Herpes zoster (fuoco di Sant'Antonio): sintomi, terapia e cura | OK Salute (2022)

L’Herpes zoster, comunemente definito fuoco di Sant’Antonio, è una patologia virale a carico della pelle e delle terminazioni nervose. È caratterizzata da eruzioni cutanee simili alle vesciche della varicella, che compaiono di solito sul torace o sulla schiena. Più raramente si manifestano anche sul viso, attorno agli occhi, all’interno della bocca, su un braccio o su una gamba. Di solito sono presenti su un solo lato del corpo, comunque sempre in corrispondenza di un nervo sensitivo colpito dal virus. Nella zona interessata dall’esantema è presente anche un dolore molto intenso. Il nome deriva dalle parole greche herpes (serpente) e zoster (cintura), descrivendo bene i sintomi della malattia, come un serpente di fuoco che si annida all’interno del corpo.

Ecco il focus a cura di Giuseppe De Benedittis, direttore del Centro interdipartimentale per lo studio e la terapia del dolore all’Università degli Studi di Milano.

Herpes zoster (fuoco di Sant'Antonio): sintomi, terapia e cura | OK Salute (1)

In questo articolo

Il decorso

L’Herpes zoster ha un decorso da dieci giorni a tre mesi. Nella metà dei casi si risolve con la guarigione completa e nell’altra metà purtroppo si cronicizza nella nevralgia post erpetica, ovvero un dolore persistente, anche per mesi o per sempre, nelle parti dove in precedenza si è diffuso l’esantema.

I sintomi

L’Herpes zoster esordisce con una sensazione di formicolio nelle parti del corpo più colpite dal virus (torace, viso, arti). Insorge poi un’eruzione cutanea con una striscia di puntini rossi che segue il percorso del nervo infettato. L’esantema evolve in pustole piene di liquido che si seccano con la formazione di croste. Allo sfogo epidermico è associato un dolore acuto che impedisce qualsiasi attività. Se il dolore, trascorso un periodo di circa tre dalla scomparsa dell’esantema, non regredisce è probabile che sia in gioco la nevralgia post erpetica.

(Video) Fuoco di Sant'Antonio (Herpes zoster) - sintomi, cura, vaccinazione

Le cause

Responsabile della malattia è lo stesso virus che provoca la varicella: il virus dell’Herpes zoster, tra i più aggressivi della sottofamiglia degli Alphaherpesvirinae. La sua caratteristica è quella di rimanere annidato nell’organismo, dormiente nei gangli delle radici dorsali del midollo dopo la guarigione dalla varicella, per risvegliarsi quando la risposta immunitaria è più vulnerabile e mettersi a «viaggiare» lungo le fibre nervose. Si calcola che circa il 90% della popolazione si ammali di varicella nella vita e il 10% di questi abbia una recidiva dell’infezione nella forma del fuoco di Sant’Antonio.

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    (Video) Fuoco di Sant'Antonio, quali sono i sintomi?

Chi sono le persone più a rischio?

Nella popolazione anziana, tra i 70 e gli 80 anni, o in soggetti immunodepressi il cosiddetto fuoco di Sant’Antonio può riattivarsi per diversi motivi (malattie, trapianti, stress). In alcuni casi, quando il virus colpisce persone giovani potrebbe essere il campanello d’allarme di patologie importanti come linfomi o altri tumori. L’incidenza dell’herpes zoster in Italia è di 350mila persone l’anno. I numeri, negli ultimi decenni, sono più che raddoppiati, sia per l’innalzamento dell’età media, sia per fattori epidemiologici. La nevralgia post erpetica colpisce la metà degli ultrasessantenni e i due terzi degli ultrasettantenni che hanno sofferto di herpes zoster. L’herpes zoster si può scatenare, molto raramente, anche in gravidanza.

La diagnosi

La manifestazione più evidente, dalla quale si può diagnosticare l’Herpes zoster, è l’eruzione cutanea. In rari casi (4-5%), si può verificare lo zoster sine herpete, ovvero senza esantema. Riconoscere i sintomi e attribuire il dolore neuropatico al virus spesso è difficile. Il paziente rischia di girare a vuoto prima di riuscire a identificare la causa, per scoprirla quando è già in fase cronica. In presenza di sintomi sospetti in fase acuta si può effettuare il dosaggio dei virioni (particelle virali) mediante PCR; in fase cronica si può effettuare il dosaggio delle immunoglobuline (M indicano un contatto recente, G remoto). Utile può risultare l’applicazione topica a base di acido acetilsalicilico ed etere etilico (criterio ex-adjuvantibus): se il paziente risponde in modo positivo, la sua risposta suggerisce uno zoster sine herpete.

