HERPES ZOSTER
Where is it due to?
The VZV virus is responsible for the occurrence of chicken pox and shingles. Essentially, chicken pox results from the initial infection with the virus, and herpes zoster is the result of the resurgence of the latent infection. Herpes zoster occurs in about 20% of healthy adults and 50% in immunocompromised individuals. It affects both sexes equally and 2/3 of cases occur in people over 50 years of age. If it occurs in a healthy adult before the age of 50, it is usually in people who contracted chickenpox very early in their 1st year of life. The severity of the disease increases significantly with increasing age.
How is it transmitted?
After the primary infection with the virus precedes and the varicella is clinically manifested, at 14-16 days after infection, the virus is removed from the epidermis through the nerve endings and settles in the spinal ganglia, where it remains in a latent state. Any reduction in the body’s defenses (injury, surgery, immunosuppression, intense stress, radiation) leads to reactivation and multiplication of the virus in the area. Initially, there is destruction and necrosis of the cells in the nerve ganglia and nerve fibers, resulting in intense pain. Then the virus follows a centrifugal path and through the nerve fibers ends up in the nerve endings of the skin and the epidermis where the characteristic rash is created. A patient with shingles can transmit chickenpox to a healthy person (who has not had the disease in the past) if they come into contact with the fluid from the blisters. Conversely, a patient with chicken pox or shingles cannot transmit shingles to another person, only chicken pox, since shingles is the result of a resurgence and not a new infection. The extensive inflammation and destruction of the nerves in the area affected by the virus leads to chronic and intense pain, known as postherpetic neuralgia.
Clinical picture
The precursor symptoms before the appearance of the rash are local pain, burning sensation, itching and hypersensitivity in the area of the affected neurotome in more than 90% of cases. The pain is diagnostic and a differential diagnosis should be made from acute myocardial infarction, angina pectoris, colic and back pain. Initially spots appear, which within 24 hours turn into blisters and then pustules. In some cases there is accompanying fever and lymphadenitis. 50% of herpes zoster cases occur in the area of the neurotomies between the T1 and O2 vertebrae. A frequent location also (10-15%) is the area of the 1st trigeminal branch. Involvement of the ophthalmo-nasal branch causes a rash in the eye area with severe swelling of the eyelids, extension to the corresponding side of the nose, and frequent corneal involvement (Hutchinson’s sign). The patient should be referred for an ophthalmological evaluation, because conjunctivitis, keratitis, scleritis, anterior uveitis may occur and if the patient does not receive treatment it leads to permanent corneal ulceration, optic neuritis and possible blindness in severe cases. Affection of the 2nd and 3rd branches of the trigeminal causes a rash on the cheek, jaw and oropharynx respectively. In case of involvement of branches of the facial and auditory nerve (Ramsay-Hunt point), facial paresis occurs (in 75% of cases) and a herpetic rash of the external auditory canal. The patient should be examined by an ENT because neglected cases lead to ear drum injury and possible deafness
The most frequent complication of herpes is postherpetic neuralgia (MEN), in a percentage of 10-15% and its severity increases with age.
Treatment
See your dermatologist immediately, because herpes zoster requires immediate medical treatment.
Herpes simplex
Where is it due to?
Herpes simplex infections are caused by two different types of the virus, HSV-1 and HSV-2, which cause cold sores and genital herpes. The infection has similar characteristics regardless of the type of virus. At a global level, it has been shown that antibodies against HSV-1 at the ages of 20-40 reach rates of the order of 90%. In children under 10 years of age, herpes infections are 80-90% due to HSV-1 and are often asymptomatic. HSV-2 is associated, in 70-90% of cases, with herpes manifestations in the genital area, although several studies in recent years attribute genital herpes to HSV-1 (by 10-30%), due to oral-genital contact.
How is it transmitted?
The transmission of the virus takes place mainly through saliva or other secretions and after the continuity of the affected mucous membrane is dissolved, the herpes virus is installed in the nucleus of the cells. This is followed by the replication of the virus and the destruction of the affected cells, resulting in the intense inflammatory reaction of the cell and the formation of the characteristic blister. Subsequently and after the active infection has passed, the herpes viruses follow a centripetal course through the nerve endings and settle in a latent state in the nerve ganglia of the region. During the latent period, the virus remains non-infectious and can remain in this state for long periods of time. Its reactivation can be done automatically but usually factors such as stress, fever, immunosuppression, exposure to ultraviolet radiation, menstruation, viruses, psychosis, etc. affect and mobilize the virus. Patients with neoplasms, HIV infection and generally depressed patients present more frequent and heavier relapses.
Clinical picture
Herpetic primary infection
Symptoms of primary infection appear 3 to 7 days after infection with the virus. Prognostic symptoms include painful lymphadenopathy, malaise, anorexia, fever, local pain, and burning and tenderness. We will rarely encounter herpes simplex infection in infants, because as mentioned above the majority of the population has antibodies against HSV-1, so infants get antibodies from the mother. After the first year of life and after antibody titers fall, primary infection can occur. It often presents as herpetic gingivitis in children with fever, erosions of the oral mucosa, painful lymph nodes and pharyngitis. In young adults, primary infection usually presents with multiple painful blisters on an erythematous (red) base, mainly in the lip area.
Recurrences of herpes simplex
Recurrent herpes simplex appears mainly in the area of the lips but also in other places, such as the nasal mucosa, the cheek, the sacrococcygeal region, the fingers of the extremities and various other places on the trunk. Before the blisters appear, there is a burning sensation and slight pain. The blisters in 3-4 days become scaly and subside within 8-9 days without leaving a scar. Recurrences usually range from 3 to 4 per year.
Treatment
Visit your dermatologist for the administration of the appropriate medication.