Shingles is a painful rash, usually on one side of the body, caused by the herpes zoster virus, or varicella zoster virus (VVZ). This virus triggers chickenpox in children, but it can reactivate in adults and cause shingles. What are the symptoms and treatments?
The vast majority (95%) of the adult population has already been infected with VVZ, which is responsible for various diseases.
Shingles and Pregnancy : What is shingles?
When you are pregnant, you may fear being surrounded by sick people or developing a health problem that could affect you or your baby. Shingles is a disease that may worry you.
About 1 of 3 people will develop shingles at some point in their lives. Although shingles, or shingles, is more common in the elderly, it is still a disease to be aware of if you are expecting a baby.
Shingles is a viral infection that causes painful rashes and itching. The same virus that causes chickenpox causes shingles. This is called the varicella-zoster virus (VZV).
If you had chickenpox when you were young, VZV remains dormant in your system. The virus can become active again and cause shingles. People don’t quite understand why this is happening.
• Primary infection causes chickenpox , a contagious skin disease that usually occurs in children. Several vaccines against chickenpox are available on the market.
• The VVZ then “sleeps” in the nervous nodes, but it can wake upafter several decades and cause shingles, which mainly affects seniors.
• Shingles can lead to sometimes serious complications (read below): chronic pain (post-zoster pain), damage to the eyes and ears, neurological sequelae …
We do not know the reasons why the virus becomes active again after many years, even though risk factors have been identified. It spreads along the nerves to the skin, where it causes a painful rash.
A person who has developed shingles may suffer from it again, but it is rare. In the event of repeated attacks, more in-depth examinations are required.
Risk factors by Shingles in Pregnancy
The advancing age is an important risk factor. People over 60 are proportionally two to three times more likely to suffer from it than those under 40 (12 per 1,000 over 60 and 4 / 1,000 under 40). This is probably linked to less effective immunity in the elderly and the elderly.
According to some studies, women are more at risk than men, but other research says the opposite.
A weakened or disturbed immunity is an important risk factor. Thus, it is more frequent in patients with an autoimmune and / or inflammatory disease (systemic lupus, rheumatoid arthritis, Wegener’s granulomatosis, Crohn’s disease, ulcerative colitis, multiple sclerosis), suffering from cancer (lymphoma of Hodgkin, adherent tumor), of AIDS, or having undergone an organ transplant (immunosuppressive treatment increases the risk).
• The role of genetic factors has not yet been elucidated.
• It is possible that surgery or trauma (such as a broken leg) may cause shingles.
• The place of physical or mental stress as a risk factor is unclear.
Are shingles contagious?
Yes for people who have never had chickenpox. The fluid from the vesicles is contagious for 1 to 2 weeks. The crusts are no longer contagious.
For people who have never had chickenpox, it is therefore important to avoid infection. This mainly affects newborns and pregnant women (the virus can also cause harm to the unborn child during the first three months of pregnancy).
• Make sure the vesicles are covered, for example with gauze.
• Wash your hands thoroughly with soap and water if you have been in contact with the blisters (not dry).
Symptoms of Shingles and Pregnancy
Shingles is not always serious: in children and young adults, the infection is generally milder.
• Shingles usually starts with itching and tingling , or suddenly with intense , burning and persistent pain on part of the skin (abdomen, chest, back …). A headache, fever and a feeling of flu (flu-like illness) may also occur.
• After a few days, the skin becomes red and blisters Painful (blisters) appear in a cluster, usually on the stomach or waist, chest or back, sometimes on the limbs (arms, leg), neck or face. The vesicles form a heap or a band (belt).
• The rash may be marked by severe pain , especially in the event of friction, in contact with clothing, while sitting … A shingles in the face is often accompanied by a very severe headache, and the facial muscles can temporarily sag.
• After 10 to 14 days , the vesicles dry, forming crusts. After 2 to 4 weeks , recovery is generally complete, with no serious residual symptoms, except obviously in the event of complications.
• Sometimes there is a reduced or increased permanent sensitivity to pain and / or depigmentation of the skin.
Complications by Shingles and Pregnancy
The most serious complications of shingles are postherpetic neuralgia and eye damage, knowing that a bacterial infection secondary to skin lesions can occur.
