the following diseases of the peripheral nervous system are distinguished.
Neuritis (neuropathy) – a disease in which pathomorphological changes in the nerve are accompanied by impaired motor, sensory and autonomic functions.Neuralgia is characterized by attacks of pain along the nerve without signs of organic damage.
This pathology of the peripheral nervous system is mainly due to metabolic, degenerative processes in the nerve fiber, with minor inflammatory changes in it.
- Polyneuritis (polyneuropathy) – damage to many nerves.
- Plexitis – damage to the nerve plexus.
- Ganglionitis – damage to the intervertebral nodes.
- Radiculitis – damage to the roots of the spinal cord.
- Radiculoneuritis – simultaneous damage to the roots of the spinal cord and nerve trunks.
- Myeloradiculoneuritis – damage to the spinal cord, roots and nerve trunks.
The most common forms of disorders of the peripheral nervous system are vertebrogenic pathology (osteochondrosis), neuritis (neuropathy) and neuralgia. Moreover, those nerves most often suffer, whose trunks pass through narrow bony canals – facial, trigeminal, sciatic.
Disorders of the nervous system of a peripheral nature: facial neuritis
Neuritis of the oculomotor nerve. Disease of predominantly vascular, inflammatory, diabetic genesis. It is observed with intracranial tumors.
Such peripheral neuritis is manifested by drooping of the upper eyelid (ptosis), dilated pupil (mydriasis), diverging strabismus, and double vision (diplopia).
Treatment according to the etiology of the disease, vitamin therapy, biostimulants.
Neuropathy (neuritis) of the facial nerve. Occurs more often than other cranial nerve lesions.
The cause of the disease can be hypothermia, infection, trauma, inflammation of the ear or meninges, tumors of the base of the skull. Since the trunk of the facial nerve passes through a narrow bony canal and its terminal branches are located superficially, the nerve is easily injured, and tissue edema develops during inflammatory processes, which leads to compression of the nerve and the vessels feeding it.
This peripheral nerve neuritis develops acutely or subacutely. Distinguish between peripheral and central paralysis of the facial nerve.
Peripheral paralysis is characterized by facial asymmetry – the face is skewed to the healthy side. On the side of the lesion, the skin folds are smoothed, the eye does not close (lagophthalmos), when you try to close the eye, the eyeball turns up (Bell’s symptom), food gets stuck behind the cheek, teeth grin more in a healthy direction. Dry eyes or watery eyes, hearing, taste and salivation disorders are possible.
With central paralysis, only flattening of the nasolabial fold and drooping of the corner of the mouth are observed.
A complication of this disease of peripheral nerves can be persistent contracture of the affected muscles and tonic muscle spasm – facial hemispasm.
Diagnosis is based on clinical data and sometimes LOP examination, skull x-ray, computed tomography are performed to clarify the diagnosis.
Treatment for this disease of the peripheral nervous system should be started early and appropriate to the cause of the lesion.For infectious and inflammatory genesis, salicylates, urotropine, indomethacin, acyclovir, prednisolone are prescribed.
In parallel to etiological treatment, vasodilators are prescribed dibazol, aminophylline, trental, nicotinic acid, decongestants (lasix, furosemide, hypothiazide), vitamins of the group. Thermal procedures (UHF, paraffin, ozokerite) are prescribed from 5-7 days of the disease. In the recovery period, proserin, aloe, FiBS, ultrasound with hydrocortisone on the mastoid process and the affected half of the face, electrical stimulation of facial muscles, exercise therapy, adherent massage, acupuncture are used. If there is no effect within 12 months, resort to neurosurgical intervention.
Treatment consists of instilling moisturizing eye drops and wearing glasses during the day. Eye ointment is applied at night and eyes are covered with a bandage.
Prevention: avoid hypothermia, anti-epidemic measures.
Neuritis of the peripheral nerves of the extremities: symptoms and treatment of neuropathies
The neuropathies of the peripheral nerves of the extremities are most often based on external trauma or compression of the nerve trunk.It is possible that the nerve is pinched in the bone canal, it is compressed in deep sleep, when the arm is thrown back, with prolonged anesthesia, when a tourniquet is applied. Also, the cause of neuritis can be infections, ischemia, intoxication.
