HERPES ZOSTER

Shingles (herpes zoster) is a

blistering rash (blisters) and
painful. It is due to the varicella virus.
shingles. That is the same virus that
causes thechickenpox.

History:
The description of shingles is
present in medical texts since
a long time ago, but these stories
historical figures do not distinguish the formation of
blisters caused by VVZ and the
caused by
thesmallpox, ergotismyerysipelasIt was not
until the end of thecentury
EighteenwhenWilliam Heberdenestablished
a way to differentiate between herpes
shingles and smallpox, and at the end of the 19th century
it was distinguished from erysipelas.13In
1831,Richard Brighthe upheld the hypothesis that
the disease arose from thedorsal root ganglion, local was confirmed byFelix
from bear springin 1861.
The first signs that the chickenpoxand shingles are caused by the
the same virus was observed in early 20th century. Some doctors began
to report that cases of chickenpox were occurring in young people living together
with patients affected by shingles. The idea of an association between the two
diseases took shape when it was demonstrated that thelinfaof a person who
suffers from shingles can induce chickenpox in young people. Finally, the
the relationship was demonstrated by isolating the virus in cell culturesprize
NobelThomas Huckle Wellerin 1953.
Until the 1940s, the disease was considered benign and the
serious complications were thought to be very rare. However, in 1942, they
he acknowledged that shingles is more severe in adults than in children, and that
the frequency increased with age. Other studies during the 1950s
in individualsimmunocompromisedthey showed that the disease was not so
benign as it was thought, beginning to seek therapeutic measures
preventive.

Epidemiology
Shingles is a disease distributed worldwide. Unlike
thechickenpoxshingles does not exhibit seasonality. It is estimated to affect
around 20% of the population, with a higher risk for thosepeople
Caucasianthan the othersethnicities.1819It can appear at any age,
although it is more common in people over 50 years old. Other risk factors
they are thestress, exposure toimmunotoxinsand thetraumas.
Approximately 4% of patients suffer a second episode of
shingles, and more cases have been reported in some patients.
Theincidentof this pathology varies in different age groups. The
the annual frequency of shingles is 4.8 cases per 1000 inhabitants and
About 75% of cases occur in people over 50 years old.8The
The annual incidence is 1-3 cases per 1000 inhabitants in those under 50.
years, while for people aged between 50 and
79 years, it is 5-7 cases per 1000. The incidence rises to nearly 11.
cases per 1000 individuals over 80 years old. In young children, the
shingles is rare. If during thegestationthe mother has suffered from chickenpox,
there may have been a primary infection of thefetoin theuterusand that develops
shingles in thelactation.
In a study, it was estimated that 26% of patients who contract herpes
shingles develop complications. Postherpetic neuralgia occurs in
approximately 20% of the patients. Another study conducted
inCaliforniaIn 1994, he found hospitalization rates of 2.1 patients for each
100,000 people per year, reaching 9.3 per 100,000 people per year for
over 60 years old.23A previous analysis inConnecticuthello a rate of
even greater hospitalization, possibly due to the prevalence of theHIVin the
first study, or the introduction of theantiviralsin California before 1994.

