Skin rashes with shingles

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

Men are sick more often than women. Skin changes resemble those with simple herpes.

[1], [2],

Causes of the rash with shingles

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

The development of clinical manifestations of herpes zoster is the result of the reactivation of a latent virus present in the body after a chicken pox transferred in childhood. The reasons for this can be various endogenous and exogenous factors that reduce the body's resistance: infections, hypothermia, somatic diseases, radiation exposure, etc.

[3], [4], [5]

Symptoms of the rash with shingles

In the majority of patients skin rashes are preceded by prodromal phenomena: fever, malaise, general weakness, headache. At the same time asymmetric neuralgia of a certain zone of innervation develops.

In typical cases, before the onset of skin rashes along the affected nerves, pain is noted that is localized and in the absence of a rash it simulates the clinical picture of myocardial infarction, stomach ulcers, pancreatitis, etc. Usually blunt, shooting or burning pains of varying duration and intensity are noted. Then, for a few days, single bubbles appear on the slightly edematous and hyperemic background. The pathological process can be located on any part of the skin and mucous membranes: the trunk, in the zone of intercostal nerves, along the branches of the trigeminal nerve, on the head, face, limbs, etc. Soon the contents of the vesicles grow turbid, pustules are formed, and after their resolution - erosion and crust. The process is resolved by the formation of secondary hyperpigmentation. Sometimes, in individuals with severe concomitant diseases (lymphoma, lymphocytic leukemia, etc.) and in patients receiving systemic drugs for a long time (glucocorticosteroids, X-ray therapy, cytostatics), rashes take on a widespread character (generalized form). In this case, there is an increase in regional lymph nodes, their soreness.

Flow

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

[6], [7], [8], [9], [10]

Forms

Gangrenous form, the most severe, occurs in elderly people with diabetes, stomach ulcers, etc. In this case, there are bubbles with hemorrhagic contents and the development of long-term non-healing deep gangrenous ulcers.

At the thoracic and lumbar ganglia border sympathetic ganglia and celiac nerves, the solar plexus, are usually affected. This leads to dysfunction of the digestive tract, delayed urination and other disorders.

Ophthalmoherpes occurs in 15% of patients. In ophthalmoherpes, edema often occurs, leading to ptosis in most patients, then the cornea, conjunctiva, sclera, and iris are affected, which is clinically manifested by photophobia, blephoraspism, lacrimation, pain, and a number of other symptoms. When the subarachnoid spaces and various brain formations are affected, symptoms of meningoencephalitis are observed. In some patients, the ciliospinal center can be affected. In this case, there is Bernard-Harner syndrome (enophthalmus, miase, narrowing of the eye gap).

The defeat of the cells of the geniculate ganglion is characterized by the triad of Hut: paresis of the facial nerve, pain in the ear and bubble rashes along the affected nerve.

As can be seen from the above data, the clinical manifestations of herpes zoster differ in pronounced polymorphism.

[11], [12]

Differential diagnosis

At the onset of the disease, before the rash, severe pains occur during the intercostal nerves and angina should be excluded. In the presence of skin rashes, the disease should be distinguished from the vesicular form of erysipelas, zosteriiform herpes simplex.

[13], [14], [15], [16], [17]

Treatment of the rash with shingles

Given the etiology, complex pathogenetic mechanisms, the nature of the damage to the skin, nervous system and other organs and tissues, treatment should be comprehensive. It is necessary to prescribe analgesics to eliminate the pain syndrome. As etiotropic drugs used antiviral drugs (acyclovir, valaciclovir, famciclovir). Drugs have been quenched, herpevir, vorrax contain acyclovir. The daily dose of acyclovir is 4 g, which must be divided into 5 single doses of 800 mg. The course of treatment is 7-10 days. The best effect is observed with the early administration of the drug.

Valaciclovir - second-generation acyclovir is prescribed up to 3 g per day, and the number of procedures 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.

In practice, proteflasite is widely used, which has antiviral and immuno-corrective properties. The daily dose of the drug is 40 drops in two divided doses for 30 days.

Locally, you can use irrigation with interferon, aniline dyes, acyclovir ointment (herpevir). With gangrenous forms of shingles, ointments containing antibiotics are used, and after cleansing the lesion for healing ulcers, solkoseril.