Herpesviruses are a family of viruses with 100 members, 8 of which affect humans. These include herpes simplex virus (HSV) types 1 and 2, varicella-zoster virus (the virus that causes chickenpox and shingles), cytomegalovirus, Epstein-Barr virus, human herpesviruses 6 and 7, and Kaposi's sarcoma-associated herpesvirus. As evident, there are various manifestations of herpes infection, so we will focus on the most common ones related to the skin. By far, the most common is oral herpes, commonly known as cold sores, along with genital herpes. In older age groups, shingles caused by the varicella-zoster virus is significant.
What is herpes?
These viruses have DNA as their genetic material. They can only replicate inside the cells of our body, using our cellular reproductive machinery. A key characteristic is that after an acute phase of primary infection, they can hide from our immune system and re-emerge after a long period (years) when the opportunity arises, such as when our immune defenses are weakened. The symptoms they typically cause include inflammation with itching, pain, redness, and blisters filled with the virus.
What types of herpes exist and what causes the infection?
HSV-1 typically causes oral herpes, manifesting as gingivostomatitis during the acute phase, usually occurring in infancy and childhood, with fever, sore throat, and ulcerative lesions. It then recurs less intensely as cold sores. HSV-2 causes genital herpes, where the primary infection is more severe in symptoms of pain and irritation than recurrences. Due to sexual practices, oral herpes can also be caused by HSV-2, and genital herpes can be caused by HSV-1. Cells carrying the herpes virus shed from the area a few days before the recurrence and for several days afterward, potentially transmitting the infection through contact.
After infecting children, varicella-zoster virus remains latent within the nervous system, hidden from immune cells by lying dormant. It stays in a latent state without multiplying or causing inflammation until there is a drop in immunity. This can happen during periods of intense stress and sadness, but smoking and advanced age facilitate it. Additionally, we must not forget cases of immunosuppression from medication or conditions like HIV. When it finds the opportunity, it multiplies and presents as inflammation in a zone, affecting a dermatome innervated by the nerve where it was hiding. That is, it appears in the area of the skin served by the nerves where it was hiding. It usually affects an area on the trunk where chickenpox was severe.
Unfortunately, the virus can also affect the face, particularly the eye, putting it at risk. It is characteristic that involvement of the nasociliary branch is associated with eye involvement and even blindness. Such a clinical picture requires urgent treatment.
Herpes associated with Kaposi's sarcoma causes proliferation of blood vessels in the skin and other organs, leading to a characteristic appearance that was a hallmark for AIDS patients and those with immunosuppression due to HIV in the past.
Human herpesviruses 6 and 7 are associated with the sudden appearance of a rash in infants and young children (roseola infantum) with high fever and a rash after the fever, and with pityriasis rosea in adults usually. Although noisy as a rash, it usually has no symptoms and complications. However, if diagnosed in a pregnant woman, she should consult her obstetrician, as complications during pregnancy have been reported.
How is it treated and why trust the specialists at Totalskin?
If left untreated, this virus typically runs its course, causing inflammation and pain. Inflammation is caused by and simultaneously leads the immune system to create antibodies against the virus and deal with it, without effectively eliminating it. Symptoms pass, and the virus hides again. Unfortunately, if it develops in a dangerous area, it can cause ocular disturbances, personal paralysis, and even brain disorders, usually in infants, as rare complications. More often, shingles leaves intense pain in the area it affected, even months after its resolution, as post-herpetic neuralgia. In some cases, this leads unfortunate patients to pain management clinics for treatment. Thus, early diagnosis and management of herpes infections are important.
The drugs we have for treating HSV-1, HSV-2, and varicella-zoster virus are very effective, especially when given within the first 72 hours of symptom onset. We mainly talk about oral therapy, while severe infections with herpes may require intravenous treatment. Essentially, the drugs prevent the virus from multiplying, allowing our bodies to produce antibodies. They also drastically reduce the likelihood of complications from these viruses. In our clinic, besides timely recognition, diagnosis, and management of infection, we ensure that the therapeutic protocol prevents possible bacterial superinfections of herpes rashes, which, due to the blisters breaking, leave the skin exposed to the environment.
Instructions are also given for reducing and managing pain, limiting spread and transmission, while efforts are made simultaneously to boost the immune system and achieve long-term reduction in recurrences. In recent years, an effective vaccine against shingles has been developed for elderly individuals, while efforts are underway to develop vaccines for oral herpes as well.
