At first, you may not think much about the condition shingles. As romantic as it sounds, unfortunately, this disease is not. If one listens to one another, one may connect them with the upper body, the other connects them with the face. What is she exactly and can you get the shingles elsewhere, for example on the leg?
Shingles are referred to as herpes zoster or zoster infection in medical terminology. It is a viral disease that shows its symptoms on the skin, but is a disease of the associated nerve. The involvement of nerves that supply the leg causes shingles on the leg.
The first signs of shingles, as well as on the chest or the abdomen, are a general malaise and fever. Soon after the typical skin problems occur, which may affect one to three band-shaped skin areas and are usually found only on one side of the body. These include severe pain as well as a tingling sensation and an increased sensation of pain when touched in the diseased skin area. About four days after onset of pain, a reddish rash and small, dense blisters follow. The diseased area of the skin does not follow the typical horizontal boundaries on the leg as on the chest and abdomen, but runs as a strip from the side of the leg sloping to the inside. Rarely, paralysis also develops in this area of the skin.
Especially in the leg, these symptoms may initially be confused with a lumbago or lumbar disc herniation of the lumbar spine. In parallel, however, a slightly elevated temperature can be measured, more rarely also fever.
After a few days, the skin symptoms of the herpes zoster appear. It begins with the appearance of small fluid-filled blisters on reddened skin. Later, the bubbles are cloudy, burst and form crumbly crusts. With the bursting of the bubbles usually the pain disappears. It is rare for the blisters to start bleeding, or the affected skin dies and turns black (necrosis). As a rule, the shingles healed after 2 to 3 weeks.
Itching is actually a form of pain. With the shingles, it can occur right at the beginning together with the sharp pains and tingling sensations or only later together with the rash and the blisters. He should also be treated, as otherwise the patients tend to scratch the blisters. In order to distribute the highly contagious vesicle content on the body or transfer it to others. Unvaccinated children, as well as adults who previously had to suffer from chickenpox, can catch it and develop chicken pox.
Shingles is an inflammation of the nerves. This irritation causes pain, rarely paralysis and numbness. The feelings of numbness are caused by damage to the nerves by the virus and usually occur during the acute phase of the disease. As a rule, no permanent feelings of numbness are to be expected, as these subside again after shingles. For this reason, no therapy is carried out in relation to it.
The inflammation and irritation of nerves caused by the virus can cause severe pain or tingling in the affected area of the skin. The pain associated with shingles should be differentiated between those that develop during a course of the disease and soon fade away and those that last long beyond the period of the blisters and rash.
The latter is called "post-zoster neuralgia". They either go beyond the disease for more than four weeks or only arrive four weeks after a pain-free interval. Especially older people are often affected by this late succession. They are characterized by piercing attacks in addition to the constant pain and a touch pain, which also occur during the disease. Both pain should be treated by a comprehensive therapy.
Describing the course of a shingles should be started with the first infection. Often in childhood, the future patient is suffering from chickenpox. This is caused by the herpes zoster virus, which settles in the nerve roots after the disease subsides. There often remains many years without an outbreak.
Frequently in higher adulthood or after a weakening of the immune system, the virus reignites a re-infection. It spreads along the nerves, causing pain, numbness, tingling, paralysis, a rash and blisters. This re-infection is called shingles. Unfortunately, especially in older people, it often comes to permanent pain even after shingles.
For some years now, children can be protected with a chickenpox vaccine. Nevertheless, it is believed that they too can develop a shingles due to the vaccine. However, one assumes less illness and milder courses. The future will show this in more detail.
For more information read: How long does a shingles take?
In contrast to pain and tingling sensations, paralysis of shingles is rare but may occur. They are the result of damage to the nerve lanes, which usually affects the sensory nerves and the movement nerves. As a rule, however, these form completely back after the illness. In some cases, the problem can persist permanently.
The shingles are caused by the varicella-zoster virus, which belongs to the family of herpesviruses (human herpesvirus-3). In the first infection, this virus causes the well-known chickenpox. This often happens in childhood and usually heals without complications.
However, the varicella-zoster virus remains in the body and nestles in the so-called ganglia. A ganglion is a nerve node, a switching center outside the central nervous system (brain and spinal cord). In them sit the nerve cell bodies, whose extensions then form the nerve. Man has ganglia along the spine and in the head. Often, the Varicella-Zoster virus slumbers for a lifetime in these ganglia. However, if someone is exposed to certain triggering factors, such as stress, or has a weakened immune system, the virus can become active again. Each nerve supplies a skin area (so-called dermatome), which is clearly demarcated and attributed only to him. When the virus reactivates, it spreads out of the ganglion along the nerve, affecting the dermatom supplied by this nerve.
