Prognosis and course
The prognosis for varicella or zoster disease is generally good: the skin symptoms heal without scarring and the pain from zoster subsides completely after the nerve inflammation. After contracting varicella, one is immune to the virus for life, i.e. despite renewed contact with the virus one does not contract chickenpox. However, immunocompromised patients, patients with zoster ophthalmicus or oticus, children with congenital varicella and premature babies who develop chickenpox after birth have a serious prognosis because they can suffer severe permanent damage from the infectious disease.
Special case: shingles
Shingles is therefore a secondary disease after varicella infection (= wind pox) in childhood or adolescence and occurs when the varicella zoster virus is reactivated as a result of the body’s defensive weakness. This immune weakness can occur, for example, in the course of an infection. Shingles is an inflammation of the nerves (=neuritis), which is accompanied by pain and blistering of a certain area of skin.
The sharp demarcation of the pain and the grouped vesicles to a specific skin region can be explained by anatomical factors: The affected skin region is supplied sensitively (= tactile sensations and sensations of pressure and pain are mediated by sensitive nerves) by the nerve cells infected by the virus, which run to the skin in bundled form. Each nerve bundle supplies a part of the skin; these areas innervated by a nerve bundle are called dermatomes. In the case of shingles, one or more dermatomes or the associated nerve cells are affected.
In most cases, the inflammation affects the nerve cells that sensitively supply the central part of the trunk: the vesicles appear in a belt-shaped arrangement in the lumbar region, which is why it is called shingles. If the immune system is extremely weakened by an existing disease, zoster generalisatus can occur, in which the zoster blisters and pain occur throughout the body. Patients with shingles are contagious, and this applies to people who have not yet contracted chickenpox or who have not been vaccinated against chickenpox.
Analogous to the vesicles of chickenpox, the vesicular rash of shingles contains the virus in high concentrations, which can be transmitted by direct contact or by air. The disease of shingles announces itself through pain and an altered sensation in the affected skin region. After a few days, a sharply defined area of skin finally blisters.
The rash is indistinguishable from that of chickenpox, but due to its limited area of occurrence and the severe pain, it can be separated from the varicella. Patients are often limited by the disease: they are afraid of light, have fever and headaches and have swelling of the local, i.e. nearby, lymph nodes. The disease of shingles can lead to the following complications: Particularly in older patients, a persistent pain in the area of the body affected by herpes zoster is observed, even long after healing.
If the supply area of the ophthalmic nerve, which sensitively innervates the eye region, is affected during virus reactivation, complications may occur in the eyes. In zoster oticus, in which the nerve supplying the ear is affected by the inflammatory process, the course of the disease can extend to deafness. You can learn more about shingles here: shingles