What is shingles?
Shingles or herpes zoster is a rash of bumps or blisters on the skin.
It is caused by the varicella-zoster virus, the same one that causes the chickenpox.
After having chickenpox, the virus remains in your body. It may not cause
problems for many years, but as the virus ages it can
reappear like a little snake.
Is shingles contagious?
Shingles is not contagious, but someone with shingles can spread it.
chickenpox. If you have never had chickenpox or have not received the chickenpox vaccine,
try to stay away from someone who has shingles.
If you have shingles, try to avoid getting close to those who have not had it.
chickenpox or have not been vaccinated against chickenpox, or any person
that may have a weak immune system.
Who is at risk of having shingles?
Anyone who has had chickenpox is at risk of developing shingles.
But this risk increases as you age. Shingles is more common in
people over 50 years old.
People with weak immune systems are at a higher risk of having
little snake. This includes those who:
They have diseases of theimmune systemlike theHIV and AIDS
They have certain types of cancer.
They take immunosuppressive medications after atransplant of
organ
Your immune system may be weakened when you have an infection or are
stressed. This may increase your risk of shingles.
It's rare to have shingles more than once, but it can happen.
What are the symptoms of shingles?
The first signs of shingles include burning or stabbing pain and tingling or
itching. Generally, it occurs on one side of the body or the face. The pain can be
from mild to severe.
Between one to 14 days later, you will have a rash. This consists of blisters that
they usually last between seven and 10 days. The rash usually appears in a
only band around the left or right side of the body. In other cases, the
eruption occurs on one side of the face. On rare occasions, usually in
people with weakened immune systems, the rash may be more
extended and resembling a chickenpox eruption.
Some people may also present other symptoms, such as:
Fever
Headache
Chills
Abdominal pain

What other problems does shingles cause?

Shingles can cause complications, such as:
Postherpetic neuralgia: It is the most common complication of shingles.
Causes intense pain in the areas where the shingles outbreak occurred.
general, improvement in a few weeks or months. But some people
they can have pain from postherpetic neuralgia for many years and
it can interfere with daily life
 If shingles affects your eye, you may haveloss of visionIt could be
temporary or permanent
Hearing problemsoequilibriumThey are possible if it has shingles inside or
near your ear. It can also cause weakness of the muscles in that
side of the face. These problems can be temporary or permanent
On very rare occasions, shingles can also causepneumoniainflammation
of the brain ( encephalitis) or death.

How is shingles diagnosed?

In general, your healthcare provider can diagnose shingles.
seeing your medical history and observing the rash. In some cases, it may
take a sample of the tissue from the rash or the liquid from the blisters and send it
to a laboratory for its analysis.
What are the treatments for shingles?
There is no cure for shingles. Antiviral medications can help.
that the outbreak is shorter and less severe. They can also help prevent
postherpetic neuralgia. Medications are more effective if you can
take them within three days of the appearance of the rash. For this reason,
If you think you might have shingles, talk to your healthcare provider.
as soon as possible.

Thepain relieversthey can also help with the pain. A cold towel, lotion
calamine and oatmeal baths can help relieve some of the itching.
Can shingles be prevented?
Vaccines exist to prevent shingles or reduce its effects. The Centers
The Centers for Disease Control and Prevention (CDC) recommend that the
healthy adults aged 50 years or older receive the Shingrix vaccine. You need two.
vaccine dose, separated by two to six months. Another vaccine, Zostavax, is
can be used in certain cases.

Transmission:

Shingles cannot be transmitted from one person to another. However, the virus
what causes shingles —the varicella-zoster virus— can be spread by
a person who has active shingles to another person who has never had it
having had chickenpox. In such cases, the exposed person may get chickenpox, but
no shingles.
The virus spreads through direct contact with secretions from the
blisters from the rash caused by shingles.

A person with active shingles can spread the virus when the rash is
finds in the blister stage. The person is not contagious before
the blisters appear. When the scabs form on the blisters, the person
stop being contagious.

Shingles is less contagious than chickenpox and the risk of a person with the
The spread of the virus from shingles is low when the rash is covered.

If you have shingles:

Keep the rash covered.

Avoid touching or scratching the rash.
Wash your hands frequentlyto prevent the spread of the virus of
chickenpox shingles.
Until scabs form on the blisters of the rash, avoid the
contact with the following people:

oPregnant women who have never had chickenpox or do not know.

have been vaccinated against this disease;
o premature babies or those with low birth weight and
opeople with weakened immune systems (such as those who take
immunosuppressive medications or are receiving chemotherapy,
those who have received organ transplants and those who have the
infection by the human immunodeficiency virus (HIV).

Prevention:
 One of the ways to prevent the appearance of this pathology through
vaccination of children against chickenpox. According to the Advisory Committee on Vaccines
from the Spanish Association of Pediatrics, the vaccine against chickenpox, "contains a
small portion of live viruses that help stimulate the body's defenses without
producing disease or producing a very mild form," he assures.

