The legendary "snake sore" - shingles
Ms. Wang, 62, has always been in good health, but after winter, Ms. Wang found that a small blister appeared on the skin of her right rib, which was hot and painful, and it was a little itchy.
Ms. Wang's first reaction was that she had the commonly known "snake sore", so she hurried to the dermatology department of Dandong Hospital of Traditional Chinese Medicine, and the doctor diagnosed that Ms. Wang had shingles.
What is shingles?
Herpes zoster is an infectious skin disease caused by the reactivation of varicella-zoster virus (VZV), characterized by skin lesions and neuropathic pain. VZV can be transmitted by droplets and/or contact, and the primary infection causes chickenpox.
When the body's immunity is reduced, the latent virus is reactivated to cause shingles. Risk factors for VZV reactivation include: advanced age, trauma, systemic diseases (such as diabetes, kidney disease, fever, hypertension, etc.), human immunodeficiency virus (HIV) infection, immunosuppression due to malignant tumors, etc.
The incidence of herpes zoster in the general population worldwide is (3 ~ 5) per 1 000 person-years. The incidence of herpes zoster in mainland ≥ 50-year-old population was (2.9 ~ 5.8) per 1 000 person-years, and the lifetime prevalence rate of women (3.94% ~ 7.9%) was slightly higher than that of men (2.86% ~ 7.6%).
Clinical manifestations of herpes zoster
Probolate symptoms
There may be mild fatigue, low-grade fever, loss of appetite and other systemic symptoms, the affected skin feels burning sensation or neuralgia, and there is obvious pain sensitivity to the touch, or there may be no prodromal symptoms.
Features of skin lesions
Typical lesions present as clusters of blisters with pain along the dermatome, which have been shown to occur in the corresponding dermatomes of the intercostal nerves (53%), cervical nerves (20%), trigeminal nerves (15%), and lumbosacral nerves (11%). Lesions are banded along a peripheral nerve region, usually on one side of the body, usually no longer than the midline. The course of the disease is generally 2~3 weeks, and the elderly are 3~4 weeks. The blisters dry up and the scabs fall off, leaving temporary pale erythema or pigmentation.
Symptoms of self-awareness
Pain is the main symptom of herpes zoster, also known as herpes-associated pain (ZAP), and the chronic phase of ZAP is PHN: pain that lasts for more than 90 days after the appearance of the rash. Older and frail patients have more severe pain. In addition to pain, some patients experience itching. Severe pruritus is caused by constant scratching of the lichenified skin.
Special clinical types
Ocular shingles
It is more common in older people and can manifest as unilateral eyelid swelling or bilateral, conjunctival hyperemia, often severe pain, often accompanied by ipsilateral headache, and can involve the cornea to form ulcerative keratitis.
Herpes zoster in the ear
It is caused by the virus invading the facial nerve and auditory nerve, and is manifested as herpes in the external auditory canal and pain in the external auditory canal.
Abrupt shingles
Only erythema, papules, and no blisters develop.
Shingles without exanthema
There is only pain in the dermatome area and no rash.
Recurrent herpes zoster
Refers to herpes zoster that does not occur for the first time, which is rare in immunocompetent people and has a higher recurrence rate in immunosuppressed people.
Central nervous system herpes zoster
Viral encephalitis and meningitis occur when the brain parenchyma and meninges are violated.
Visceral shingles
When the splanchnic nerve fibers are violated, it causes acute gastroenteritis and cystitis, which is manifested as abdominal cramps, difficulty urinating, and urinary retention.
Generalized herpes zoster
Refers to the simultaneous involvement of 2 or more ganglia, with lesions on the contralateral or ipsilateral multiple dermatomes.
Disseminated herpes zoster
In patients with malignant tumors or extremely weakened immune function, the virus spreads through the blood, resulting in a generalized varicella-like rash on the skin of the whole body except for the affected dermatomes, often accompanied by systemic poisoning symptoms such as high fever.
So, how to treat shingles, how to quickly relieve the symptoms, shorten the course of the disease?
Contributed by: Dermatology
Editor: Advocacy Section