Radial nerve neuropathy. It manifests itself as a symptom of a “drooping hand”, while the patient cannot straighten the arm in the wrist and elbow joints, cannot withdraw the thumb and supine the palm, the carporadial reflex decreases, the sensitivity on the dorsum of the 1st, 2nd, 3rd fingers is impaired.
Ulnar nerve neuropathy is characterized by deformity of the hand as a “bird’s paw” as a result of paralysis and atrophy of the small muscles of the hand; violation of adduction and spreading of fingers; pain and decreased sensitivity on the 5th and 4th fingers.
Median nerve neuropathy. Manifested by impaired flexion of the hand and fingers in the interphalangeal joints, opposition of the thumb; violation of sensitivity on the lateral surface of the palm and 1-4th fingers.Also, symptoms of such peripheral neuropathy are atrophy of the muscles of the forearm and flattening of the palm like a “monkey paw”. The patient cannot clench his fingers into a fist. Characterized by severe pain with a causalgic tinge and severe vegetative-vascular and trophic disorders (hyperhidrosis, hyperkeratosis, brittle nails, skin atrophy and cyanosis).
Neuropathy of the external cutaneous nerve of the thigh (Roth’s disease) . It occurs as a result of infection, intoxication (alcohol, nicotine, diabetes mellitus), atherosclerosis, prolonged nerve injury.This neuropathy of the peripheral nerve is manifested by paresthesias and pain along the outer surface of the thigh. The pains are worse at night and especially when standing upright and when walking. Determined by hyper- or hypesthesia on the outer surface of the thigh.
Neuropathy (neuritis) of the peroneal nerve. Characterized by drooping of the foot and the impossibility of extending it and the toes. The patient cannot stand on the heel. The muscles of the anterior surface of the leg atrophy. Sensitivity to the outer surface of the lower leg and the dorsum of the foot is impaired.The gait becomes steppazhny, “cock”.
Neuropathy (neuritis) of the tibial nerve. Leads to impaired flexion of the foot and toes. The patient cannot stand on his toes. The muscles of the back of the leg atrophy, and the Achilles reflex fades away. Sensitivity disorders are noted along the back surface of the lower leg, sole; severe pain and vegetative-trophic disorders.
Treatment of peripheral neuropathy of the extremities includes the use of vitamins B, C, nicotinic acid, aloe extract, proserin, if necessary – analgesic agents.
Physiotherapy is widely used:
- Laser and magnetic therapy
- exercise therapy
Care consists in the prevention of persistent paresis and contractures (suspension, bandages, splints for fixing the limb, orthopedic shoes), teaching the patient the elements of therapeutic gymnastics. If there is no recovery within two months, surgery is indicated.
Lesions of peripheral nerves: neuralgia
Trigeminal neuralgia. Disease of peripheral nerves with severe pain syndrome and recurrent course.
The cause may be infections, intoxication, atherosclerosis, hypothermia, pathological processes at the base of the skull, in the paranasal sinuses, teeth, orbits, narrowing of the bone openings.
The main symptom of this disease of the peripheral system is attacks of sharp shooting pain in the innervation zone of one or more branches of the nerve.The pain lasts for a few seconds, less often for minutes. Pain is provoked by excitement, chewing, talking, touching the tongue to the sensitive points (trigger points) of the mucous membrane of the mouth and gums. Therefore, patients may develop obsessive fear, and, in order not to provoke an attack, they freeze, hold their breath, and are afraid to make the slightest movement. Attacks can be accompanied by redness of half of the face, cramps of facial muscles, lacrimation, and profuse nasal discharge. In the interictal period, hypersthesia in the area of the affected branch and soreness at the point of its exit can be detected.
With the defeat of the trigeminal nerve node, constant burning pains and herpetic eruptions are observed. Herpetic keratitis is especially dangerous when the first branch of the nerve is affected.
Treatment is primarily aimed at eliminating the cause of the disease.
