Treatment of Herpes Zoster
Written by:Herpes zoster, more commonly known as St. Anthony's Fire, is a viral pathology affecting the skin and nerves. The professor. Giuseppe De Benedittis, an expert in Pain Therapy in Milan , explains how this painful pathology is treated
What is the fire of St. Anthony?
Herpes Zoster is characterized by very severe pain, associated with skin rashes distributed at the nerve endings. The herpes zoster virus (VZV) belongs to the family of Alpha-Herpesviridae, the same as the varicella virus.
The virus remains nested in the body, then wakes up when immune defenses are most vulnerable: advanced age, intercurrent illnesses, acquired immunodeficiency syndromes, xenografts, pathologies requiring immunosuppressants, stress, etc.
Most affected are elderly people between the ages of 70 and 80, with prevalence in females. In recent years, however, there has been an increase in incidence among the younger population, especially in immunodeficient patients and as a warning bell of serious illnesses such as lymphomas or other cancers.
The risk of contracting herpes zoster is very low in acute phase and zero in chronic phase. Contagion occurs by direct contact with the fluid contained in the vesicles, present only during the first days of the disease
The symptoms of the fire of St. Anthony
The first symptom of the Herpes Zoster is pain in the affected skin, pain similar to continuous heartbeat and medium to high intensity. The vesicles, on the other hand, may appear together with the pain or some days later. The most affected sites are the chest and the face.
Skin can become particularly sensitive and feel painful any tactile stimulus, such as contact with clothing or a slight change in temperature. Other symptoms may be pruritus and an annoying feeling of numbness. In the most serious cases, severe complications (eg meningoencephalitis and disseminated herpes) may occur and motor functions may be compromised.
The complications of Zoster herpes: Post-Erpetic Neuralgia
The course of the disease is usually self-limiting: rashes and pain regress spontaneously within 4-6 weeks.
If pain persists more than 3 months after onset, the disease may have evolved into a Post-Erpetic Neuralgia (NPE). It is a disabling disease, often accompanied by depression, insomnia and weight loss, due to a permanent and stabilized nerve injury.
Treatment of Zoster herpes
The use of antiviral drugs in the first 72 hours after the onset of the disease, despite not having significant consequences on the therapeutic response, helps to reduce the exanthema and pain, as well as the duration of the disease and any complications.
The neuropathic pain caused by the Herpes Zoster is a real therapeutic challenge. Even today, there is no ideal therapy, although some therapeutic prescriptions have proved to be quite effective:
- Systemic treatments with tricyclic antidepressants (eg. amitriptyline) and antiepileptics ( eg , gapapentinide).
- Topical treatments (local). The treatment consists of a suspension of acetylsalicylic acid (aspirin) and ethyl ether to be applied on the affected area. Liquid aspirin, the efficacy of which is carried by the ethyl ether cutaneous solvent, allows desensitization of the nerve endings affected by the inflammatory process. Other topical remedies include low or high dosage capsaicin (extracted from chili) and patches with local anesthetics.
Unfortunately, to date there is no treatment able to prevent Post-Erpetic Neuralgia (NPE). It depends on the severity of the infection, the compromise of immune defenses, the site (the face is the most at risk of chronicity), delays and mistakes in treatment.
Of course, acting as quickly as possible helps to counteract viral infection more effectively, to control the pain and reduce the risks of post-erpetic neuralgia.
Editor Karin Moscow