The chicken pox , which is a disease that usually affects children, disappears after a while and then the patient is immune.
Over time, we forget about the blisters on our skin and think that the disease will never bother us again. Years later, an uncomfortable tingling in the ribs appears.
She hid. Chickenpox, defeated by the child’s immune system, hid in the body waiting for an opportune moment to return.
This is herpes zoster: a new attempt by a sleeping virus that is not very dangerous, but that we cannot completely eliminate from our body.
Keep reading to learn about shingles!
Herpes zoster, also known as shingles , is a disease caused by the varicella zoster virus (VZV) or human herpesvirus type 3.
This virus is the same responsible for chickenpox (also called chickenpox ), common in children.
When a patient is infected with the chickenpox virus for the first time, blisters appear and, after some time, disappear and the person is cured of chicken pox, usually without the need for medical intervention.
The infection leaves the patient immune to chickenpox, but the varicella zoster virus is not completely eliminated.
It lodges in a nervous ganglion , a structure that connects the nerves to the spinal cord, and is incubated for an indefinite period, often for years.
The nerve ganglia are outside the central nervous system. There are several, and they are located right next to the spine along the spinal cord.
They are arranged in pairs, a ganglion on each side of the body. They can be found from the neck to the base of the spine.
A curious detail about herpes zoster is that as it affects a nervous ganglion (which is at the root of the nerves) and spreads only to the respective nerve, it affects only one side of the body . If herpes zoster is on the right side, it will not spread to the left.
In ICD-10 the herpes zoster code is B02 .
What triggers the incubation of the incubated virus is not certain, but the result when this happens is a reactivation of the virus.
It follows the path of the nerve where it is lodged, causing blisters on the skin similar to those of chicken pox. However, in this case, the bullae are located only in the region where the affected nerve is located.
Herpes zoster cannot be transmitted by air, only by contact, since the active viruses are only present inside the blisters on the skin and on the nerve. Over the course of a few days, the immune system clears the disease.
In chickenpox, the VNV virus lodges in the nerve ganglia that connect to the spinal cord and affects the entire body.
After the immune system conquers the virus, the patient acquires immunity to the disease, but some of them are incubated in the ganglia. Herpes zoster is caused by the awakening of the chicken pox virus.
It is not known exactly what triggers the virus to awaken, but it usually happens years after the initial infection, often in adulthood.
Weakened immune systems or stress are believed to trigger viral reactivation.
The transmission of herpes zoster occurs years before the onset of the disease, initially in the form of chicken pox.
This disease is common in children between 3 and 13 years old and leaves the person immune to infection, but it is possible that someone older will be infected if they have not been vaccinated and never caught the disease in childhood.
Chicken pox can be transmitted in different ways, such as having direct contact with the blisters or with saliva (which can come from coughing or sneezing) from someone infected, and with contaminated surfaces, such as door handles and controls, for example.
It is easily transmitted, spreads quickly, but the disease usually disappears quickly thanks to the immune system.
However, the virus lodges in a nerve, preparing the body for possible future reinfection in the form of herpes zoster.
Is herpes zoster contagious?
Yes , but not in the same way as chicken pox. As herpes zoster is especially localized, it cannot be transmitted through saliva, for example.
Its dissemination is more difficult. The only way is direct contact with the blisters that the disease causes, since the active virus is inside them.
It is also not possible to catch herpes zoster itself. The patient who does not have VZV immunity (because he has not had a vaccine or contracted the disease in childhood) can contract the virus, but the disease will manifest itself in the form of chicken pox.
If the patient is immune, nothing happens and the virus does not manifest itself.
The only risk group for herpes zoster is to have contracted the chicken pox virus in the past. It is important to note that contamination by the chicken pox virus may not necessarily result in the disease manifesting itself.
The immune system may be able to prevent this from happening, which results in the virus lodging in the ganglia without the classic symptoms of chickenpox manifesting. In this case, even if the person has not had chickenpox, they can still have herpes zoster, since the virus is there.
People who have never been infected and come into contact with the virus do not get herpes zoster, but chicken pox, which affects the whole body, and only then are vulnerable to another disease.
However, it is believed that most people have the sleeping virus. If you’ve ever had chickenpox, you’re one of those people. Some conditions that favor the reactivation of the virus are:
Above 50 years
Herpes zoster is more common in people over 50 years of age, probably because of biological changes related to aging.
People who have immune deficiencies, such as HIV carriers , are more likely to develop shingles as the weakened immune system can allow the virus to wake up.
For the same reason as people with immunodeficiencies, when on immunosuppressive treatment, chickenpox virus is more likely to awaken as herpes zoster.
These treatments include chemotherapy or the use of continuous medications that reduce immunity, such as those used after transplants.
Herpes zoster in pregnancy is not a risk, as the disease is very limited to the affected nerve and is unable to reach the baby.
There is no reason to worry, just treat the disease in the same way that you would treat without pregnancy.
However, the situation is different for chickenpox. If you have never had chicken pox, infection with the virus (which, the first time, affects the whole body) can reach the baby, which poses a risk to him. Therefore, it is important to get vaccinated against these diseases.