Next, analgesics and anti-inflammatory drugs are prescribed (analgin, sedalgin, reopirin, indomethacin, pentalgin):
To suppress neuralgic paroxysms, carbamazepine (finlepsin), trimethine, convulex clonazepam, neurontin, lamictal are used:
They also stimulate metabolic processes (retabolil, solcoseryl, actovegin, B vitamins): Baclofen is also used: For herpetic eruptions, acyclovir, herpesin are prescribed:
From physiotherapy, UHF, UFO, diadynamic currents, SMT, novocaine electrophoresis, laser therapy are used….
Care consists in creating a protective regime, preventing hypothermia of the patient and feeding him non-hot, well-mashed food.
Pterygopalatine neuralgia (Slader’s syndrome). The disease is caused by the same causes as trigeminal neuralgia. Symptoms of this disease of the peripheral nervous system are attacks of pain in the area of the eye, root of the nose, jaw, teeth, spreading to the tongue, soft palate, ear, and cervico-shoulder-scapular zone.Sometimes the pain covers half of the head, noise, dizziness, ringing in the ear appear in it. In this case, half of the face turns red, tears and salivation intensify. The attack lasts up to one hour.
Treatment and care for is the same as for trigeminal neuralgia. As a local therapy, the middle nasal passage is lubricated with novocaine.
Glossopharyngeal neuralgia. Occurs more often in the elderly. The reasons are atherosclerosis, tumors, scars, osteophytes.This violation of the peripheral system is characterized by attacks of severe pain in the root of the tongue, tonsils, radiating to the ear, eyes, neck. In this case, the patient experiences dry mouth, cough, profuse salivation.
Treatment is carried out as for trigeminal neuralgia; locally – smearing the root of the tongue with cocaine.
Neuralgia of the occipital nerve. Caused by hypothermia, infections, degenerative processes in the spine, arachnoiditis and tumors of the posterior cranial fossa.The disease is characterized by attacks of pain in one half of the occiput, radiating to the ear, neck, shoulder girdle, and scapula. The pain increases with movement, coughing, sneezing. A forced position of the head is possible. With this violation of a peripheral nature, pain in the points of exit of the nerve and sensory disturbances in the occiput are noted.
Treatment of the underlying disease, analgesic drugs, vasodilators, vitamins, topically – UFO, UHF.
Intercostal neuralgia. Can be primary or secondary, i.e. arising against the background of other diseases, especially with pathology of the spine (osteochondrosis, tumors, tuberculosis) and internal organs (lungs, pleura, liver).
The disease is characterized by shingles, shooting pains that spread from the spine along the intercostal spaces around the chest. The pain increases with movement, deep breath. Disorders of sensitivity in the zone of innervation of the intercostal nerves, soreness of the paravertebral and intercostal points are noted.Loss of abdominal reflexes and paresis of the abdominal muscles are possible. When the intervertebral ganglion is involved in the process, symptoms of shingles appear. To clarify the diagnosis, a thorough examination of the patient is necessary in order to exclude the secondary nature of neuralgia.
Treatment includes elimination of the cause of the disease, pain relievers (analgin, baralgin, diclofenac, indomethacin):
Anticonvulsants (finlepsin, 0.2 g 1-2 times a day):
Vitamins, physiotherapy (UHF, DDT),
Care provides for the creation of a gentle regime, the choice of a comfortable position, the prevention of hypothermia.
Shingles (ganglionitis, herpetic intercostal neuralgia). The disease is caused by the neurotropic virus herpes zoster and is triggered by hypothermia. In the spinal nodes and their cranial analogs, an inflammatory process develops, spreading to the nerves and roots.
The disease begins with general malaise, fever and pain in the innervation zone of the affected ganglion (most often in the thoracic region). After 2-3 days, redness and rash of very painful blisters filled with serous fluid appear at the site of pain.The vesicles often fester, forming pustules, which are covered with a crust that falls off after a few days.
With the defeat of the Gasser node, rashes appear on the skin of the forehead, upper eyelid, nasal bridge and on the membranes of the eye, which can result in keratitis and blindness.
In some patients who have had shingles, pain remains for a long time (postherpetic neuralgia) and relapses are possible.
