Herpes Zóster: Causes, Diagnosis and Treatment

Herpes Zóster is a viral infection that can affect anyone who has spent the chickenpox at some point in their life. Although it usually appears more frequently in people over 60 years of age or in patients with the weakened immune system, it can also occur in young adults. Identifying your symptoms early and going to a specialist is essential to start effective treatment and prevent complications.

This article has had the collaboration and review of Dr. Pablo Villagrasa Boli, dermatologist in Viamed Santiago, to whom we appreciate his support and medical validation. In it we explore who can suffer Herpes Zóster, how it is diagnosed, its possible complications and the keys to its treatment.

What is Herpes Zóster?

Herpes Zóster is a disease caused by the reactivation of the Zóster Varicela virus, which causes the chickenpox. Once the infection has passed, this virus can remain latent in our body for years and, under certain circumstances, reactivate causing characteristic symptoms such as intense pain and cutaneous rashes.

Who can suffer Herpes Zóster?

Herpes Zóster appears due to the reactivation of the Zóscter Vicela virus, which remains latent in the dorsal nodes or cranial pairs after having caused an initial infection (chickenpox). This means that anyone who has had chickenpox has the risk of developing it.

Some key data about who can suffer Herpes Zóster:

• Any person who has had chickenpox: It is estimated that up to 90% of adults have been infected by the virus, and approximately 20% of the population will develop Herpes Zóster at some point in their life.
• More common in over 60 years: The incidence increases with age.
• Immunosuppressed people: Those with diseases or treatments that weaken the immune system, such as the use of corticosteroids, immunosuppressants or chemotherapy.
• Children and adolescents: Although less frequent, they can also be affected, especially if they have received prolonged treatments with immunosuppressive drugs.

How is Herpes Zóster diagnosed?

The diagnosis of Herpes Zóster is, in most cases, clinical. This means that it is based on the symptoms and signs that the patient presents. On some occasions, as in atypical or doubtful cases, tests can be performed to confirm the presence of the virus, such as PCR, cytodiagnosis techniques of the content of vesicles, serologies or skin biopsies.

Characteristic symptoms:

• Burning, anthill and/or sharp painwhich can be very intense.
• These symptoms usually occur on a single side of the body, neck or face, following the path of a sensory nerve.

Visible signs on the skin:

• Redness and the appearance of a rash With small vesicles or ampoules full of liquid, grouped in the form of a band.
• These injuries usually appear 4-5 days after the start of pain.

What is postherpetic neuralgia and how is it?

Postherpetic neuralgia is one of the most common complications of Herpes Zóster. It is characterized by chronic pain that persists beyond a month after the resolution of skin lesions.

Why does it happen?

The Varicela Zóster virus, when reactivating, irritates the sensory nerves, causing pain, itching and burning. In some cases, this irritation can damage nerve roots, giving rise to residual pain that can be disabling.

Who is more risk?

• People over 60 years.
• It is not necessarily related to the seriousness of skin lesions during the acute phase.

Treatment options:

• Analgesics, including opioids in severe cases.
• Tricyclic antidepressants, such as nortriptyline or amitriptyline.
• Antiepileptics, such as gabapentin, pregabaline or carbamazepine.
• Interventional techniques: infiltrations with botulinum toxin or nerve blockages with local or corticosteroid anesthetic.

Hipes zoster treatment in acute phase.

The treatment focuses on:

1. Cutaneous lesions: Use of iodized povidone, topical antibiotics or promotions with zinc sulfate to accelerate the drying of vesicles and avoid secondary infections. Topical acyclovir has not demonstrated effectiveness in these lesions.
2. Pain: Analgesics of different steps, getting to use opioids in severe cases, in addition to drugs that block pain transmission, such as antiepileptics.
3. Antivirals: Aciclovir, Famciclovir, Valaciclovir and Brivudina. These medications are especially effective if they are administered early, since they accelerate healing and reduce the risk of postherpetic neuralgia. As a general rule, all Herpes Zóster has an indication of oral treatment.

Do immunosuppressed patients have a higher risk of complications?

Yes, immunosuppressed people have a higher risk of complications associated with Herpes Zóster.

Although in most cases Herpes Zóster is a self -limited process that is resolved in one or two weeks, in patients with a weakened immune system, the virus can spread beyond the skin and the affected nerve.

Possible complications in immunosuppressed:

• Ocular affectation.
• Meningitis or encephalitis (affectation of the central nervous system).
• Myocarditis (inflammation of the heart).
• These complications can be serious and even put the patient’s life at risk.
• Serious skin forms with ulcers and necrosis.

Why is early diagnosis and treatment important?

The diagnosis and early treatment of Herpes Zóster are fundamental to prevent complications and reduce the risk of postherpetic neuralgia.

Benefits of early treatment:

• Accelerate healing.
• Reduce the intensity and duration of pain.
• Avoid complications in high -risk patients, such as older people, immunosuppressed or with comorbidities.

If you present symptoms such as localized pain and skin rashes, consult a doctor as soon as possible to receive proper treatment.

Herpes Zóster is a disease that can affect anyone who has had chickenpox, but their incidence increases with age and in immunosuppressed people. Clinical diagnosis and early treatment are key to reducing the risk of complications and improving the patient’s quality of life.

If you have herpes zoster symptoms or belong to a risk group, in Viamed we can help you with adequate diagnosis and treatment. Consult our specialists.