Frequency distribution

Every year, about 350,000 – 400,000 people in Germany contract shingles. About two thirds of them are over 50 years old. Due to the declining performance of the body’s immune system, age is therefore the biggest risk factor.

Diseases of the immune system, such as an infection with HIV, 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 or the use of drugs that suppress the immune system, such as cortisone preparations, cyclosporine, etc. However, stress should not be underestimated as a factor either.Shingles on the leg is the third most common location for a herpes zoster outbreak after shingles on the face and upper body.

The third lumbar nerve, L3, is the most common location for a herpes zoster outbreak. The affected area of skin extends over the thigh to the inside of the knee, but can vary from person to person. Usually shingles affects only one side, more rarely both legs are affected (so-called zoster duplex).

Diagnosis

The diagnosis of shingles in the leg is made on the basis of the clinical picture. Shingles offers such a typical constellation of symptoms and visible skin appearances that this is usually sufficient for diagnosis. It is characteristic that the same stage of the skin appearance is visible in the whole dermatome at the same time.

During the course of the disease, either blisters or crusts can be seen everywhere, they do not appear simultaneously. This distinguishes herpes zoster from 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.

Chickenpox, on the other hand, is scattered all over the body and shows a colorful picture of blisters and crusts. The therapy of shingles on the leg is based on three components: fighting the virus, controlling the pain and preventing a second infection of the affected skin with bacteria. Antivirals are given to combat the virus.

Infection of the leg is an easier course, as no sensory organs are affected. In tablet form can be given: Aciclovir (e.g. Zovirax®) 5x 800mg a day for 7-10 days Valaciclovir (e.g.

Valtrex®) 3x 1000mg a day for 7 days Famciclovir (e.g. Famvir®) 3x 250mg a day for 5-6 days Brivudin (e.g. Zostex®) 1x 125mg per day for several days In more severe cases, e.g. involving the genitals or the bladder, an intravenous therapy with acyclovir infusion is used.

For the treatment of the pain, a so-called step-by-step scheme is used. First, non-steroidal and non-opioid painkillers such as paracetamol, ibuprofen, naproxen or metamizole (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, additional drugs can be used which, although not painkillers in this sense, have a clear pain-relieving effect in combination, such as amitriptyline or gabapentin. The last stage of pain therapy includes strong opioids such as morphine or buprenorphine.

It is advisable to consult a pain specialist for the elaboration of an adequate pain therapy. It is absolutely necessary to bring the pain under control in case of shingles, otherwise it can become chronic and a continuous burden for the patient. In the case of shingles on the leg, it is also possible to apply ointments and compresses.

These should have an antiseptic and drying effect. Ointments with oak bark extract (Tannosynt; Tannolact®) or with the active ingredient clioquinol (2-3% in Lotio alba) can be used. Creams with antibacterial or virostatic additives are also used.

If superinfection with bacteria is suspected, antibiotics in tablet form are also given additionally. However, these have no effect against the Varicella zoster virus.

Aciclovir (e.g.
Zovirax®) 5x 800mg a day for 7-10 days
Valaciclovir (e.g. Valtrex®) 3x 1000mg a day for 7 days
Famciclovir (e.g. Famvir®) 3x 250mg a day for 5-6 days
Brivudine (e.g. Zostex®) 1x 125mg per day over several days