Post-Zoster Neuralgia Post-Zoster
Neuralgia (NPZ) is characterized by severe and persistent pain in the affected skin area. It can persist for months or even years. This neuropathic pain is thought to result from inflammation and nerve damage.
• The risk of this complication increases with age: in people under 50, it is less than 2%, then increases to 20% in people over 50 and to 30% after 70 .
• Patients whose symptoms (fever, pain, number of vesicles, etc.) were significant before and during the acute phase have a higher risk of suffering from NPZ.
• NPZ is also more common if shingles have affected the face.
The optic nerve can be damaged in patients with shingles on the head and neck. This would happen in about 15% of patients.
There is also a high risk of keratitis (inflammation of the cornea), iridocyclitis (inflammation of the iris), conjunctivitis (inflammation of the mucous membranes), secondary glaucoma or panophthalmia (inflammation of all parts of the eye ).
Rashes on the tip and on the side of the nose indicate damage to the nerve branch that innervates the eye. If the nose is affected, special attention should be paid to the eye.
Complications in the ear
If the virus is found in the nerve of the ear, a herpes zoster oticus can develop, with the formation of blisters in the ear canal. Possible complications are hearing loss, balance problems (dizziness) and paralysis of the facial nerve.
The spread of the virus can occur in people with impaired (cellular) immunity. It is a serious condition that can lead to death.
If the central nervous system is affected by the disease (which is rare), meningoencephalitis or paresis can occur.
Concerns related to Shingles and Pregnancy
If you are pregnant and have already had chickenpox, you and your baby are safe from exposure to anyone with chickenpox or shingles. You can, however, develop shingles during your pregnancy if you have had chickenpox as a child. Although this is unusual since shingles typically appear after your pregnancy years, it can happen. Your baby will be safe if you just develop shingles.
If you notice a rash of any kind during your pregnancy, talk to your doctor. It may not be chickenpox or shingles, but it could be another potentially serious condition that warrants a diagnosis.
If you have never had chickenpox and you are exposed to someone who has chickenpox or shingles, you should also tell your doctor immediately. They can recommend a blood test to help them determine if you have antibodies to the chickenpox virus. If antibodies are present, it means you have had chickenpox and you may not remember it, or that you have been immunized against it. If this is the case, you and your baby should not be at risk of contracting the disease.
If they can’t find any antibodies against the chickenpox virus, you can get an immunoglobulin injection. This vaccine will contain antibodies to chickenpox. Getting this injection may mean that you are avoiding chickenpox and possibly shingles in the future, or that you may have a less severe case of chickenpox. You should receive the injection within 96 hours of exposure for it to be as effective as possible.
You should tell your doctor that you are pregnant before you receive an immunoglobulin injection or any other injection. Whether it is early in your pregnancy or nearing the date of delivery, you should be careful about all the drugs, supplements and foods that enter your body.]
The diagnosis on Shingles and Pregnancy
The typical rash is sufficient to establish the diagnosis. Occasionally, skin damage (such as blisters) may rs very discreet, if not non-existent, and more research is needed (a blood test can help show if the virus is active or has been active) recently).
If you have shingles in the trigeminal region, look for eye abnormalities. In the event of a rash on the nose or in the corner of the eye, always consult an ophthalmologist for additional examination.
Shingles heals spontaneously after two to four weeks. Usually, pain relief and blister drying treatment are sufficient. However, always consult a doctor, and as soon as possible under certain circumstances.
• you are weakened by a serious illness
• you are over 60 years old
• you suffer from an immune disorder or you take immunosuppressive drugs
• shingles affects the face
• you experience tingling, itching or pain in the eye or nose
Care of the vesicles
It is absolutely necessary to avoid scraping blisters, this can cause permanent scars.
• A shower or bath with not too hot water provides relief.
• To avoid abrasion, cover the blisters with a soft compress.
• On the ampoules, you can apply a drying ointment (ointment or zinc oxide paste). If necessary, also use a liquid or cream to relieve itching.
• The application of chlorhexidine in aqueous solution to the vesicles is useful for the prevention of bacterial superinfection.
• Wet wipes or ice can help with itching and pain.
One of the biggest problems with shingles is pain, which can be very intense.
• You can take paracetamol (do not exceed the dose prescribed by the doctor or mentioned by the manufacturer). If this is not enough, a stronger pain reliever may be necessary (ask your doctor for advice).
