The head of the Department of Dermatology at the Sofia Medical University, Dr. Vesel Kantarjiev, is a third-generation doctor. Both his maternal and paternal grandfathers were professors. His father - Prof. Todor Kantarjiev, is the director of the National Center for Infectious and Parasitic Diseases. From 2004 to 2006, Dr. Vesel Kantarjiev worked as a volunteer at the Dermatology Clinic of the Academy of Medical Sciences. After that, he specialized in it for 4 years, continuing to work here as a resident, since 2014 he became the head of the department, and since June 2015 he is already the head of the clinic.
Herpes zoster is a common disease that manifests itself with unpleasant rashes that affect the skin and peripheral nerves in a certain area of the body. It is estimated that about 50% of people over the age of 80 can get shingles. What are the symptoms of herpes zoster and about the treatment of this disease, we talk with Dr. Kantarjiev.
What is herpes zoster, Dr. Kantarjiev?
- Herpes zoster is a secondary disease caused by the reactivation of the varicella zoster virus after a primary active or latent infection, usually at an early age. Varicella zoster virus is an alphaherpes virus of the herpes virus family that causes two diseases - chicken pox and herpes zoster, which occur with a different clinical picture. It is transmitted by air-droplet and contact-bite mechanism. Once in the body, the virus multiplies in the epithelial cells, followed by primary and secondary spread through the blood. In the primary one, the liver and spleen are affected, and in the secondary one, T-cells are responsible for proteins that bind to skin receptors, leading to skin damage. It also affects sensory neurons, where it remains latent.
What activates the virus?
- Virus activation correlates with the acute phase of another infection or exacerbation of a chronic disease. It is usually associated with stress, trauma, radiation therapy, and immunosuppressants.
Who is prone to this disease?
- Herpes zoster usually occurs in people over the age of 50, but it is possible to appear in young people who had a primary chickenpox infection in the first years of life. The possibility of developing the disease increases with age. According to recent studies, herpes zoster occurs in 2.5 per 1,000 people between the ages of 20 and 50, 5.1 per 1,000 between the ages of 51 and 79, and 10.1 per 1,000 over the age of 80.
In immunocompromised patients, for example those with HIV, the disease is many times more common.
What is the clinical picture of the disease and which parts of the body can it affect?
- The course of the disease can be divided into several phases. The first lasts between 5-7 days and is manifested by tickling, itching or pain, and there is still no skin manifestation. In some cases, it can be mistaken for symptoms of a heart attack or pleurisy. The dermatological manifestation is observed in more than 95% of cases, being a uniform rash represented by grouped bubbles filled with fluid on reddened skin along the course of the corresponding affected nerve on one side. On the 3rd day, there is a new push of the disease, and on the 7th, the formation of crusts is observed.
Is shingles contagious?
- The herpes zoster disease itself is not contagious, but the herpes zoster virus that causes it is. If a person has not had chickenpox, he can become infected through contact if the patient's rash with herpes zoster has not reached crusting.
Prof. Todor Kantarjiev
What complications can the disease cause?
- Herpes zoster can occur with many complications. The most common of them is postherpetic neuralgia, which is observed in 10-15% of patients. It is possible to affect the oculomotor arm of the trigeminal nerve, which can lead to blindness. Another complication of herpes zoster affects the vestibulo-cochlear nerve, also known as Ramsey-Hunt syndrome, leading to headache, nausea, vomiting and deafness. A secondary infection is also possible, in which the liver - hepatitis, lung - pneumonia, or the brain and meninges - encephalomeningitis can be affected.
Can we talk about prevention? Do immunostimulants help?
- Prevention of primary varicella infection has become a major focus worldwide. Administration of varicella zoster immunoglobulins to all suspected immunocompromised patients at their first exposure to the virus, within 96 hours of exposure, is used. Also, it is recommended for mothers who fell ill a few weeks before giving birth. The protective effect lasts up to three weeks.
The application of varicella zoster vaccine, which is highly effective, has also been approved. It is administered in two doses - one at 12 months of age and the second between 4 and 6 years of age to provide protection and induce a long-lasting effect. Studies have shown that the vaccine provides complete immunity in 70-90% of cases, and it has been found that vaccinated children suffer from herpes zoster much less often than those who have acquired natural immunity after a primary infection. For now, the vaccine is not mandatory in Bulgaria, but its inclusion in the immunization calendar as a component of the trivalent vaccine - measles, mumps, rubella is being discussed.
Immunostimulators have a certain role in the prevention of the disease, but they cannot provide complete immunity, so they are recommended as an additional measure of protection.
What is the treatment?
- For herpes zoster, it is important to start treatment within the first 72 hours, but taking measures within the 7th day is not fatal. Administration of antiviral drugs such as Acyclovir and Valaciclovir - is the therapy approved by the US Federal Drug Agency.
Analgesics are also used for postherpetic neuralgia. A vitamin B complex is also recommended. It is important to know that taking aspirin during the illness can cause serious damage to the liver.
Can cold sores that appear on the lips develop into herpes zoster?
- Cold sores are caused by herpes simplex virus infection and herpes zoster is a result of varicella zoster virus infection. Although they are from the same family, the two viruses are not related. Frequent reinfection with herpes simplex may be a signal of a weakened immune system, which subsequently leads to reactivation of the varicella-zoster virus by another mechanism.