Le cure

La risoluzione dell’esantema è spontanea. Il dolore invece va trattato per alleviarne l’intensità. Ecco farmaci e trattamenti indicati per la terapia di Herpes zoster e nevralgia post erpetica.

I farmaci antivirali

Come aciclovir, famciclovir, valaciclovir, citarabina, brivudina. Assunti per via orale o endovenosa (nei soggetti immunodepressi), sono somministrati per ridurre esantema e dolore, la durata della malattia e le eventuali complicazioni. La terapia va iniziata non oltre le 72 ore dalla manifestazione del rush cutaneo e protratta per sette-dieci giorni.

Farmaci antidepressivi

Come l’amitriptilina. Prescritti a fini antalgici, influiscono sui neurotrasmettitori (come la serotonina e la norepinefrina) che inviano i messaggi fra le cellule cerebrali e che nel caso dell’herpes zoster giocano un ruolo nel modo in cui il corpo interpreta le sensazioni dolorose. Si somministrano soprattutto se il dolore è bruciante e continuo.

Farmaci antiepilettici

Regolarizzano l’anomala attività elettrica del sistema nervoso causata dai nervi danneggiati. Si prescrivono soprattutto se il dolore si manifesta a fitte.

Il vaccino

Indicato nella prevenzione dell’Herpes zoster e della Nevralgia post-erpetica a partire dai 50 anni. Agisce contrastando la riattivazione e la replicazione del virus, già presente e latente. Non è un vaccino terapeutico, cioè non serve come cura ma riduce il rischio di sviluppare la malattia: si stima che almeno la metà dei casi di Herpes zoster sarebbe evitata dalla vaccinazione. (aggiornato a luglio 2015)

(Video) Herpes Zoster (Fuoco di Sant'Antonio): prevenirlo con il vaccino

Terapie topiche

Sono le cure da usare localmente, sulla parte interessata dall’eruzione e dal dolore, direttamente sulla pelle.
1. Soluzione a base di acido acetilsalicilico ed etere etilico: ha un effetto antalgico e riduce il rischio di nevralgia post erpetica.
2. Capsaicina: pomata a base di semi di peperoncino rosso che viene utilizzata soprattutto nelle forme posterpetiche.
3. Cerotti o pomate a base di lidocaina (un anestetico): hanno un effetto antidolorifico.
4. Desensibilizzazione: è una tecnica che punta a riabilitare la cute dolente stimolandola. Se, per esempio, il male si scatena al contatto con i vestiti, il medico può suggerire di strofinare per parecchi minuti sulla parte interessata un asciugamano. Ancora: se il dolore arriva da una abnorme sensibilità alle temperature, può essere consigliabile applicare impacchi caldi o freddi.

Tens

Una stimolazione elettrica transcutanea dei nervi. Consiste nell’applicazione sulla zona dolorante di elettrodi collegati a un piccolo stimolatore che il paziente può portare con sé, azionandolo quando il male cresce, per placarlo. L’efficacia, però, è modesta.

Il contagio

L’Herpes zoster è contagioso? Il contagio è raro nella fase acuta, impossibile nella fase cronica. Avviene tramite contatto diretto con il liquido contenuto nelle vescicole, quindi solo durante i primi giorni della malattia. Il rischio di contrarre l’herpes zoster in questo modo, però, è molto basso. Se si verifica un caso in famiglia valgono le normali precauzioni, ovvero evitare di toccare le zone interessate dallo sfogo cutaneo.

Le ricadute

Un attacco di herpes zoster si può ripetere? Per fortuna è rarissimo soffrire di fuoco di Sant’ Antonio due volte nella vita. Tuttavia, secondo gli esperti non esistono forme di prevenzione efficaci: è però buona norma non avere contatti diretti con pazienti colpiti dall’infezione o con i loro indumenti.

Il nuovo vaccino contro l’Herpes Zoster

Il Fuoco di Sant’Antonio si può prevenire grazie alla vaccinazione. L’anno scorso l’Italia ha dato il via libera al nuovo vaccino ricombinante adiuvato. Molto alta la sua efficacia, rispetto al vecchio siero. Ha un’efficacia superiore al 90% e può essere somministrato anche nei pazienti immunocompromessi.

Leggi anche…

  • Fuoco di Sant'Antonio in gravidanza: quali rischi per il bambino?

  • L'herpes simplex può uccidere?

