When the image of Canadian singer Justin Bieber with his face paralyzed spread through social networks, few associated the painting with a very common childhood disease, chickenpox. But Ramsay Hunt syndrome, diagnosed by the artist, is caused by the same virus, Varicella-zoster, which is hidden in nerve ganglia and can reappear years later in those who had chickenpox as a child.
Usually in adulthood it causes herpes zoster, a skin infection popularly called shingles. Facial paralysis diagnosed in the actor is much rarer. The good news is that a new vaccine has just arrived in Brazil capable of preventing the reactivation of the Varicella-zoster virus and preventing the emergence of these late diseases.
“We are seeing a huge increase in cases of herpes zoster in the office”, observes dermatologist Beni Grinblat, from Hospital Israelita Albert Einstein. In fact, research conducted by the State University of Montes Claros, in Minas Gerais, found a 54% increase in herpes zoster cases (not Ramsay Hunt, which is much rarer) during the covid-19 pandemic, compared to with the same period before the pandemic.
The reasons are still not entirely clear, although the suspicion is that the triggers are anxiety, emotional stress, depressive disorders and low immunity during the pandemic. This disease should not be confused with genital herpes, caused by another type of virus, herpes simplex.
In a first contact, the Varicella-zoster virus leads to chickenpox or chickenpox, characterized by the famous blisters on the skin that later form a crust. The lesions can appear all over the body and are very itchy. In most cases, the disease resolves on its own without further complications.
However, the virus can lie dormant for years in nerve ganglia. At some point of low immunity – whether due to illness or even age – it reactivates, causing herpes zoster, a disease popularly known as “cobreiro”, with vesicles and blisters and a lot of pain along the path of the nerve where the virus was dormant. It can affect the back, abdomen, face. In much rarer cases, it causes paralysis by inflammation of a nerve in the face, which can prevent movements such as closing the eyes or smiling.
“The earlier it is diagnosed, the better the treatment and the chance to avoid sequelae,” says Grinblat. It is customary to prescribe antiviral, anti-inflammatory and analgesic drugs, among others. In the case of paralysis, physical therapy may be required.
The best way to prevent herpes zoster is the vaccine. The immunizer that arrived in Brazil last month has an advantage over what already existed because it is made with inactivated viruses. This means that it can be used by immunosuppressed individuals. In addition, it has a high degree of protection, about 90%. It is recommended for anyone over 50, or adults over 18 with some immune compromise. But for now, it’s only available in private services.