What are the symptoms of shingles and how to prevent it?

Shingles is a very common skin disease that is usually caused by a virus. There is a certain degree of latency after herpes zoster infection. When the patient has poor resistance, fatigue, or a cold, the virus will grow rapidly and cause obvious inflammation on the skin. There will also be pain, so what are the symptoms of shingles and how to prevent it?

Clinical manifestations

1. Typical manifestations

Before the rash occurs, there may be systemic symptoms such as mild fatigue, low fever, and poor appetite. The affected skin will feel burning or neuralgia, and there will be obvious pain sensitivity when touched, which lasts for 1 to 3 days. The rash may also occur without any prodromal symptoms. The most common sites are the areas innervated by the intercostal nerves, cervical nerves, trigeminal nerves and lumbar sacral nerves. The affected area often first develops erythema, soon followed by millet- to soybean-sized papules, which are clustered and not fused, and then quickly turn into blisters with tense and shiny blister walls, clear blister fluid, and a red halo around the periphery. The skin between clusters of blisters is normal. The lesions are arranged in a band-like manner along a peripheral nerve, mostly on one side of the body, usually not exceeding the midline. Neuralgia is one of the characteristics of this disease, which may occur before the onset of the disease or accompany skin lesions, and is often more severe in elderly patients. The course of the disease is generally 2 to 3 weeks. After the blisters dry up and the scabs fall off, temporary light red spots or pigmentation remain.

2. Special performance

(1) Herpes zoster ophthalmicus is caused by a virus that invades the ophthalmic branch of the trigeminal nerve. It is more common in the elderly and causes severe pain. It can also affect the cornea and form ulcerative keratitis.

(2) Herpes zoster oticus is caused by a virus invading the facial nerve and auditory nerve, and manifests as herpes in the external auditory canal or tympanic membrane. When the geniculate ganglion is affected and the motor and sensory nerve fibers of the facial nerve are invaded at the same time, a triad of facial paralysis, ear pain, and external auditory canal herpes may occur, which is called Ramsay-Hunt syndrome.

(3) Postherpetic neuralgia: Herpes zoster is often accompanied by neuralgia, which can occur before the rash, during the rash, and after the skin lesions have healed. However, it usually disappears after the skin lesions have completely subsided or within 1 month. In a few patients, the neuralgia may last for more than 1 month, which is called postherpetic neuralgia.

(4) Other atypical herpes zoster are related to the differences in the body's resistance of patients, and can manifest as abortive type (no skin lesions, only neuralgia), incomplete type (only erythema and papules appear without blisters and then disappear), bullous type, hemorrhagic type, gangrenous type and generalized type (simultaneous involvement of more than two ganglia, resulting in skin lesions in multiple areas on the contralateral or ipsilateral side). The virus can occasionally spread through the blood to produce widespread varicella-like rash and invade organs such as the lungs and brain, which is called disseminated herpes zoster.

prevention

1. Drug therapy

(1) Antiviral drugs can be selected from acyclovir, valacyclovir or famciclovir.

(2) Drug treatment for neuralgia: ① The main antidepressants include paroxetine (Ceroxetine), fluoxetine (Prozac), fluvoxil, sertraline, etc.; ② Anticonvulsants include carbamazepine, sodium valproate, etc. ③Narcotic analgesics include analgesics represented by morphine. The available drugs include morphine (MSContin), hydroxymorphone (OxyContin), oxycodone, fentanyl (Durogesic), dihydroetofen, and Lugaix. ④Non-narcotic analgesics include NSAIDs, tramadol, aconite, capsaicin, etc.

2. Nerve Block

When severe pain is difficult to control with medication, direct and effective sensory nerve block therapy should be considered. The choice of block location should depend on the extent of the disease and its response to treatment. The general principle should be from shallow to deep, from simple to complex, from peripheral to nerve trunks and nerve roots.

3. Nerve damage

Radiofrequency temperature-controlled thermocoagulation for nerve destruction is the most direct and effective treatment method. Neurodestructive treatment also includes medial thalamic stereotactic radiotherapy (Gamma Knife or X-Knife), surgical subdural spinal cord dorsal root destruction, pituitary destruction, sympathetic trunk ganglion destruction, etc.