Skin rashes in shingles

Shingles is a disease that is characterized by damage to the nervous system and skin, often observed in the spring and autumn periods.

Men are more likely to get sick than women. Skin changes resemble those of herpes simplex.

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Causes of shingles rash.

The disease is caused by the Varicella zoster virus, which is also the causative agent of chickenpox.

The development of clinical manifestations of shingles is the result of reactivation of the latent virus present in the body after chickenpox suffered in childhood. The reasons for this may be various endogenous and exogenous factors that reduce the body's resistance: infections, hypothermia, somatic diseases, radiation exposure, etc.

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Symptoms of shingles rash.

In most patients, skin rashes are preceded by prodromal symptoms: increased body temperature, malaise, general weakness, headache. At the same time, asymmetric neuralgia of a certain innervation zone develops.

In typical cases, before the skin rash appears, pain along the affected nerves is localized and, in the absence of a rash, simulates the clinical picture of myocardial infarction, gastric ulcer, pancreatitis, etc. Dull, shooting or burning pains of varying duration and intensity are usually noted. Then, within a few days, isolated blisters appear on a slightly edematous and hyperemic background. The pathological process can be located on any part of the skin and mucous membranes: the trunk, in the area of the intercostal nerves, along the branches of the trigeminal nerve, on the head, face, limbs, etc. Soon the contents of the blisters become cloudy, pustules form, and after their resolution - erosions and crusts. The process is resolved by the formation of secondary hyperpigmentation. Sometimes in people with severe concomitant diseases (lymphoma, lymphocytic leukemia, etc.) and in patients who have been receiving systemic drugs (glucocorticosteroids, X-ray therapy, cytostatics) for a long time, the rash becomes widespread (generalized form). In this case, an increase in regional lymph nodes and their soreness are noted.

Flow

Usually the disease does not recur; recurrent forms against the background of somatic complications are described in the literature: oncological diseases, diabetes mellitus, HIV infection.

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Forms

The gangrenous form, the most severe, is found in elderly people suffering from diabetes, gastric ulcers, etc. In this case, blisters with hemorrhagic contents and the development of long-term non-healing deep gangrenous ulcers are observed.

In thoracic and lumbar ganglia, the border sympathetic ganglia and splanchnic nerves, solar plexus are usually affected. This leads to dysfunction of the digestive tract, urinary retention and other disorders.

Ophthalmic herpes occurs in 15% of patients. With ophthalmic herpes, eyelid edema often appears, leading to ptosis in most patients, then damage to the cornea, conjunctiva, sclera, iris is noted, which is clinically manifested by photophobia, blepharospasm, lacrimation, pain and a number of other symptoms. With damage to the subarachnoid spaces and various brain formations, symptoms of meningoencephalitis are observed. In some patients, the ciliospinal center may be affected. In this case, Bernard-Harner syndrome occurs (enophthalmos, myiasis, narrowing of the palpebral fissure).

Damage to the cells of the geniculate ganglion is characterized by Huth's triad: facial nerve paresis, ear pain, and vesicular rashes along the course of the affected nerve.

As can be seen from the above data, the clinical manifestations of herpes zoster are characterized by pronounced polymorphism.

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Differential diagnosis

At the onset of the disease, before the rash, severe pain is noted along the intercostal nerves and angina pectoris must be excluded. In the presence of skin rashes, the disease should be distinguished from the vesicular form of erysipelas, zosteriform herpes simplex.

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Treatment of shingles rash.

Taking into account the etiology, complex pathogenetic mechanisms, the nature of the damage to the skin, nervous system and other organs and tissues, the treatment should be comprehensive. It is necessary to prescribe analgesics to eliminate the pain syndrome. Antiviral drugs (acyclovir, valacyclovir, famciclovir) are used as etiotropic agents. The drugs ulkaril, herpevir, zavirax contain acyclovir. The daily dose of acyclovir is 4 g, which should be divided into 5 single doses of 800 mg. The course of treatment is 7-10 days. The best effect is observed with early administration of the drug.

Valaciclovir - second generation acyclovir is prescribed up to 3 g per day, and the number of doses is up to 3 times, the course of treatment is 7-10 days.

Famciclovir is taken 250 mg 3 times a day for 7 days. Along with antiviral therapy, ganglion blockers, analgesics, multivitamins, in particular B vitamins are used.

Proteflazit, which has antiviral and immune-correcting properties, is widely used in practice. The daily dose of the drug is 40 drops in two doses for 30 days.

Locally, you can use interferon irrigation, aniline dyes, acyclovir ointment (herpevir). In gangrenous forms of shingles, ointments containing antibiotics are used, and after cleansing the lesion, solcoseryl is used to heal ulcers.