A 62-year-old woman came to the hospital with a rash on the patch. She said that a week ago, after making kimchi, she had stiff and throbbing muscle pain in her right waist, so she applied her patch, and two days ago, the area where she had applied her patch turned red and blistered. On her visit to the hospital, a red rash extending from her right back to her flank and blisters were observed. It was a typical herpes zoster lesion, not a rash caused by Pars. She was hospitalized for severe pain, and after antiviral treatment, both pain and skin lesions improved and she was discharged. Let’s find out about ‘herpes zoster’ with the help of Bora Im, director of the dermatology department at Daejain Hospital.
■ What is shingles?
The word shingles means ‘a rash that appears as a cluster of band-shaped blisters’. If you have had chickenpox in the past or have been vaccinated against chickenpox, the varicella-zoster virus lies dormant in your body’s nerve ganglia. When the immune system is weakened by age, fatigue, stress, etc., the dormant varicella-zoster virus is reactivated, causing inflammation and necrosis of nerves, resulting in characteristic band-shaped blisters on the skin, which is herpes zoster. am.
■ Symptoms of shingles
Prodromal symptoms such as pain and paresthesia appear along the nerve where shingles occurred on average 4 to 5 days before the appearance of skin lesions. Pain can appear in a variety of ways, such as a tingling pain that feels like an electric shock, a knife-like pain, or a burning pain. In some cases, pain may be accompanied by fatigue, headache, chills, and fever. Therefore, until skin lesions occur, it is often thought of as body aches or muscle pain rather than shingles.
Skin lesions develop after an average of 4 to 5 days, and a maximum of 2 weeks after the onset of prodromal symptoms. Skin lesions appear in the form of band-shaped blisters that do not cross the midline of the body along the site of pain.
■ Complications
Shingles doesn’t just cause blisters on the skin, it can also cause other complications. In particular, in the case of herpes zoster that occurs around the eyes, keratitis, uveitis, and glaucoma may be accompanied, and vision damage may occur due to this. When shingles occurs in the auditory nerve of the ear, tinnitus, hearing loss, and facial paralysis may occur along with severe ear pain.
In some cases, the pain persists for more than 3 months after the skin lesions improve, which is called postherpetic neuralgia. Postherpetic neuralgia is the most common and most painful complication, occurring in 1 out of 3 patients with shingles.
■ Cause
It is caused by a weakened immune system that reactivates the varicella-zoster virus that has been dormant in the body. Therefore, irregular living habits, excessive diet, excessive exercise, overwork, and stress that can cause a decrease in immunity can be risk factors for shingles. Among the various risk factors, the most important is known to be old age. This is because cellular immunity to the varicella-zoster virus decreases with age. In addition, shingles can occur when immunosuppressants are administered for diseases that weaken immunity, such as lymphoma or cancer, or for organ transplantation.
■ treatment
The goal of treatment for shingles is to suppress pain, prevent the spread of the virus and secondary bacterial infection, and prevent and minimize complications such as postherpetic neuralgia. Within 72 hours of the occurrence of shingles skin lesions is the golden time for treatment, and antiviral drugs administered at this time can promote healing of skin lesions, reduce the period of acute pain, and reduce the frequency of postherpetic neuralgia. It is common to take oral antiviral drugs, but in the case of immunocompromised patients, intravenous administration is required. Antiviral ointments are ineffective.
■ How to prevent shingles
It can be prevented with the shingles vaccine. There are two main types of shingles vaccine: live vaccine and inactivated vaccine. In the case of live shingles vaccine, a single inoculation has a 51.3% preventive effect, and the preventive effect is maintained for up to 8 years. One of the important reasons for shingles vaccination is to reduce postherpetic neuralgia. In the case of live shingles vaccine, it is effective in reducing postherpetic neuralgia by 66.5%. However, live vaccines cannot be administered to immunocompromised patients, those receiving immunosuppressive treatment, those suffering from active tuberculosis, and pregnant women.
The herpes zoster vaccine is administered twice, and has a preventive effect of about 90% in those over 50, which is the highest prevention rate among the shingles vaccinations currently used. The prevention rate of neuralgia after shingles is also good at 91.2% in those in their 50s or older. In addition, unlike live vaccines, it has the advantage that it can be vaccinated even in immunocompromised patients such as blood cancer or organ transplant patients.
■ Director Lim Bora “Zoster can be prevented through vaccination… It is recommended that people over 50 get vaccinated.”
Anyone who has had chickenpox or has been vaccinated against chickenpox can get shingles. Sometimes, the pain is so severe that daily life is difficult, and even after the skin lesions are improved, the pain persists for several years or more. Prompt treatment and prevention are the most important to prevent excruciating pain from lasting for a long time. If you have painful rashes and blisters on one side of the skin on your face, trunk, or neck after severe stress or overwork, you should seek medical attention as soon as possible. Since the shingles vaccine can prevent both shingles and postherpetic neuralgia, it is recommended that people over 50 get vaccinated against shingles.
Reporter Jang Soo-in
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