Herpes Zóster

 

El herpes zoster, también conocido como “herpes” a secas o “la culebrilla” es un problema bastante común que se desarrolla años después de haber sufrido varicela, apareciendo sobre todo en las épocas primaverales. Si quieres saber más acerca de esta patología, te lo explicamos en este post.

¿Qué es el Herpes Zóster?
El herpes zóster es una lesión de la piel causada por el virus varicela-zóster. Aparece como una erupción formada por muchas vesículas agrupadas en una zona de la piel de manera unilateral del tronco (tanto en el pecho como en la espalda), cara e incluso a nivel de los ojos.
Esto es debido a que el virus de la varicela, después de haber padecido la enfermedad previamente, ha quedado inactivo y latente (como si estuviera dormido) y así permanecerá el resto de la vida instalado en cualquier nervio debajo de la piel. Al reactivarse, las lesiones aparecerán en el recorrido de ese nervio.
No se sabe cuál es la razón por la que este virus se reactiva después de tanto tiempo, pero hay factores que predisponen aún más a la enfermedad, como por ejemplo en personas mayores de 60 años o personas con un sistema inmune muy debilitado ya sea por fármacos o por alguna enfermedad.
¿A quién puede afectar?
Puede presentarse casi a cualquier edad, pero cualquier persona que haya pasado la varicela puede desarrollar un herpes zóster más delante, incluso los niños o adolescentes sanos, siendo casos bastante raros.
¿Cuáles son sus síntomas más comunes?
Los síntomas del herpes zoster suelen ser a nivel local. En el lugar de la aparición de la erupción de las vesículas suele haber dolor, hormigueo y ardor a veces acompañado de picor. Las vesículas en casos extremos podrían dar lugar a la formación de úlceras en la piel. Cuando la afectación es a nivel del ojo, es muy frecuente la aparición de una ulcera a nivel de la córnea acompañándose de dolor ocular y a veces de pérdida de visión dependiendo del lugar en el que aparezca la úlcera herpética.
Podrían aparecer también síntomas generales como dolor abdominal, fiebre con escalofríos o malestar general con dolores articulares. Afortunadamente, tanto los niños como los adolescentes casi siempre presentan casos leves; los casos graves sólo afectan a la gente mayor.
¿Es contagioso?
El virus varicela-zoster es muy contagioso, por tanto puede ser fácil que las personas que entren en contacto directo con las lesiones del herpes y que no hayan tenido la varicela, puedan contraerla, pero no un herpes zóster.
¿Cómo se diagnóstica el herpes zoster?
El diagnóstico del herpes zoster se realiza con la clínica, al aparecer las lesiones, no es necesaria ninguna prueba complementaria por parte de su médico.
Si sospecha que las lesiones dolorosas y molestas que presenta pueden ser un herpes zóster acuda a su médico.
¿Cómo se trata el herpes?
El tratamiento dependerá de la edad del paciente, sus enfermedades, su sistema inmune y la evolución de las lesiones, ya que la infección puede seguir su curso y generalmente desaparece en menos de un mes por sí solo y el tratamiento simplemente prevendrá las complicaciones en las personas más vulnerables.
El principal tratamiento son los antivirales durante vía oral mantenidos durante una semana siempre y cuando aún no hayan pasado más de 72 horas desde la aparición de las vesículas. El tratamiento, aun pasadas las 72 primeras horas, se pautará también si el paciente es mayor de 60 años, está inmunodeprimido o existen enfermedades que puedan agravarse con la presencia de la infección. Se acompañará de tratamiento tópico con toques de alcohol para el secado de las vesículas y evitar la infección de las lesiones. No es necesario tapar las lesiones, pero sí es importante evitar el contacto directo con ellas. Los medicamentos antivirales no pueden eliminar el virus del cuerpo, pero pueden reducir el riesgo de complicaciones y ayudar a acelerar el proceso de curación. Cuanto antes se inicie el tratamiento, más eficaz será y menor será el riesgo de que haya complicaciones.
Es importante el uso de analgésicos como paracetamol o antiinflamatorios como ibuprofeno o metamizol, muy útiles para aliviar el dolor asociado al herpes zoster. A veces éstos pueden complementarse con parches cutáneos con tratamiento específico para este tipo de patología en casos rebeldes y muy dolorosos.
En caso de herpes zoster oftálmico, el tratamiento será similar, al tratamiento oral se asociarán antivirales en pomada para su aplicación ocular.
¿Puede prevenirse el herpes?
No hay forma de prevenir el herpes zóster por completo. Existe la vacuna contra la varicela puede hacer que el herpes zóster sea menos grave, pero está destinada para ciertos casos muy específicos como ancianos y esto se debe, en parte, a que, cuanto mayor es una persona, más grave puede ser su herpes zóster.
Los bebés recién nacidos, las mujeres embarazadas y toda persona cuyo sistema inmunitario esté debilitado, así como cualquier persona que no sea inmune a la varicela, deben evitar el contacto con personas que padezcan un herpes zóster hasta que el sarpullido se haya curado por completo.
¿Existe alguna complicación?
La mayoría de los casos de herpes zóster se curan solos, con o sin tratamiento, y no desencadenan ningún otro problema. En casos muy raros, el herpes zóster puede generar complicaciones como las siguientes:
– Dolor mantenido (neuralgia postherpética): las lesiones en los nervios debajo de la piel irritados por la infección generan un dolor que puede persistir durante un período prolongado tras la desaparición de las lesiones en la piel.
– Problemas en la vista: si el herpes zóster aparece cerca del ojo o dentro del ojo, puede provocar pérdidas visuales.
– Infecciones en la piel: la erupción del herpes zóster puede infectarse con bacterias.
– Problemas del sistema nervioso: el herpes zóster en la cara puede afectar a varios nervios distintos pudiendo conllevar problemas como parálisis facial y problemas auditivos o de equilibrio. En casos excepcionales, el herpes zóster puede evolucionar a una encefalitis (inflamación del cerebro).


María Hernández Carrasco

Médico de medicina familiar y comunitaria. C.S. Arturo Eyries, Valladolid

 
BIBLIOGRAFIA
– Klassen TP, Hartling L, Wiebe N, Belseck EM. Aciclovir para el tratamiento de la varicela
en niños y adolescentes sin otra enfermedad (Revisión Cochera e traducida). En: La Biblioteca Cochrane Plus, número 4, 2008. Oxford, Update Software Ltd. Disponible en: http://www.update-software.com (Traducida de The Cochrane Library, 2008 Issue 3. Chichester, UK: John Wiley&Sons, Ltd.).
– Niv D, Maltsman Tseikhin A. Postherpetic Neuralgia: The Never-Ending Challenge. Pain Practice 2005; 5. Issue 4: 327-340. 3.
– Thyregod HG, Rowbotham MC, Peters M, Possehn J, Berro M, Petersen KL. Natural history of pain following herpes zoster. Pain 2007; 128:148-156.

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