Types:
There are no types of this disease.
Diagnosis:

To properly assess the presence of this virus, the doctor usually does
a physical inspection of the patient to detect possible rashes and blisters
that may have appeared as a consequence of shingles.
If there are still doubts, one way to confirm the diagnosis is to take a sample of
blood of the affected person and send it to the laboratory to analyze it and see if there is
elevated concentrations of antibodies. Additionally, a bit of skin can be extracted.
to analyze it and see if there is presence of shingles.

Tratamientos:
In cases of healthy individuals, treatment is usually unnecessary, except to alleviate the...
discomfort caused by itching and [Link]-inflammatories can also be prescribed.
to reduce the increase in body temperature and to alleviate pain.
It is advisable to maintain proper hygiene of rashes and blisters until
that they improve to avoid getting infected. The correct thing is to maintain
rest during the time recommended by the doctor and apply soothing baths to the
affected people.
It appears in cases of people with immune system problems such as
patients fromHIVantiviral treatments can be applied to eliminate this virus
in a shorter period of time and, in addition, help to lessen the discomfort that
it causes in the sick.

Other data

Complications:
The possible complications that may arise from this disease
they can be the following:
The emergence of the pathology again.
Skin infections derived from shingles.

It can cause blindness and deafness.

Infections such asencephalitiso sepsiswhich are more serious, especially in

people who have some deficiency in the immune system.

Ramsay Hunt syndrome may appear, which manifests with a rash.

in the dermis surrounding the ear area when the chickenpox virus affects any
nerve located in the head area.

Postherpetic neuralgia. It is a common neurological complication according to

SEDolor. It is defined as 'the persistence of pain after the initial episode,'
considering a period of three months," they assure.

Antiviral therapy:

Oral antiviral treatment reduces the severity and duration of

the acute eruption and the rate of serious complications in patients
immunodeficient; it may reduce the incidence of postherpetic neuralgia.

The treatment for shingles should be started as soon as possible, ideally

during the prodromal period, and it is usually not effective if administered more than 72
hours after the appearance of the lesions. Famciclovir (500 mg orally
3 times a day for 7 days) and valacyclovir (1 g orally 3 times a day
for 7 days) have greater oral bioavailability than acyclovir, because of the
What is usually preferred for shingles instead of 800 mg of acyclovir for
oral route 5 times a day for 7 to 10 days. Corticosteroids do not decrease the
incidence of postherpetic neuralgia.

For patients with less severe immunocompromise, there are options

reasonable famciclovir, valacyclovir, or acyclovir orally (see above);
famciclovir is preferred and valacyclovir. In patients with
severe immunodeficiencies, it is recommended to administer 10 to 15 mg/kg of
acyclovir intravenously every 8 hours for 10 to 14 days in adults and
from 10 to 20 mg/kg intravenously every 8 hours for 7 days in the
children under 12 years old.

Although data on the safety of acyclovir and valacyclovir during the

Pregnancy is reassuring, the safety of antiviral therapy during the
pregnancy is not firmly established. Because congenital chickenpox
It can be the result of maternal chickenpox, but it is rarely due to shingles.
maternal, the potential benefit of treatment for pregnant patients
must outweigh the possible risks to the fetus. Pregnant patients with
severe eruption, strong sharp pain or ophthalmic shingles can be treated with
valaciclovir or aciclovir, especially in the later stages of pregnancy.

Management of postherpetic neuralgia:

The treatment of postherpetic neuralgia can be particularly difficult. The

treatments include gabapentin, cyclic antidepressants, and topical capsaicin or
lidocaine ointment. Opiate pain relievers may need to be used.
administration of methylprednisolone via intrathecal route may be useful.

A recent study suggests that injecting the entire affected area with toxin
Botulinum toxin A (40 injections in a chessboard pattern) can reduce the
pain.