Herpes zoster, also known as shingles, is caused by the reactivation of the varicella-zoster virus. Its symptoms exhibit high individual variability. Initially, there may be only mild discomfort, followed by the appearance of characteristic skin lesions and neuralgia. The virus distributes along nerve ganglia, leading to unilateral dermatomal rashes, which is why it is called "Herpes Zoster".
Main symptoms include skin lesions, neuralgic pain, and possible systemic discomfort. About 30% of patients experience prodromal symptoms before the rash appears, such as localized tingling or burning sensations. The disease progression typically involves an incubation period, an acute phase, and a recovery phase, with variations in symptom intensity and type at each stage. Early diagnosis and treatment can significantly reduce the risk of complications, especially postherpetic neuralgia.
The early symptoms of herpes zoster are often mistaken for other conditions. Approximately half of the patients experience nonspecific signs 3-5 days before the rash appears. Typical prodromal symptoms include abnormal sensations on the skin, such as sharp stabbing pain, persistent burning, or touch sensitivity. Some patients may also have mild fever, dizziness, or general fatigue. These signs usually occur on one side of the body and correspond to the future distribution of the rash.
It is noteworthy that about 15% of patients only exhibit neuralgia in the early stage, with no rash yet present. This "zoster sine herpete" can be misdiagnosed as muscle strain or sciatica. Physicians often differentiate based on detailed medical history and nerve distribution examination.
When the virus activates, a typical three-stage rash appears sequentially. The first stage is the erythematous stage, where affected areas show redness, followed by the papulovesicular stage, and finally the scabbing stage. The vesicles are usually distributed unilaterally along nerve paths, arranged in a band-like pattern, commonly on the chest, abdomen, trigeminal nerve area of the face, or limbs. Initially, the vesicle contents are clear, but later may become turbid with exudate.
Neuralgia is the core symptom, with pain characteristics including:
About 20% of patients experience systemic symptoms such as mild fever (<38°C), dizziness, or loss of appetite. Immunocompromised patients may have more severe systemic reactions, such as high fever or lymphadenopathy.
When the trigeminal nerve in the face is affected, ocular involvement may occur, leading to keratitis or retinitis, causing blurred vision and eye discomfort. Ear involvement may cause hearing loss and vertigo, known as "Ramsay Hunt syndrome." These specific site infections require immediate medical attention to prevent permanent damage.
The typical course lasts about 2-4 weeks, but severity varies among individuals. The initial erythema usually progresses to vesicles within 1-3 days, and pain may intensify after vesicle formation. About 7-10 days later, vesicles dry and scab over. During this phase, pain may gradually decrease, but 10-18% of patients develop postherpetic neuralgia, with pain lasting more than 3 months.
During the acute phase, patients often describe pain as "touch-evoked," meaning allodynia. For example, friction from clothing or wind can trigger severe pain. This abnormal pain perception is a key indicator of nerve damage.
In the recovery stage, although skin lesions heal gradually, nerve repair takes time. Some patients experience intermittent pain recurrence, especially with weather changes or fatigue. Physicians recommend ongoing follow-up for at least 6 months to assess the risk of sequelae.
Children typically have milder and self-limiting symptoms, while adults, especially those over 50, have increased severity and risk of complications. Immunodeficient patients may develop extensive rashes, persistent high fever, and prolonged healing. These high-risk groups should start antiviral treatment promptly to prevent tissue damage.
Seek medical help immediately if you experience any of the following signs: Unilateral dermatomal rash with severe pain, Facial trigeminal nerve involvement, or Symptoms in immunocompromised individuals. Even if symptoms are mild, if accompanied by headache, ear pain, or vision problems, prompt diagnosis is necessary to prevent complications.
The following conditions are considered emergency indicators:
Even if symptoms seem mild, early medical consultation is recommended if the rash distribution matches typical herpes zoster patterns. Early antiviral therapy can shorten the disease course and reduce nerve damage risk. Doctors may perform viral antibody tests or skin scrapings to confirm the diagnosis.
The rash caused by herpes zoster usually heals within 2 to 4 weeks, but severe blisters or ulcerated areas may cause temporary pigmentation or minor scars. If the skin damage is extensive or complicated by bacterial infection, the risk of scarring increases. It is recommended to avoid scratching and follow medical advice on ointments to minimize sequelae.
What pain relief methods can be used in daily life for herpes zoster neuralgia?For mild pain, over-the-counter medications such as ibuprofen can be considered, but severe neuralgia requires prescription medications like gabapentin or antidepressants. Cold compresses, avoiding friction on affected skin, and topical anesthetic patches can also alleviate discomfort. For persistent severe pain, seek medical attention promptly to prevent chronic postherpetic neuralgia.
Can herpes zoster be transmitted through daily contact?Herpes zoster virus can be transmitted through direct contact with vesicle fluid, but it only causes chickenpox in contact individuals who have not been vaccinated or previously had chickenpox. The risk of transmission to healthy adults is low, but contact with skin lesions should be avoided, especially for immunocompromised persons, newborns, or unvaccinated individuals.
Do people vaccinated against chickenpox still need the herpes zoster vaccine?The chickenpox vaccine reduces the risk of herpes zoster but does not completely prevent it. For those over 60 or with risk factors, doctors may recommend the herpes zoster vaccine (such as Shingrix), which provides stronger antibody protection and significantly reduces incidence and severity.
Will herpes zoster symptoms be more severe in people with autoimmune diseases taking steroids?Yes. Immunosuppressed individuals (such as those undergoing chemotherapy, organ transplant recipients, or long-term steroid users) tend to have more extensive lesions, longer disease duration, and higher complication risks. These patients should be monitored regularly, start antiviral therapy immediately upon infection, and closely observe for neurological symptoms.
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