Be wary of “puzzling” shingles

Herpes zoster is a viral skin disease caused by the reactivation of the varicella-zoster virus lurking in the human body. It is often clinically manifested as clusters arranged in bands on one side of the body. Blisters or pustules are often accompanied by obvious neuralgia.

The Roman scholar Celsus was the first to use the word “Herpes Zoster” to describe this skin lesion surrounding one side of the body. The word “Herpes” is derived from the Greek word meaning “crawling”, and “Herpes Zoster” “Zoster” comes from Latin and means “belt”, which means that this disease crawls over half of the body like a snake and wraps around the body like a belt.

In our country, there have been records of herpes zoster as early as the Sui Dynasty. The Sui Dynasty physician Chao Yuanfang referred to this disease as the “Zang Zhuang”, and his book “Theories of Various Disease Sources·Zang Zhuang Zhuang” It is recorded in Volume 35: “The person with the sore on the retort is born around the waist…like a retort belt, because it is named.” There are also many records in later generations of doctors, and the name of the disease is varied, such as “snake-wrapped sore.” “Loin waist fire pill”, “open flame with sore”, “snake sore”, “spider sore”, etc., and so on. So far, the folks in our country still call it “snake disk sore”.

● How does shingles happen
When it comes to shingles, one has to talk about its “twin brother”-chickenpox. Varicella and shingles are a group of homologous diseases caused by the same virus-varicella-zoster virus.

Varicella-zoster virus, also known as human herpesvirus type 3, belongs to the alpha subfamily of the Herpesviridae family, and humans are its only natural host. It is mainly spread through direct contact with respiratory droplets or blister fluid.

When a patient is infected with this virus for the first time, it is mainly manifested as chickenpox, and a small number of people have an insidious infection. After the viremia is cleared by the human immune system for the first time, the virus tends to move through the sensory nerve endings of the skin along the nerve fibers to the posterior root ganglia of the spinal cord, and stay lurking in the neurons there for a long time. When stimulated by external factors (which also occurs spontaneously), the varicella-zoster virus lurking in neurons will be reactivated and replicated in neurons in large numbers. In this way, the varicella-zoster virus can re-migrate along the nerve fibers back to the skin on the one hand, and produce specific nerve segmental distribution on the skin, namely herpes zoster; on the other hand, it can cause neuroinflammation. , Produces severe neuralgia, that is, herpes zoster neuralgia.

● Is shingles contagious?
We know that chickenpox is very contagious, so is it also very contagious, its “brother disease”-shingles? Since shingles is a manifestation of the latent varicella-zoster virus reactivation, there is no risk of infection if healthy people come into contact with shingles patients. However, if you come into contact with herpes zoster fluid, the varicella-zoster virus can be transmitted to individuals who have not been infected with chickenpox, causing them to develop chickenpox. Because the main way of transmission of chickenpox is respiratory droplets, the probability of getting chickenpox through contact with herpes zoster fluid is not high. It is good to pay attention to isolation and protection in daily life.

Therefore, shingles cannot be transmitted to each other, but healthy people who have not been infected with chickenpox have a smaller probability of getting chickenpox through contact with blister fluid.

● What are the manifestations of herpes zoster
How can we recognize the signal from shingles as early as possible? The typical course of herpes zoster can be divided into 3 stages, with different stages and different symptoms.

Prodromal stage: More than 90% of patients may first experience local skin itching, pricking (tenderness) pain, hyperesthesia and (or) severe pain. Since there is no rash at this time, the patient may be misdiagnosed as myocardial infarction, acute abdomen, or oral disease.

Blister stage: After 1 to 3 days, most patients will have clustered blisters on one side of the body on the basis of erythema, accompanied by obvious pain, and the distribution area of ​​blisters corresponds to the sensory nerve segment on one side of the human body.

In most cases, these water (pust) blisters are small and dense, and will appear in a sensory nerve segment on the side of the midline of the body, but there are also bullous skin lesions. In severe cases, the blisters can also cross the midline of the body or involve multiple sensory nerve segments. The natural course of the blister phase is 2 to 3 weeks for children and young people, and 3 to 4 weeks for the elderly.

