Shingles in children: Causes, diagnosis and treatment.


03. 03. 2021 Paediatrics

This unpleasant and often painful disease is caused by the herpes virus, which is also responsible for chickenpox. When are children most susceptible to shingles, and how are they treated? Read what our doctors warn against and what their recommendations are.

Shingles (Herpes Zoster virus) is a viral disease that affects about a third of people at one point in their lifetime. The risk of developing the disease increases with older age, however, it is not uncommon to see cases of shingles in children. "Herpes zoster is an infectious diseases of the skin caused by the herpes virus, which also causes chickenpox in children. Stress and exhaustion in a child, both physical and mental, can contribute to the disease. It can also occur in children with weakened immune system, especially if they have a disorder of cell-mediated immunity, "explains Dr. Ilona Hülleová, President of the Association of General Practitioners for Children and Adolescents.

When and why can shingles develop?

Shingles is caused by the varicella zoster virus. This virus is also the culprit that causes chickenpox in children (rsometimes adults). Anyone who has had chickenpox can get shingles. After suffering from chickenpox, the virus remains in the body and in some cases can be reactivated many years later, manifesting as shingles.

Chickenpox in children: What are the symptoms, treatment and biggest complications?

"A number of factors can contribute to the reactivation of the virus, one of the most common being reduced cell-mediated immunity and the conditions that lead to its reduction: emotional and physical stress, nerve injuries, shock, trauma, or UV radiation. These factors can act both temporarily (in which case its dependent on the intensity of the given factor) or more permanently. Furthermore, immunosuppression caused by another disease is another common cause – systemic diseases and infections, immunosuppressants or cancer treatment medication, but also naturally weakening immunity due to age. This means that shingles is a relatively rare disease in children, and it usually occurs as a complication of an more serious and chronic disease, "says Dr. Petr Žáček, paediatrician at Canadian Medical.

What are the symtpoms of shingles?

The disease is manifested by a painful blistering skin rash, which can last for two to four weeks. "Children usually complain of skin hypersensitivity pain and occasional itching of the skin. Sowing of blisters occurs, typically unilaterally, on the chest, between the ribs or on the head. The symptoms can be easily confused for insect bites at the early stages of the disease. Children tend to be very fatigued and a raised temperature isn’t uncommon, but in most cases they do not have general symptoms. Younger children often cannot even specify that their skin hurts or itches. Further along the line the manifestation on the skin is highly discernible” explains Dr. Ilona Hülleová.

How are shingles treated? When to go see your paediatrician?

Most forms of juvenile shingles are treated depending on the severity of symptoms. The blisters are usually treated with liquid powder or zinc oil or ointment (relieving itching and speeding up the healing of skin lesions).

A raised temperature or pain can be relieved with painkillers. Children should remain at rest and stay out of groups abecause it is an infectious disease. In rare occasions when the condition is more severe, the paediatrician will prescribe antiviral drugs in tablet form.

"It’s much more common that we see cases where the children don’t present with the symptoms of pain and itching, and that their parents confuse it with insect bites or a rash. They only seek a doctor when the condition lasts longer, the blisters remain on the body in a pattern or the child develops new symptoms. Nowadays, thanks to the Covid-19 pandemic, the use of telemedicine means that parents can take a picture of the child’s skin and describe the symptoms that the child has. However, if the child has any pain (skin or headaches),  a fever or a rash appears, they should definitely see a doctor without hesitation and in person," says Dr. Hüllerová.

Acute tonsilitis can have various manifestations in children, but antibiotics are always necessary.

"Antivirals are the main form of treatment for overall systemic therapy. Antiviral therapy is used mainly for rashes on the head, central nervous system disorders, eye and organ disorders, in the elderly and with significantly weakened immunity, in patients with atopic eczema and more generally in the case of a more severe course of the disease. Systemic antiviral therapy alleviates the course of the disease and reduces the incidence and severity of later long-term complications," explains MUDr. Petr Žáček.

Common symptoms of shingles:

"A typical clinical manifestation of this disease is the appearance of groups of blisters along the sensory nerves. The scattering is often one-sided, along one sensory nerve – around the "belt" area and it does not usually pass to the other half of the body. Any sensory nerve can be affected, so shingles can be located anywhere on the body: torso, limbs, neck or even the head area when the trigeminal nerve is affected. The symptoms of the disease are typically local and non-specific overall. From the local symptoms, there may be feelings such as tingling, burning and pain at the site of future sowing. The pain can sometimes be so severe that it can mimic a migraine, cardiac pain, gallbladder or kidney colic, toothache (if the blisters is located in the area of ​​the trigeminal nerve). Headaches, malaise, and occasionally fevers may appear as general symptoms at the onset of the disease.

Skin manifestations begin as reddish "bumps," with blisters forming within 12 to 24 hours. They are arranged in groups of different sizes, although some may also occur solitarily. There are a couple of millimeters in diameter. The contents of the blisters are clear at first, then gradually it hardens. Within seven to ten days, the blisters dry out and turn a crust forms on top. After the crust is separated, the color changes persist for some time. The appearance of the rash is gradual, ”says Dr. Petr Žáček, paediatrician.


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