Herpes zoster

"In the indicated cases it is essential to start antiviral treatment early to avoid chronification of the herpes virus infection".

DR. PILAR GIL SÁNCHEZ
SPECIALIST. DERMATOLOGY DEPARTMENT

The herpes zoster virus is called this because it is the agent responsible for both chickenpox and shingles.

Usually the first contact with the virus is in childhood and is manifested clinically as chickenpox.

After this infection, the virus migrates through the nerve endings from the skin to the ganglion and there it remains latent, reappearing in the skin in certain situations giving rise to the so-called herpes zoster.

Herpes zoster is generally a self-limited condition that resolves spontaneously in one or two weeks. In some patients a postherpetic neuralgia of variable duration may persist.

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What are the symptoms of herpes zoster?

The patient feels a sensation of itching or pain in a cutaneous territory (preferably the trunk) and 4 or 5 days later presents a reddening of the skin in that zone on which some vesicles sprout that are arranged grouped.

During this phase the lesions are highly contagious because the virus is inside the vesicles.

After 7 to 10 days, the lesions dry up, forming yellowish-brown scabs that are eliminated, sometimes leaving a residual scar. The territories most frequently affected are the trunk, thigh or eye region. This last one presents a greater gravity since the risk of formation of corneal ulcers exists that lead to the blindness.

Sometimes, after the episode of herpes zoster a residual pain can persist in that location that remains for days, months and even years, being called postherpetic neuralgia. This happens more frequently in individuals whose age exceeds 50 years.

What are the most common symptoms?

  • Itchy or painful sensation in a skin area.
  • Burning sensation.
  • Blisters.

Do you have any of these symptoms?

You may have a herpes zoster

Who can get herpes zoster?

It mainly occurs in adults, but is increasingly common in children. To suffer it is necessary to have been previously in contact with the virus and to have passed the chickenpox.

The frequency of presentation of this disease and its severity are greater in individuals who are immunosuppressed, either by chemotherapy or radiotherapy treatments or immunosuppressive drugs such as transplant patients.

Also included in this group are patients affected by AIDS and those who have tumors or other diseases that determine a situation of immunosuppression.

However, it is also common to observe herpes zoster in immunocompetent people in situations of weakness or tiredness.

What is your prognosis for herpes zoster?

Herpes zoster is usually a self-limited condition that resolves spontaneously in one or two weeks. In some patients a postherpetic neuralgia of variable duration may persist.

In immunosuppressed patients, there is a risk of generalization of the virus affecting other organs and a worse prognosis. Hence the importance of early diagnosis and treatment in these patients.

Regarding the location, ocular herpes has a worse prognosis than the rest, due to the possibility of evolving into blindness.

It is important to comment that herpes zoster is a contagious disease and during its duration contact with people who have not been in contact with the virus previously should be avoided, especially if they are immunosuppressed or pregnant women.

How is herpes zoster diagnosed?

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The diagnosis of herpes zoster is mainly made by the clinic. In doubtful cases it can be confirmed by performing a virological culture of the vesicles in the initial phase of the disease.

The cause of the virus in the nerve is unknown, as well as the predisposition of each individual to suffer the disease.

The reactivation of the virus produces a reddening of the skin with small blisters that follow a characteristic metameric distribution, usually in the trunk, although other anatomical locations are not uncommon.

How is herpes zoster treated?

Herpes zoster is treated with oral or intravenous antiviral drugs, but it is not always necessary to treat it, as it resolves spontaneously in about 7 days.

Treatment is mainly indicated in immunosuppressed patients, due to the risk of spreading the virus to other organs. In these patients it is necessary to use the intravenous route for treatment.

Treatment with oral antiviral drugs is also indicated in patients over 50 years old, to reduce the possibility of developing postherpetic neuralgia (brivudine, acyclovir, valacyclovir, famciclovir).

It is important to note that treatment is effective if started within the first 72 hours from the beginning of the vesicles and that superinfection of the lesions must be avoided through the use of topical antiseptics.

Postherpetic neuralgia, if it occurs, can be treated with analgesics and, if it does not improve, other drugs such as antiepileptic or antidepressant can be used.

Where do we treat it?

IN NAVARRE AND MADRID

OUR MEDICAL TEAM

Specialists of the Department of Dermatology

The Department of Dermatology of the Clinica Universidad de Navarra has extensive experience in the diagnosis and treatment of dermatological diseases.

We have extensive experience in highly precise surgical treatments, such as Mohs surgery. This procedure requires highly specialized personnel. 

We have the latest technology for the dermo-aesthetic treatment of skin lesions, with the aim of achieving the best results for our patients.

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Why at the Clinica?

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