    (Video) Fuoco di Sant'Antonio, quali sono le cause scatenanti?
  • Vaccini sì o vaccini no? Tutte le risposte

  • Vaccino Fuoco di Sant'Antonio: dove, quando e come viene fatto

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fuoco-di-santantonio herpes zoster cura herpes zoster terapia herpes zoster vaccino herpes-zoster nuovo vaccino fuoco di sant'antonio

(Video) La risposta dell'Esperto - Medicina del dolore: dolore da herpes zoster

FAQs

What test is done for herpes zoster? ›

Polymerase chain reaction (PCR) is the most useful test for confirming cases of suspected zoster sine herpete (herpes zoster-type pain that occurs without a rash). PCR can be used to detect VZV DNA rapidly and sensitively, and is now widely available.

How do you get herpes zoster? ›

What causes herpes zoster? Herpes zoster is caused by the reactivation of the chickenpox virus. After a person has had chickenpox, the virus lies dormant in certain nerves for many years.

What causes the varicella zoster virus to reactivate? ›

The primary factors that impact a person's cellular immunity are age and medical conditions or medications that suppress the immune system. Post-pregnancy and menopausal hormonal fluctuations in women have also been linked to VZV reactivation.

Can herpes zoster recur? ›

Herpes zoster (HZ) is generally thought to occur once in a lifetime and recurrence is considered to be limited to immunocompromised individuals. Although HZ recurrence rates seem to be increasing, there have been few studies exploring these rates in the general population.

Can you test positive for herpes and not have it? ›

False positive test results show that a person has an infection or condition when they do not. This can happen with many kinds of diagnostic tests. However, the chance of a false positive herpes test result is much higher than when testing for STIs like chlamydia or gonorrhea.

What diseases are caused by herpes virus? ›

Overview. Infection with herpes simplex virus (HSV), known as herpes, is common globally. HSV type 1 (HSV-1) is typically transmitted by oral-to-oral contact and causes infection in or around the mouth (oral herpes), but it can also cause genital herpes. HSV-2 is mainly sexually transmitted and causes genital herpes.

Who is at risk for herpes zoster? ›

As a result, almost all older adults in the United States are at risk for herpes zoster. Approximately 1 out of 3 people in the United States will develop herpes zoster during their lifetime. Most people have only one episode of the illness in their lifetime, however, multiple episodes are possible.

What is the main cause of herpes? ›

Genital herpes is a common sexually transmitted infection caused by the herpes simplex virus (HSV). Sexual contact is the primary way that the virus spreads.

Can herpes be cured? ›

There is no cure for genital herpes. However, there are medicines that can prevent or shorten outbreaks. A daily anti-herpes medicine can make it less likely to pass the infection on to your sex partner(s).

How long does it take for your immune system to recover after shingles? ›

In many cases, shingles gets better within around two to four weeks. However, it's still important to see your GP or pharmacist as soon as possible if you recognise the symptoms of shingles, as early treatment may help reduce the severity of the condition and the risk of potential complications.

What is the most painful stage of shingles? ›

Typically, the peak pain of shingles is felt within 4 or 5 days after the first symptoms develop, and it comes along with a blistering rash. As the blisters scab over, the pain usually starts to disappear. In some cases, the pain does not go away. This is known as a condition called postherpetic neuralgia.

How can herpes zoster be prevented? ›

Zoster vaccine is recommended for all persons aged >60 years who have no contraindications, including persons who report a previous episode of zoster or who have chronic medical conditions. The vaccine should be offered at the patient's first clinical encounter with his or her health-care provider.

Can stress cause shingles? ›

Since stress affects the immune system, many researchers believe that stress could be a trigger for shingles. Researchers in multiple studies have linked chronic, daily stress, and highly stressful life events as risk factors for shingles.

Is your immune system weaker after shingles? ›

Weakened Immune System

There is a clear association between shingles and weakened immunity to infection.

What are the first signs of herpes in woman? ›

The first signs may include:
  • Itching, tingling, or burning feeling in the vaginal or anal area.
  • Flu-like symptoms, including fever.
  • Swollen glands.
  • Pain in the legs, buttocks, or vaginal area.
  • A change in vaginal discharge.
  • Headache.
  • Painful or difficult urination.
  • A feeling of pressure in the area below the stomach.

Can a blood test detect herpes? ›

Testing with no symptoms. Blood tests can be used when a person has no visible symptoms but has concerns about having herpes. Blood tests do not actually detect the virus; instead, they look for antibodies (the body's immune response) in the blood.

