(Updated at Feb 3 / 2023)
What is shingles and how is it treated?
Shingles or Herpes zoster is a disease caused by a certain type of herpes virus, chickenpox virus (Varicella zoster). It manifests in unilateral rashes and severe local pain. When the virus is first encountered by the body (often at a young age), it causes typical chickenpox.
Short information about shingles
In people who have had chickenpox, the virus becomes latent in the nerve nodes. Subsequently, in the elderly and people with compromised immune systems, it can activate and cause herpes zoster (in approximately 10-20% of people who have already had chickenpox).
The frequency of the disease varies from 12 to 15 per 100,000 people aged 60-75 years. In some patients (about 2% among patients with normal immunity and in 10% of patients with immunodeficiency), the disease occurs repeatedly. Upon contact of children who hadn’t had chickenpox with patients with herpes zoster, they may develop typical chickenpox.
Tinea versicolor is clearly associated with a drop in the level of chickenpox virus-specific (Lat. Varicella Zoter virus) T-cells in people who previously had chickenpox. The herpes zoster episode activates a specific T-cell response. Also, in rare cases, shingles occurs in people vaccinated with a live chickenpox vaccine.
How can you get shingles?
Infection is possible from a person who is sick with herpes zoster or chickenpox. Ways of transmission of the virus are airborne, contact, and transplacental (from mother to an unborn baby). The virus is neurodermatotropic, that is, it can affect cells of the nervous system and skin epithelium. Initially or after chickenpox, the virus penetrates through the skin and mucous membranes, then through the circulatory and lymphatic systems into the intervertebral nodes and posterior roots of the spinal cord, where it can remain in a latent state for a long time, like its herpes simplex virus.
Activation of infection occurs with a decrease in the immune resistance of the body. The most common causes of the onset of the disease are:
- Taking drugs that reduce immunity;
- Chronic stress and debilitating work;
- Local hypothermia;
- Cancerous diseases (lymphogranulomatosis, malignant tumors);
- Consequences of radiation therapy;
- Patients with HIV infection in the transition to AIDS;
- Transplantation of organs and bone marrow.
- Age over 55 years old;
- Prolonged treatment with antibiotics, cytostatics, and/or glucocorticosteroids.
How can you know if you have shingles?
The first symptom of the disease is an intense ache in the affected area. In 2-3 days, this place becomes covered in a rash. It commonly occurs on one side of the body with the most common locations being chest and lower back.
The infection can spread also on the other areas of the skin or even internal organs, especially in immunocompromised patients.
Typically, the symptoms persist for three to four weeks. In rare cases, if the disease is caught at an early stage, it can be treated within 10 days. In some cases, pain syndrome is persistent for several months.
How is shingles diagnosed?
The disease is easily diagnosed just by a look at the symptoms when typical pain and unilateral rash are present. However, at an early stage of development, mistakes in diagnosis can be made if there is no rash. Thus, in the presence of severe pain and no rash, additional tests are made through a laboratory blood test or test of the rash contents.
How is shingles treated?
Most cases of herpes zoster result in self-healing without any therapy. Nevertheless, treatment can substantially alleviate the symptoms of the disease and prevent complications.
Herpes zoster treatment is aimed at:
- Speeding up recovery;
- Reliving pain;
- Preventing complications;
- Lowering the likelihood of postherpetic neuralgia occurrence.
Drug therapy is especially necessary for people with a high risk of complications i.e. with immunodeficiency, and patients aged over 50 years.
Uncomplicated cases are treated at home. Hospitalization is required only in suspected disseminated process (i.e. spread of the virus to the internal organs), with damage to the eyes and brain.
Drugs for shingles
Acyclovir, Valaciclovir and Famciclovir are used to reduce the amount of virus in the body. Valacyclovir is completely converted into acyclovir in the body. The acyclovir molecule has the ability to integrate into viral DNA, thus stopping the multiplication of viral particles. Famciclovir is transformed in the body into penciclovir and acts alike.
The effectiveness and safety of the use of these medicines have been proven by many years of studies. When starting their intake within 72 hours from the occurrence of the first rashes, these medicines are able to substantially diminish the severity of pain, shorten the duration of the disease and the probability of postherpetic neuralgia development. Famciclovir and Valaciclovir have a more convenient intake regimen than acyclovir, but they are several times more expensive but you can opt for a generic version instead of the branded drug and get the same results cheaper.
Reduction of pain is one of the key points in the therapy of shingles. Effective analgesia makes it possible to breathe and move normally and reduces psychological discomfort. In the USA, narcotic analgesics, such as oxycodone, are used for pain relief. Non-narcotic analgesics that can be used include: - Dexketoprofen
For post-herpetic neuralgia, capsaicin-based agents are effective. Amantadine sulfate is the drug of choice for the intense pain relief and the prevention of post-zoster neuralgia due to its own antiviral properties.
Anticonvulsants are usually used for epilepsy, but they also have the ability to lower neuropathic pain. Thus, some of them are used for shingles, for example, gabapentin and pregabalin.
Antidepressants can be prescribed as an addition to the main shingles treatment to reduce the negative neurological effect of the disease.
Corticosteroids reduce inflammation and itching. Some studies have proven their ability, in combination with antiviral agents, to lower the symptoms of mild and moderate forms of the disease. Despite these findings, corticosteroids have not been recognized for the treatment of shingles for safety reasons. Currently, these drugs are not recommended for use in this disease.
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