Shingles is a viral, painful, self-limiting disease. It is caused by the reactivation, at any point in time, of the chickenpox virus, which remains dormant in the nervous system for many years after the onset of the disease.
The risk of developing shingles, as well as its complications, increases with age and most often affects people over 50 years of age, says Ms. Aikaterini N. Trikkalinou, MD, PhDc, Postgraduate Diabetologist, Metropolitan Diabetic Hospital Curator .
What are the symptoms?
Symptoms of shingles range from mild to very severe. Typically manifested by early sensory disturbances (burning, paraesthesia, constant or intermittent pain in a dermatome – area of ​​skin connected to a specific spinal nerve) lasting 1-10 days, and may mimic other conditions (eg thoracic pain, sciatica, endoscopy inflammations etc.), while it may be accompanied by myalgias and fever.
This is followed, after a few days, by the appearance of a blistering rash, often on the upper part of the body (chest and neck). The rash heals gradually (in a few weeks) unless it is complicated by a skin infection or permanent scarring. In 10-20% of cases the eye is affected, which can lead to worsening of vision or even blindness. As long as the blisters are present, chickenpox can be transmitted to people who have not been ill before.
Although in most cases the disease is self-limiting and the pain subsides with the healing of the rash, a percentage of chronic complications remain – especially in the elderly (up to 20% of people with shingles over 50 years). The most common and important of these is Curative neuralgia, which is a long-term neuropathic pain lasting more than 30 days, caused even by very mild irritations, such as the touch of clothes or a light breeze. It can last for years or even years and its effects are very serious, because they disrupt sleep, mental health, work, social life and quality of life in general and, in addition, can be difficult to cure.
Diagnosis
The diagnosis is clinical and is based on the patient’s medical history and medical examination. Laboratory detection of the virus is performed by molecular PCR detection from a bubble or blood sample only in atypical cases that mainly involve immunocompromised patients.
Treatment
The treatment is mainly symptomatic and relieving with aluminum water compresses and topical calamine lotions. Cortisone use is controversial, and pain is treated with non-steroidal anti-inflammatory drugs, opioids, antiepileptics or antidepressants.
Specific antiviral therapy (acyclovir, famciclovir, valaciclovir) is given to reduce the duration of the rash and the neuropathic pain and, in order to be effective, it must be started within 72 hours of the rash appearing.
In-hospital treatment is recommended in severe conditions, where there is an infection of the eye, central nervous system or diffuse infection as in the case of immunocompromised patients, infection of more than one dermatome and bacterial infection of the facial lesions.
Vaccination is recommended as a precaution in adults aged 60-75 years, while, in very vulnerable groups, intravenous immunoglobulin may be given after exposure to the virus.
Written by Mrs. Aikaterini N. Trikkalinou,
MD, PhDc, Postgraduate Diabetologist, Curator of the Diabetological-Cardiometabolic Center of Metropolitan Hospital.
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