Will herpes show up in a blood test? ›

If you have the herpes virus and your body has produced antibodies, it can be detected on a blood test, even if you have no symptoms. The only time the virus might not be detected on a test (after you've contracted it) is if you've been tested too early.

Can herpes affect your brain? ›

Key points. Herpes meningoencephalitis is an infection of the brain and brain covering (meninges) caused by the herpes simplex virus. It is a medical emergency that requires treatment right away.

What organs are affected by herpes? ›

Internal organs affected may include the liver, stomach, lungs, brain, and pancreas [4], [5].

Does herpes affect your health? ›

Herpes isn't deadly and it usually doesn't cause any serious health problems. While herpes outbreaks can be annoying and painful, the first flare-up is usually the worst. For many people, outbreaks happen less over time and may eventually stop completely.

Is herpes zoster an STD? ›

Shingles, also known as Herpes zoster, is not related to the sexually transmitted herpes virus disease called herpes genitalis. Shingles may cause pain that can continue after the rash disappears.

What do herpes look like? ›

What does a genital herpes outbreak look like? Genital herpes outbreaks usually look like a cluster of itchy or painful blisters filled with fluid. They may be different sizes and appear in different places. The blisters break or turn into sores that bleed or ooze a whitish fluid.

Does herpes zoster need isolation? ›

In all cases, follow standard infection-control precautions.
...
Management of Patients with Herpes Zoster.
Localized HZDisseminated HZ
Immunocompetent PatientCompletely cover lesions and follow standard precautions until lesions are dry and crustedAirborne and contact precautions until lesions are dry and crusted
1 more row

Can you get herpes from a toilet seat? ›

It's very unlikely that you would get genital herpes from a toilet seat. Genital herpes is a sexually transmitted infection (STI) spread by skin-to-skin contact. In most cases, the virus enters your body through mucous membranes — the type of skin found in your mouth, genitals or anus.

How long does herpes last for? ›

Herpes outbreaks usually last for about one to two weeks, though the first outbreak after infection may last longer. The symptoms typically go away on their own without treatment. However, there are at-home remedies and prescription treatments which may help to ease symptoms and shorten the length of outbreaks.

Can you get herpes from stress? ›

Researchers discovered that the more persistent stress reported, the greater the likelihood of a herpes outbreak the following week. Also, an increased recurrence rate occurred after participants experienced their highest levels of anxiety the previous month.

Is banana good for shingles? ›

Stress-balancing Bs are vital to a shingles diet since the virus tinkers with nerve endings causing severe pain. Get cracking with eggs of all manners, along with milk and chicken, packed with B12s, while bananas, brewer's yeast and potatoes have an abundance of calming B6s.

Are eggs good for shingles? ›

Foods good for shingles are listed below. They help support the immune system of older people. Foods rich in these nutrients: zinc (eggs), vitamin C (guava, kiwi, lemons and kale), vitamin A (egg yolks, salmon and carrots), vitamin E (avocado), vitamin B12 and vitamin D.

Is yogurt good for shingles? ›

Eating yogurt may help a person with shingles, as it contains probiotics and lysine, which may help support the immune system to better fight the virus. Vitamin-rich foods and complex carbohydrates may also improve the immune system, and a nutritious diet can be beneficial against shingles.

Does sleep help shingles? ›

Managing shingles symptoms

In addition to seeking medical treatment, people can take other steps to alleviate their symptoms and reduce discomfort. These include: getting enough sleep and rest. using a wet compress on the itchy and inflamed skin and blisters.

Can shingles be cured in 3 days? ›

Although there is no cure for shingles, numerous treatment options are available. The American Academy of Dermatology recommend that a person with shingles receive treatment within 3 days. Timely and effective treatment can help prevent complications, such as chronic nerve pain.

How can I boost my immunity? ›

Six Tips to Enhance Immunity
  1. Eat Well. Food Assistance. ...
  2. Be Physically Active. Regular physical activity helps you feel better, sleep better, and reduce anxiety. ...
  3. Maintain a Healthy Weight. Excess weight can affect how your body functions. ...
  4. Get Enough Sleep. ...
  5. Quit Smoking. ...
  6. Avoid Too Much Alcohol. ...
  7. In Summary.

What are the 4 stages of shingles? ›

The stages of shingles are tingling pain, followed by a burning feeling and a red rash, then blistering, and finally the blisters will crust over.

What painkillers are good for shingles? ›

Doctors have a variety of choices to treat shingles pain. Medications like ibuprofen or acetaminophen are often used. More severe cases might call for use of Tylenol with codeine or oxycodone.