There are some signs that indicate the presence of herpes zoster, and some are clear indications that it is the disease. The symptoms are:
One of the initial symptoms of herpes zoster, fever is low. It is a signal from the immune system that it is fighting an infection and appears before skin rashes.
The neuralgia is caused by the immune system defending the virus. It is a group of nervous sensations unrelated to external stimuli.
When the VZV awakens and begins to travel the nerve that will be affected, it is possible that there is an itchy skin in the region where the future blisters will appear.
Tingling is another sign of neuralgia, which indicates the onset of shingles. Like itching, this symptom can occur in the region where the blisters will appear, along the length of the affected nerve.
Nerve pain also arises in neuralgia. Because the infection is happening in the nerves, inflammation caused by the body’s defenses can cause pain.
In addition to these symptoms, sensations such as cold, heat and pressure can be felt in the region because of neuralgia.
Viruses lodge at the base of a nerve that comes out of the backbone and, when reactivated, they migrate through the nerve, causing blisters on the skin. They are filled with a liquid that contains the active viruses.
The curious thing about herpes zoster is that it affects only one side of the body .
Since the virus is at the base of the nerve that is connected to the backbone, but is not able to affect the spine directly, it can only go one way and cannot cross to the other side of the body.
Healers and healers took advantage of this symptom, marking a line in the middle of the patient’s body and saying that “it won’t go from here”, making people believe that the bubbles didn’t go to the other side of the body because of what the healer did, when there was no relationship.
The virus can affect any nerve, which means that blisters can appear in various parts of the body such as the legs, arms and even the face, where the symptom is more dangerous as it can affect the eye nerves.
The most common places for blisters to appear are:
- The upper half of the face;
- The shoulders and neck, in the back region;
- In the length of the last rib, both in the front and in the back;
- In the belly, both in the front and in the back.
Herpes zoster blisters can cause severe itching. This symptom is usually relieved by drug treatment, but it is also possible to use cold water compresses to relieve itchy skin.
The diagnosis of herpes zoster is made by the general practitioner , infectious disease physician or dermatologist .
It can be a difficult diagnosis before the blisters appear, which can take 5 to 10 days after the virus awakens.
Until then, the only symptom is neuralgia, which can be caused by a number of other conditions.
When the blisters appear, it is easy to identify the disease with a clinical examination from observation, since their positioning is very characteristic, affecting only one side of the body.
Scraping of lesions
To guarantee the diagnosis, it is possible that the doctor scrapes the lesions, which allows the liquid inside the bubbles to be analyzed for the virus.
Technically not . After a while, viruses are destroyed by the immune system, but some are protected in the nervous ganglion. There, the immune system is unable to eliminate them and the virus returns to the incubator state.
Which means that it is possible for herpes zoster to come back. However, this is extremely rare and only 4% of patients have a recurrence. Anyone who has had shingles is unlikely to have it again.
Herpes zoster usually goes away on its own. The immune system itself is prepared to deal with it most of the time, so the treatment used is usually focused on relieving symptoms until the disease passes.
The exception is when the condition affects the elderly or the face, since in the first case, there is a greater risk and, in the second, vision can be damaged and, therefore, there is a greater need to deal with the disease.
In that case, antiviral drugs are also used.
Medicines used to treat herpes zoster may have the action of fighting infection or simply treating neuralgia , which is a symptom that can cause severe pain in some cases.
The drugs used for the direct treatment of viral infection are not always necessary, since the immune system itself is capable of dealing with the disease in the vast majority of situations.
The medications used are:
Antiviral drugs are used to eliminate viruses from the body. They act in several different ways, preventing the reproduction of the agent, inhibiting its release, stimulating the immune system and many other types of action that vary from antiviral to antiviral.
In the case of herpes zoster, the most used antivirals are:
- Aciclovir (Zovirax);
- Valacyclovir Hydrochloride ( Valtrex ).
It is important to note that acyclovir is a medication that only has an effect on herpes zoster for the first 72 hours after the onset of symptoms.
If the diagnosis treatment is started after that time, it focuses only on reducing the pain until the disease goes away.
Corticosteroid anti-inflammatory drugs
To deal with neuralgia, corticosteroid anti-inflammatory drugs can be used. They reduce inflammation of the nerves, reducing pain and other effects that the immune fight against the virus causes.
There is a disadvantage, however, that this type of medication is immunosuppressive.
They reduce the action of the immune system, which can cause the viral infection to be somewhat prolonged. Therefore, they are often used together with antivirals.
Among the main anti-inflammatory drugs are:
- Prednisona ( Meticorten );
- Dexamethasone ( Decadron ).
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
There are a few things you can do to alleviate your symptoms, make recovery easier, and avoid herpes zoster problems.
Rest can facilitate the work of your immune system. Thus, the virus can be contained more quickly, in addition to helping to avoid possible nerve damage that can lead to complications.
Do not cover the skin
Allowing the skin to be in contact with the air can speed up healing, while covering them tends to make it difficult, in addition to causing damage to the injured skin.
Scratching the bubbles has some negative consequences.
First, it makes healing difficult, as itching can cause sores. Second, it spreads the virus. In the case of herpes zoster, viruses are found inside the blisters and scratching them can cause them to burst.
