Опоясывающий лишай – вирусное заболевание, характеризующееся везикулезными высыпаниями и болевым синдромом. Возбудителем является вирус Varicella zoster.
Первые упоминания о герпесе встречаются задолго до нашей эры. Свое название herpes берет от греческого слова "herpete", в переводе означающего "ползти". Такое происхождение связано с клинической картиной развития заболевания, при которой пузырьки распространяются в линейном порядке по ходу нервных окончаний, "ползут". Заболевание достаточно распространено. Чаще проявления опоясывающего лишая возникают у лиц среднего и пожилого возраста, реже у детей. Провоцирующим фактором являются переохлаждения, простудные заболевания, стрессовые ситуации, соматические заболевания с тяжелым течением, перенесенные оперативные вмешательства и травмы.
Инкубационный период составляет около недели.
Клиническая картина начала болезни характеризуется ощущением легкого зуда, жжением в местах последующих высыпаний. Из общих явлений встречаются общая слабость, лихорадка. На кожных покровах возникают сгруппированные пузырьки, наполненные прозрачной серозной жидкостью. Кожные покровы по периферии очагов высыпаний гиперемированы. Содержимое пузырьков с течением временем становится мутным. Через 5-7 дней покрышка пузырьков лопается или спадает. На их месте образуются корочки желтого или светло-коричневого цвета. Корочки сохраняются в течение 2-3 недель. В большинстве случаев пузырьки локализуются в эпидермисе (самом поверхностном слое кожи). Поэтому после отпадения корочек на месте высыпаний остается гиперпигментация, которая постепенно приобретает оттенок нормальной кожи. Но иногда, при нетипичном течении заболевания и присоединении вторичной инфекции, процесс затрагивает более глубокие слои кожи. В этом случае образуется рубец. Частым спутником опоясывающего лишая является ноющая боль. Причина ее кроется в тропности (сродству) вируса к нервным клеткам. Вирус обитает в нервных узлах и распространяется вдоль чувствительных нервных окончаний. Этим обусловлен и характер высыпаний с локализацией по ходу нервных волокон. Болевой синдром может сохранятся достаточно долгое время, в течение нескольких недель и даже месяцев.
Наиболее опасна локализация герпеса в глазничной области. Следствием такого расположения может быть распространение вируса по назоцилиарной ветви тройничного нерва и поражение роговицы глаза. К осложнениям опоясывающего лишая также относятся односторонний паралич лица, поражение слухового органа. У ослабленных и тяжелобольных заболевание может осложняться менингитом и энцефалитом.
Диагностика основана на характерных клинических проявлениях. В настоящее время доступны лабораторные методы подтверждения, цитологические, молекулярно-генетические и др, однако обычно для постановки диагноза в них нет необходимости.
Лечение опоясывающего лишая следует начинать как можно ранее. На поздних стадиях специфическая терапия малоэффективна. Благодаря своевременному комплексу лечебных и противорецидивных мероприятий удается достигнуть благоприятного прогноза.
Дифференцировать заболевание следует с ветряной оспой, стрептококковым импетиго, контактным везикулезными проявлениями аллергического дерматита, лекарственной токсидермией, дерматитом Дюринга.
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