Treatment includes antiviral drugs (acyclovir 0.8 x 3, retrovir 0.25 x 5, valacyclovir), detoxification (hemodez), dehydration (furosemide), qurantil, analgesics (azafen 0.025 x 6, pyrazidol 0.05 x 3, mexiletine, finlepsin, amitriptyline, herpesin):
Topically applied tebrofen ointment, gassipol, UFO.
Polyneuritis and polyneuropathies of peripheral nerves
Polyneuritis – multiple lesions of peripheral nerves of infectious origin.
Polyneuropathy – toxic damage to the nerves as a result of intoxication of the body, metabolic disorders, allergic reactions, circulatory disorders. If, along with the nerves, their radicular part is affected, then polyradiculoneuritis is determined.
Anatomically, with polyradiculoneuritis, inflammatory changes (edema, hyperemia, infiltration) of the roots are determined, and signs of myelin breakdown and degeneration of the axial cylinders are visible in the peripheral nerves.Moreover, if the pathological process is limited to mesenchial formations of membranes and vessels, then this is interstitial neuritis. If it is joined by damage to nerve fibers (demyelination, disintegration of axial cylinders), then – interstitial-parenchymal neuritis. With polyneuropathies, degenerative changes in nerves occur with a predominance of the disintegration of their myelin sheaths or nerve fibers.
Polyneuritis and polyneuropathies are manifested by pain and paresthesia in the distal extremities, peripheral paralysis, sensitivity disorders like “gloves” and “socks” and vegetative-trophic disorders (dryness, thinning of the skin or hyperkeratosis, cyanosis, trophic ulcers).
Infectious polyneuritis of viral etiology is characterized by an acute onset with general malaise, fever, pain and paresthesia in the extremities.
In the future, weakness, atrophy, paralysis of the muscles of the arms and legs, and impaired sensitivity develop. The nerve trunks are sharply painful on palpation. The reverse development of symptoms is slow.
Treatment includes antiviral drugs, antibiotics, analgesics, corticosteroids, vitamins, and biostimulants.
Acute infectious polyradiculoneuritis usually occurs in the cold season, begins acutely with a rise in temperature, catarrhal phenomena, pain and paresthesias in the distal extremities. Peripheral sensory disturbances, soreness of the nerve trunks, symptoms of tension, distal paralysis and vegetative-vascular disorders are determined.
One of the most common forms of multiple lesions of the nervous system is Guillain-Barré’s acute infectious polyradiculoneuritis.The disease begins acutely with a rise in temperature and catarrhal phenomena, usually in the cold season. Patients develop rapidly growing weakness in the legs, difficulty walking, pain along the nerve trunks.
Symmetrical flaccid paralysis, starting in the lower extremities and covering the muscles of the trunk, upper extremities, neck, lesions of the cranial nerves, sensory disturbances, and a sharp protein-cell dissociation in the cerebrospinal fluid are characteristic. The course of this form of the disease is benign.
Another type of polyradiculoneuritis is Landry’s ascending paralysis , in which mainly the anterior roots are affected. Characterized by an acute onset and rapid course of the disease. The disease begins with paresthesias, pain, weakness, paralysis of the legs, which quickly, in 2-3 days, spread to the upper limbs and cranial nerves, primarily bulbar. In this case, speech, swallowing is disturbed, respiratory and cardiac disorders occur. Fatal outcome is not uncommon.
Treatment consists in suppressing the autoimmune inflammatory reaction (prednisolone, or its analogs, intravenously in a stream up to 1.5-2.1 g per day for the first 3 days, followed by a dose reduction and switching to tableted drugs), the introduction of antibiotics (benzylpenicillin up to 20 million IU per day, gentamicin, rifampicin) and hexamethylenetetramine: Reducing pain (analgin, voltaren): Detoxification (hemodez, glucose): Improving neuromuscular transmission (proserin intramuscularly 1-2 ml twice a day, galantamine, ATP, B vitamins ): Immunoglobulin and plasmapheresis are also used: In case of violation of the act of swallowing, glucose, albumin, hydrolysin are injected intravenously; in case of respiratory failure, resuscitation measures are carried out.After the acute phenomena subside, ultraviolet irradiation, UHF sessions, light massage, passive movements are carried out, biostimulants and vitamins are introduced. After 2-3 months after the process subsides, you can prescribe hydrogen sulfide and radon baths, mud applications, exercise therapy classes. Diphtheria polyneuritis occurs two to three weeks after the postponed diphtheria. It mainly affects the cranial nerves – the vagus, facial and abducens. The appearance of bulbar disorders is especially dangerous. After recovery, the voice may remain deaf for many years.Treatment is carried out by the urgent administration of anti-diphtheria serum (5-10 thousand units). To prevent anaphylactic reaction, 0.5-1.0 ml of serum is first injected under the skin, and after 12-24 hours – the entire dose.