When the bubbles burst, the virus can be deposited on clothes, objects and in the patient’s hands, which facilitates the contamination of other people.
Apply cold compresses
Herpes zoster ointments should not be used. However, cold compresses can be used to relieve this very uncomfortable symptom.
The prognosis for herpes zoster is usually positive. The wounds caused by the disease tend to disappear in 2 to 4 weeks and, in most cases, leave no complications.
It rarely recurs and presents danger only in cases where it affects the eyes.
There are some possible complications of shingles and they are the main reasons why people should pay attention to the condition.
Post-herpetic neuralgia (Chronic neuralgia)
Post-herpetic neuralgia occurs when, even after herpes zoster is eliminated, neuralgia persists.
This can happen when nerves are damaged during viral infection, which can cause the symptoms of pain, burning and tingling to persist.
Cases of post-herpetic neuralgia, also called chronic neuralgia, can last from 3 months to several years and are more common when herpes zoster affects the elderly.
The condition causes severe pain and suffering, affecting simple movements. Getting up can become a painful action due to neuralgia and even dressing can be tricky.
There is no cure for this complication and the treatment for pain is usually extensive, but it is often the case that nerves gradually regenerate and the need for medication decreases.
Keratitis (in the eye)
The keratitis is an inflammation of the cornea (eye lens) when the infection affects the ocular nerve.
When the virus affects the cornea, it can develop scar tissue, which severely impairs vision.
In cases where the nerve affected by herpes zoster is the facial nerve, with the possibility of damage to the ocular nerve and the eyes, treatment is especially necessary to avoid eye complications and loss of vision.
In rare cases, the chickenpox virus can gain access to the brain, causing inflammation in the organ.
This is extremely dangerous and can cause irreparable damage and sequelae. Therefore, it is very important to seek medical attention to analyze the situation.
Infection with the herpes zoster virus causes inflammation. In cases where the risk is already present, it can cause clogged arteries.
The result of this type of clogging can vary from heart attacks to stroke (stroke). It is rare, but possible.
The prevention of herpes zoster occurs through vaccination against chickenpox and, in cases where the person has already had chickenpox, through vaccination against herpes zoster.
It is extremely difficult to avoid chickenpox without vaccination, as it is a disease that is transmitted very easily, especially among children. Therefore, the most effective way to avoid it is through vaccination.
However, for health reasons, some people cannot be vaccinated. In such cases, some attitudes can make it difficult to contract chickenpox.
Washing your hands thoroughly when you come into contact with people who may have an active contamination reduces the chances of being infected by the virus.
Shared environments, such as buses or classrooms, can have viruses circulating. When you can, avoid crowding and wash your hands after using one of these environments.
There is a vaccine against herpes zoster. As the disease is more common in the elderly, it is recommended that people over 50 years old be immunized, which can be done even if the patient has had a case of herpes zoster before.
However, this vaccine is not on the SUS calendar and can only be taken in private clinics.
It is not very cheap, and can cost up to R $ 450, but it protects against the disease, especially those most vulnerable to it, the elderly.
Who can get the shingles vaccine?
The shingles vaccine can be used by almost anyone, however, there are contraindications. Pregnant women , immunosuppressed people (whether due to illness such as HIV or medication) and people undergoing treatment with corticosteroids should not receive the immunizer, as problems may arise.
The immune systems of these people may have problems with the vaccine, so it should be avoided in such cases.
Can I have herpes zoster more than once?
Although rare, it is possible for a person to develop shingles two or even more times.
The virus is never completely eliminated, only controlled. Therefore, vaccination against herpes zoster can be recommended after 50 years of age, even if the person has already had the disease.
Herpes zoster contagion: how does it get?
It is not possible to contract shingles directly.
First you need chickenpox, also called chicken pox. Chickenpox is transmitted so easily that most people have had the disease, probably in childhood.
The virus can be transmitted both by blistering wounds and by the saliva and cough of people infected with chicken pox.
Herpes zoster appears years after the original infection. In this state, it cannot be transmitted through saliva, but only through contact with the bubbles.
How long does the infection last?
The cycle of the herpes zoster virus lasts between 2 to 4 weeks. Some cases may experience nerve pain for some time beyond that. When this pain is over 3 months, it can already be considered chronic neuralgia.
Is herpes zoster sexually transmitted?
No . The herpes zoster virus is found only in the nerves and blisters caused by the condition, so sex is not a means of transmission.
However, it is important to be careful as direct contact with the bubbles can cause contamination by the virus.
Remember that the herpes zoster virus is not the same as other herpes. There is the genital version of herpes and it is sexually transmitted.
Can I use home remedies on blisters?
No . The blisters of herpes zoster disappear on their own. To deal with the itchiness, use cold water compresses, always as directed by a doctor. Drug treatment usually relieves the symptom.
The use of homemade recipes in the blisters can facilitate an infection by bacteria, which can progress to a more serious condition.
Herpes zoster is a disease that can affect anyone who has contracted chicken pox at some point in their life. It causes nervous pain and the appearance of blisters that disappear in a few weeks.
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