• Severe pain can be controlled by nervous treatment during which corticosteroids are injected with or without local pain relievers in the back (epidural). This treatment is done in the hospital by an anesthesiologist or a pain specialist.
Antiviral drugs (such as aciclovir) may slightly reduce the time it takes for the rash to heal as well as the severity and duration of the pain. These drugs should be taken within the first 2 to 3 days after the rash starts. Later, they have no effect, except against ocular complications.Shingles and Pregnancy
In healthy people under the age of 50 and whose shingles are not too large, antiviral therapy is not necessary. Antiviral therapy may be appropriate in the following circumstances.
• with extensive and / or very painful
shingles • with shingles in the neck or on the face: without antiviral treatment, the risk of (permanent) eye damage is very high
• in people over 60
• in people with impaired immunity (HIV, after an organ transplant, during chemotherapy …): it may be necessary to administer this drug intravenously with an infusion, which requires hospitalization
Treatment Post-Zosterian Pain Post-Zosterian
Neuralgia is very difficult to treat. Fortunately, this pain disappears in people under 60 in nine out of ten cases after a month, and only 1% still suffer from pain after a year. In people over the age of 60, the pain subsides in about half of the cases after one month, and in 10% of the cases, it is mild to moderate pain that persists after one year.
In case of severe persistent pain, treatment at a pain center will sometimes be necessary.
• Simple pain relievers (aspirin or paracetamol) provide insufficient pain relief. More powerful pain relievers (oxycodone, morphine, methadone …) sometimes also give insufficient results and have many side effects. They can also be addictive.
• Anti-epileptic drugs are said to provide good pain relief in about half of patients. Possible side effects include dizziness, drowsiness and fluid retention in the limbs (peripheral edema).
• Some tricyclic antidepressantsprovide good pain relief and a significant improvement in quality of life in approximately half of patients. Side effects such as dry mouth, constipation, visual disturbances and weight gain are possible.
• Lidocaine patches with a concentration of 5% would help some patients, but there is not enough evidence to recommend this treatment.
• Capsaicin dressings may help some patients, but the risk of sometimes serious side effects and severe local pain is high. This product is therefore not recommended.Shingles and Pregnancy
• Antiviral drugs have not been shown to be effective on the onset or duration of NPZ.
• Corticosteroids have not been shown to be effective in the acute phase of shingles or in the case of NPZ, whether administered orally or injected epidurally.
• Acupuncture in the treatment of postherpetic neuralgia has only been studied to a limited extent. In addition, studies show conflicting results. The possible effect on pain is limited in all cases.
Vaccination for Shingles and Pregnancy
There is currently a vaccine against shingles (Zostavax). In several countries (United States, France, United Kingdom), this vaccine is recommended for people over 60, 65 or 75 years of age. In Belgium, the Higher Health Council published a recommendation in July 2017 stating that the vaccine can be considered for people aged 65 to 79 years. The efficacy of the vaccine in people over 80 is not known. For people who must undergo immunosuppressive therapy, this vaccine can be considered from the age of 50 years (if possible at least four weeks before the start of immunosuppressive therapy).
Unlike the flu or pneumococcal vaccine, for example, the Superior Health Council does not currently recommend any general vaccination in this case in people over 65 years of age. There are currently too few scientific arguments for this.
Do you need to be vaccinated? It is best to consult your doctor to check if the vaccination is useful for you.
• The current vaccine would reduce the risk of shingles by 52% in people aged 50 to 79 and the risk of post-Zoster pain by 76% for at least five years. Then this protection decreases.
• The vaccine can be used in people suffering from a chronic disease (diabetes, chronic renal failure, psoriasis, rheumatoid arthritis).
• After about five years, the protection from the vaccine decreases, and after about 10 years, the protection would be minimal.
• The vaccine should not be used in people with impaired immunity.
• The vaccine should not be used in people who are taking high-dose corticosteroids, undergoing chemotherapy or radiotherapy, taking immunomodulators, or have had a hematopoietic stem cell transplant.
• The vaccine should not be used during pregnancy. After vaccination, you must wait at least 4 weeks before getting Shingles and Pregnancy.
• The vaccine is quite expensive and is not reimbursed.
• Mild, short-term local side effects at the injection site (redness, swelling, pain) occur in about half of the cases.
• About 1 in 10 people experience mild headaches after vaccination.
• Serious side effects are extremely rare.
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