Post-herpetic neuralgia: Children and young people with a healthy immune system often have no obvious sequelae after herpes zoster is cured. However, the elderly and those with weakened immunity may often have more severe post-herpetic neuralgia, which can be manifested as Spontaneous pain (pain in the affected area and nearby areas without stimulation), hyperalgesia (increased response to stimulation), paresthesia (the diseased area is often accompanied by some paresthesias, such as ants walking sensation, numbness, itching) And other symptoms. In 30%-50% of patients, symptoms will persist for more than one year.

● Be alert to special types of shingles
Don’t underestimate herpes zoster. In addition to the pain that is unbearable, if you do not receive effective treatment in time, it will also bury hidden dangers to your health. Due to the different parts of the virus invading, some special types of shingles should be paid special attention to.

Facial shingles: Shingles that occurs on the face not only has relatively severe pain, but also often invades the trigeminal nerve, facial nerve, and auditory nerve, which can cause corneal ulcers, facial paralysis, tinnitus, deafness, vertigo, nystagmus and other symptoms.

Herpes zoster meningitis: Varicella-zoster virus may invade from the posterior root of the spinal cord to the central nervous system, causing headaches, vomiting, seizures, ataxia and other symptoms.

Visceral herpes zoster: The virus may invade the visceral nerve fibers from the posterior root of the spinal cord, causing symptoms in the urinary tract and gastrointestinal tract.

When the above symptoms appear, the patient must seek medical treatment in time and seek the help of a specialist.

● Being “wrapped up” by herpes zoster, get timely treatment
The following three types of special people should be extra vigilant about herpes zoster:

(1) The elderly.

(2) AIDS patients and malignant tumor patients.

(3) Patients who are receiving chemotherapy and immunosuppressive therapy.

The above three types of people are more prone to reactivation of varicella-zoster virus due to their low cellular immunity. Once these three types of people suffer from herpes zoster, they often have severe symptoms and more complications, so they must be accepted in time. treatment.

At present, the treatment methods for herpes zoster include antiviral therapy, analgesic therapy, nutritional nerve therapy, and local symptomatic therapy.

Receiving antiviral treatment in time can significantly shorten the duration of herpes zoster pain, and can also prevent post-herpetic neuralgia. Within 72 hours after the appearance of the blister, the earlier antiviral treatment is given, the better the effect.

Analgesic therapy can significantly improve the quality of life of patients with herpes zoster, and is an important treatment for post-herpetic neuralgia. Many middle-aged and elderly friends may resist analgesic therapy, thinking that analgesic therapy treats the symptoms but not the root cause, but the main hazard of shingles is pain. When pain becomes a disease, analgesia is the root cause. In addition, short-term use of painkillers under the guidance of a doctor will not only prevent addiction, but also greatly reduce the impact of shingles on life.

● Vaccination is currently the best prevention method
The occurrence of herpes zoster is related to the decline of cellular immunity and the reactivation of varicella-zoster virus in neurons. Therefore, vaccination of recombinant herpes zoster glycoprotein E vaccine can effectively improve cellular immunity and prevent virus reactivation.

In early July 2020, the first recombinant shingles vaccine approved by the National Medical Products Administration completed its first injection in Shanghai. After the vaccine was launched, many people were concerned about whether they were suitable for vaccination. According to the official instructions of the National Medical Products Administration and the Chinese instructions of the drug, the recombinant shingles vaccine is suitable for the prevention of shingles in adults aged 50 and above.

Here we suggest that people over the age of 50, regardless of whether they have a history of chickenpox and shingles, should be vaccinated to prevent shingles. The protective effect of the recombinant shingles vaccine can reach more than 90%, and its protective effect can be maintained8 ~10 years. Of course, the recombinant shingles vaccine is not suitable for everyone, so you must consult a professional doctor before injection.