The leg is supplied by the nerves of the lumbar and sacral spine and is divided into sections L1-L5 (L = loin) and S1-S5 (sacrum = sacrum). Each section is provided with associated dermatomes on the leg that extend in a strip from the groin region to the foot. If a patient now has a shingles on his leg, then it can be determined from the affected region, which ganglion is involved in which section.
Importantly, shingles are not necessarily contagious. The varicella-zoster virus is transmitted, which triggers the chicken pox on first contact. After an already passed chickenpox infection one is immune to a renewed infection. The occurrence of shingles as a second disease, however, depends only on the immune status of each person. However, children who have not contracted chicken pox and who have not been vaccinated against it should be kept away from zoster patients, as they may become infected and then contract chickenpox.
Every year, around 350, 000 to 400, 000 people in Germany contract shingles. Of these, about two-thirds are over 50 years old. Age is thus the biggest risk factor due to the decreasing performance of the body's immune system.
Immune system disorders, such as HIV infection, also increase the risk of the varicella-zoster virus being reactivated and appearing as shingles. Other risk factors that weaken the immune system include cancer and the use of immune-suppressing drugs, such as cortisone, cyclosporin and more. Stress, however, should not be underestimated as a factor.
The Shingles on the leg is the third most common site for a herpes zoster outbreak after shingles on the face and upper body. The most common is infestation of the third lumbar nerve L3. The affected skin area extends over the thigh to the inside of the knee, but may vary from person to person. Usually the shingles affect only one side, more rarely both legs are affected (so-called zoster duplex).
The diagnosis of shingles on the leg is based on the clinical picture. The shingles have such a typical constellation of symptoms and visible skin symptoms that this is usually sufficient to make a diagnosis.
It is characteristic that the same stage of the skin appearance can be seen in the whole dermatome at the same time. During the course you can see bubbles everywhere or crusts everywhere, they do not appear at the same time. This distinguishes the herpes zoster from the overall picture significantly from the chickenpox, although they are caused by the same virus. Another typical feature of shingles is the sharp limitation of the disease to the affected dermatome. The chickenpox, however, occur scattered throughout the body and show a colorful picture of bubbles and crusts.
The shingles therapy on the leg relies on three building blocks, namely to fight the virus, to control the pain and to prevent a second infection of the attacked skin with bacteria.
Virostatics are given for virus control. The infestation of the leg is an easier course, since no sensory organs are affected. In tablet form can be given:
Aciclovir (eg Zovirax®) 5x 800mg a day for 7-10 days
Valaciclovir (eg Valtrex®) 3x 1000mg daily for 7 days
Famciclovir (eg Famvir®) 3x 250mg a day for 5-6 days
Brivudine (eg Zostex®) 1x 125mg daily for several days
For more severe cases, such as involvement of the genitals or the bladder, intravenous therapy with acyclovir infusion is avoided.
To treat the pain, a so-called step pattern is used. First, non-steroidal and non-opioid analgesics such as paracetamol, ibuprofen, naproxen or metamizol (Novalgin®) are used. If the pain is not eliminated, the next higher level is reached. Light opioids (morphine derivatives) such as tramadol or tilidine plus naloxone are administered. If necessary, you can also use drugs that are not analgesics in the sense, but in combination have significant analgesic effect, such as amitriptyline or gabapentin. The last stage of pain therapy involves strong opioids such as morphine or buprenorphine. It makes sense to consult a pain specialist for the development of adequate pain therapy. It is essential to control the pain in a shingles, as this may otherwise be chronic and a permanent burden for the patient.
Accompanying the shingles on the leg can also be applied well with ointments. These should be antiseptic and dehydrating. Ointment oils (Tannosynt, Tannolact ® ) or Clioquinol (2-3% in lotio alba) may be used. Also creams with antibacterial or virostatic additive are used. If a bacterial superinfection is suspected, antibiotics in tablet form are also added. However, these have no effect against the varicella-zoster virus.
With age, the risk of developing shingles from so-called zoster neuralgia increases. These are nerve pains in the affected nerve that stop, even though the shingles itself has long since subsided. While this complication is not visible, it also puts a lot of psychological strain on the patient. This should be avoided by appropriate pain therapy during treatment.
Another complication may be scarring necrotizing herpes zoster, so if the skin partially dies. Also numbness or hypersensitivity of the affected skin is possible after the disease.
Although infection with bacteria is also a complication, it should be treated well with antiseptic ointments or, if necessary, antibiotics. However, you should always keep this in mind.
Meanwhile, there is a vaccine against the varicella-zoster virus, which is mainly administered to children to protect them from chickenpox. A study in which subjects were vaccinated with the drug for over 60 years has shown that the vaccine causes a reduction in the number of cases by about half. However, it does not provide complete protection.