Can I spread shingles on myself? ›

Answer: Shingles cannot spread from one person to another. However, the virus that causes shingles (varicella-zoster virus) can spread from a person with active shingles to someone who is not immune to chickenpox (most people have had a chickenpox infection or vaccinated against chickenpox).

Is there a blood test for zoster? ›

Laboratory tests can detect and measure the level of two classes of VZV antibodies in the blood: IgM and IgG. IgM antibodies are the first to be produced by the body in response to a VZV infection. They are present in most individuals within a week or two after the initial exposure.

Is there a blood test to confirm shingles? ›

What happens during chickenpox and shingles testing? You will need to provide a sample of blood from your vein or from the fluid in one of your blisters. Blood tests check for antibodies to the VZV. Blister tests check for the virus itself.

Can you test for shingles with a blood test? ›

If you have an atypical rash or there aren't any good swabs to use as a sample for PCR, serological testing can be used in addition to a physical exam to diagnose shingles, typically by looking for antibodies in your blood.

What are the first signs of having shingles? ›

Symptoms
  • Pain, burning or tingling.
  • Sensitivity to touch.
  • A red rash that begins a few days after the pain.
  • Fluid-filled blisters that break open and crust over.
  • Itching.
20 Aug 2022

Can shingles affect internal organs? ›

In rare cases, the shingles infection can affect other organs. This leads to more serious complications that can be life-threatening. In the lungs, it can lead to pneumonia. In the liver, it can cause hepatitis, and in the brain, it can cause encephalitis.

Can Covid cause shingles? ›

In a nutshell, yes. Researchers recently found that people over 50 who had COVID were more likely to get shingles than people who did not have COVID. This risk persists for at least 6 months following COVID-19 infection.

What is the most painful stage of shingles? ›

Typically, the peak pain of shingles is felt within 4 or 5 days after the first symptoms develop, and it comes along with a blistering rash. As the blisters scab over, the pain usually starts to disappear. In some cases, the pain does not go away. This is known as a condition called postherpetic neuralgia.

Can I go to work with shingles? ›

If you have shingles, you're contagious until the last blister has dried and scabbed over. To help prevent the virus being passed on, avoid sharing towels or flannels, swimming, or playing contact sports. You should also avoid work or school if your rash is weeping (oozing fluid) and can't be covered.

Can shingles go away on its own? ›

Generally, a case of shingles rash resolves within 3 to 4 weeks. It can resolve without treatment, but antiviral treatment can shorten both the duration and severity of the rash.

Can shingles cause back pain? ›

Shingles is an infection of the spinal nerves by the herpes virus causing painful blisters on the skin of the affected dermatome. Patients may experience back pain in the lumbar spine preceding the outbreak of shingles. After the infection subsides, some patients may still experience chronic nerve pain.

Do you need to see a doctor for shingles? ›

It's important to see your doctor no later than three days after the rash starts. The doctor will confirm whether you have shingles and can make a treatment plan. Most cases can be diagnosed from a visual examination. If you have a condition that weakens the immune system, your doctor may order a shingles test.

How many times can you get shingles? ›

Yes: although it's uncommon, you can get shingles multiple times. Shingles is caused by the varicella-zoster virus, which is the same virus that causes chickenpox. The virus sticks around in your body after chickenpox symptoms go away, lying dormant in your nerves, held in check by your immune system.

Can shingles spread? ›

Answer: Shingles cannot spread from one person to another. However, the virus that causes shingles (varicella-zoster virus) can spread from a person with active shingles to someone who is not immune to chickenpox (most people have had a chickenpox infection or vaccinated against chickenpox).

Is shingles caused by stress? ›

Shingles is a reminder that the mind and body are not separate. Essentially, emotional stress doesn't cause shingles as we know the virus is already lying dormant in the body. However, emotional stress can weaken the immune system, reducing the body's ability to defend against illnesses.

Do shingles make you tired? ›

You may experience fatigue while you have shingles. However, it's also possible to feel fatigued even after the shingles rash has disappeared. Fatigue may happen indirectly due to PHN, a complication of shingles that involves lingering pain. Many people with PHN experience insomnia.

What does shingles pain feel like? ›

Shingles is a painful, blistering rash that usually develops on one side of the face or body along a nerve path. People describe the pain as a burning or stabbing sensation.

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4. Herpes zoster. Intervista alla Dott.ssa Manuela Carrera – Rai2
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5. Herpes Zoster (Fuoco di Sant'Antonio) nuovo vaccino efficace e duraturo anche negli anziani
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