Allergic (rabies) polyneuritis is the result of an allergic reaction to the vaccine. After the start of vaccinations, the patient develops dizziness, weakness, dyspepsia, diffuse pain. Then the temperature rises; vomiting appears, an indomitable, severe headache, flaccid paralysis of the limbs and pelvic disorders develop.Reverse development of symptoms is rapid.
Diabetic polyneuropathy develops with hyperglycemia. It is characterized by paresthesias, itching and pain in the legs, sensory disturbances in the distal extremities, and extinction of the Achilles and knee reflexes. Possible damage to the oculomotor nerves and autonomic ganglia.
Treatment includes correction of hyperglycemia (diabetes, insulin), vitamins, trental, coplamine, nootropics, analgesics, biostimulants, anabolic steroids, lipostabils, thioctacid:
Alcoholic polyneuropathy develops subacutely with chronic alcohol intoxication.The disease begins with paresthesias, burning pain in the feet against the background of pronounced autonomic disorders (cyanosis, cold snap, sweating) of the extremities.
In the distal parts, paresis develops, superficial and deep sensitivity (sensitive ataxia) is disturbed, and muscle atrophy appears. Korsakov’s syndrome is very characteristic – loss of memory for recent and current events, confabulation, temporal and spatial disorganization.
Treatment consists in eliminating alcohol, prescribing large doses of B vitamins, benfogamma, mil-gamma, vasodilators (spazvin) and other drugs used for polyneuropathies.
Polyneuropathy of pregnant women is associated with a violation of vitamin metabolism, insufficiency of liver function. Characterized by paresis, peripheral sensory disturbances, extinction of reflexes, disorders of autonomic innervation in the form of hyperhidrosis, cold extremities. Landry’s syndrome is possible.
Lesions of the peripheral nervous system: plexitis
Cervical plexitis is caused by infections, tumors, tuberculosis, and injuries of the cervical spine.It is manifested by pain and sensory disturbances in the occiput, ear, neck, upper scapula and shoulder. Characterized by dysfunctions of the phrenic nerve (respiratory failure, hiccups, complete or partial immobility of the diaphragm).
Shoulder plexitis occurs after shoulder injuries, collarbone fractures, infections, pathology of the spine and lungs. Depending on the localization of the lesion, upper, lower and total brachial plexitis are distinguished.
Upper (Duchenne-Erb paralysis) is manifested by pain in the upper third of the shoulder, decreased reflex with the so-called.biceps, difficulty in shoulder abduction, supination, flexion of the arm at the elbow joint, as well as impaired sensitivity along the outer surface of the shoulder and forearm.
Lower (Dejerine-Klumpke paralysis) is characterized by pain and sensory disturbances along the inner surface of the shoulder and forearm, paresis and atrophy of the muscles of the hand and forearm, and a decrease in the carporadial reflex. Possible Horner-Bernard syndrome.
Total plexitis is rare, characterized by pain in the supra- and subclavian region, radiating to the arm, loss of reflex
c, paresis and impaired sensitivity in the entire arm, gross vegetative-vascular disorders.
Lumbosacral plexitis occurs as a result of infections, intoxications, diseases of the pelvic organs and abdominal cavity, during pregnancy, with pathological childbirth and injuries of the spine and pelvic bones. Clinically, plexitis is manifested by pain and impaired sensitivity in the buttocks, thighs and lower legs, loss of the knee and Achilles reflexes, paresis of the foot and atrophy of the muscles of the buttocks and thighs.
Treatment is similar to that for polyneuropathy.
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