Shingles is a viral skin disease common, due to herpes zoster, the same virus as chickenpox. The adjective is related zoster.
The condition is complicated mainly pain that can become chronic and debilitating post-herpetic neuritis by.
Shingles is a viral disease due to reactivation of varicella zoster virus or VZV, Varicella Zoster Virus for belonging to the family of herpes viruses, which is the virus that causes chickenpox.
VZV, after recovery from chickenpox, remains dormant in nerve ganglia, but are integrated into host chromosomes. Most often during a waning immunity (age, mononucleosis, simple stress-blown AIDS, some cancers, etc..), The virus reactivates in one or more ganglia. From there it goes through nerve fibers to the skin (or mucous membrane as affected nerves), causing a characteristic rash of chickenpox. However, unlike chicken pox, the topography of the eruption is confined to metameric ganglia where the virus is reactivated (that is to say in an area of skin and / or mucosal very characteristic corresponding to the territory of innervation of nerves or nerve ganglia corresponding to infected).
The microscopic lesions in the skin are identical to those of varicella (presence of multinucleated giant cells with mononuclear infiltration). The diagnosis is usually easy, histological analysis is often not necessary
The three main types of shingles are the intercostal form, notable by its frequency, and ophthalmic and otic forms, remarkable for the high risk of complications.
Unlike chickenpox where the itching is predominant, shingles is usually marked by pain, which may even prove disabling in affected territories (territory root), even after recovery. The pain is also described as a burning sensation.
As with chickenpox, the lesions appear in crops, but limited to the territory affected sensory (radicular topography in the area of sensory ganglion where virus reactivation occurred). The scabs fall off after seven days.
The most frequent case is that of intercostal herpes zoster, which is the reactivation of VZV at a sensory ganglion of an intercostal nerve. Sometimes multiple nerve roots are affected simultaneously. Territories also include abdominal lumbar and pelvic and cervical region (territory of Arnold, C2 and C3) as regularly affected, with palpation of satellite nodes.
It represents about 10. The ophthalmic zoster, in untreated, can affect the quality of vision due to damage to the cornea. Reactivation of the virus occurs in the trigeminal ganglion and reached the territory of the sensory branch of the trigeminal nerve V1, corresponding to the ophthalmic nerve. The rash affects the forehead, around the edge of the eye (around the eye, eyelids ...) and the cornea, unilaterally. The corneal involvement is not visible by direct examination, and requires an examination by slit lamp and instillation of a product color to blue light. The differential diagnosis may be a violation of herpes, erysipelas, dacryocystitis, eyelid dermatitis ... The main complications of ophthalmic zoster are. It can also be tinnitus (perception of sound that did not really exist) and dizziness, and decreased hearing. The classic facial paralysis can occur from the painful stage or in the days following the eruption, with a risk of persistent, more or less important.
The treatment of this form of shingles.
Most affected by shingles are quite mundane and heal spontaneously, but unlike chicken pox, the body can become immune against the recurrence form of shingles and the most common complication is simply ".
However, it may occur in more or less serious complications, either immediately or later.
The usual vaccine against varicella in the infant did not show a currently effective on the prevention of shingles (mostly because of lack of perspective, vaccination occurring in childhood and shingles that occur after the sixties in general).
A vaccine against shingles, higher dose and similar to that used for children against chickenpox, is under development. To be injected in the elderly, it reduces by nearly 50.
The last French consensus conference on the subject, dating from 1998, laid the foundation for this part of the article
Burning sensation may occur in the acute phase. The treatment of shingles is usually only symptomatic. When indicated, treatment should be started as early as possible. Available molecules likely to be active in VZV are acyclovir (Zovirax ®), valacyclovir (Zelitrex ®) and famciclovir (Oravir ®). Antiviral treatment is systematic, typically making use acyclovir intravenously, at least one week. Valaciclovir and famciclovir orally are sometimes used. Treatment efficacy was more pronounced if initiated within the first three days, ideally one immunocompromised patient knows the first signs of shingles, to start treatment as early as possible.
Antiviral treatment of ophthalmic zoster is systematic. Aciclovir or valaciclovir, used orally over a period of at least one week, are indicated for avoid ocular complications. The ophthalmic zoster should be systematically supported urgently by a specialist who will decide whether further treatment (acyclovir ophthalmic ointment, topical steroids and / or overall) by type of eye. Corticosteroids are formally listed as cons-can cause an outbreak of disease.
Otic treatment of shingles, because the risk of persistent facial paralysis, antiviral treatment is systematic. Despite this treatment, the risk remains, however. Note that the corticosteroid is indicated for some cons-start of treatment.
In the immunocompetent patient, antiviral treatment is offered to individuals over 50 years, to prevent post herpetic pain more frequently from this age. He appealed to valaciclovir or famciclovir orally for 7 days. In adults younger than 50 years, and for the same purpose, some also offer the same treatment if rash very florid, or severe pain during the prodromal phase or the eruptive phase. In France, the antiviral treatment of herpes zoster in immunocompetent individuals under 50 years is not subject to management by health insurance.
The main drugs used in addition to the usual analgesics, are amitriptyline (Elavil ® Laroxyl ®), gabapentin (Neurontin ®) and carbamazepine (Tegretol ®). Amitriptyline causes a halving of pain intensity in 50% of patients with a lower incidence of painful paroxysms. There are also treatments using physical techniques such as TENS, or intrathecal injection of methylprednisolone weekly lidocaine.
Since the vesicles and scabs of shingles, the same way as those of chickenpox, VZV contain, there is a risk for infectious unimmunized (ie, those that have not had varicella and unvaccinated). For a patient with herpes zoster, to prevent people are very young children and pregnant women and immunocompromised individuals in whom chickenpox could have serious conséquences.Noter however, that infants who are breastfed are protected by maternal immune nature of this type of diet.
The annual incidence is between 1.5 and 4 new cases per thousand. It is much more common in the elderly and immunocompromised patients (including AIDS). Monitoring trends in incidence in France is conducted by the sentinel network of INSERM.
The frequency of PHN is almost 40
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