The  herpes zoster also known colloquially as shingles , is a viral disease caused by a reactivation of the varicella-zoster virus , which can remain dormant for years after the previous infection of chickenpox, why to being the same agent causally, it affects the peripheral nerves and the skin, producing small  painful blisters (rash) in a semicircular shape grouped along a dermatome (area of ​​the skin that is supplied by a single spinal nerve).

In what type of people is it more frequent to observe it?

The herpes zoster is distributed universally and is more common among people watch old age or alterations in their immune system, either of acute type diseases such as respiratory infections, urinary tract, etc., or chronic conditions such as AIDS, SLE (Lupus Systemic Erythematosus), Psoriasis, among others.

Shingles symptoms

The first symptoms of herpes zoster are generally non-pathognomonic (nonspecific) and can often be related to some other temporary reason (stress, flu, etc.), among them are:

  • Fever and malaise
  • Photosensitivity.
  • Headache (headache)
  • Itching (itching or stinging) that will be localized in the affected area.

As the disease progresses its natural course, the following may occur:

  • Paresthesia (numbness and tingling) and hyperesthesia (increased sensitivity) in the affected area.
  • Severe pain in the area of ​​injured innervation (stinging, burning, or burning sensitivity).
  • Skin rash (rash)

The pain that the patient with shingles presents may differ in its characteristics and way of manifesting itself, so it usually develops in acute outbreaks, with periods of calm and exacerbations, and can be confused with other pathologies.

The skin rash produced by shingles begins as erythematous macular lesions after 24 hours, after the first symptoms, which progress to vesicles distributed in dermatomes, in a pattern similar to a belt and without exceeding the midline of the body.

Typically, new lesions can be seen during the first week. After 72 hours, the vesicles turn into blisters filled with serous fluid, generally painful and accompanied by symptoms such as fever, asthenia (weakness) and general malaise. Finally, these skin lesions dry out, remaining as scabs for a period that goes from 2 to 4 weeks.

Where are skin lesions located?

Reactivation of the virus produces a reddening of the skin with small blisters that follow a characteristic metameric distribution, generally on the trunk, although they can also appear in other anatomical locations, such as the face, abdomen, extremities, etc.

The most commonly affected regions are the mid-chest region and the ophthalmic area of ​​the face, where it can affect vision.

Diagnosis of herpes zoster

The diagnosis of herpes zoster is made mainly by the clinical manifestations, being necessary in doubtful cases confirmation by carrying out more complex and specific tests such as the virological culture of the vesicles in the initial phase of the disease, than in the case that the Blisters that have already healed may not be of much use to the test.

Some patients may have related symptoms and not develop a skin rash, which can make diagnosis difficult.

The diagnosis can be supported, in the same way, when the clinical signs are not so clear through laboratory tests, such as the measurement of IgM antibodies specific for the virus, or through tests such as PCR (polymerase chain reaction that allows to estimate viral DNA).

Herpes zoster complications

The shingles may have different complications according to the nerves affected, especially in individuals with immune system not competent or immunocompromised, including those who could be included including respiratory failure or neurological involvement.

The main sequela that can occur once the cutaneous signs have subsided is post-herpetic neuralgia, which consists of a chronic painful sensation at the level of the affected dermatome, which can resolve spontaneously in a few days or remain present for years.

Dr. Eric Jackson

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses. He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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