Vaccination can save you from the unpleasant consequences of chickenpox

Scars can hardly be called decoration. And often they are an unpleasant reminder of past injuries and illnesses. One way or another, the question of how to get rid of scars worries many people. Modern cosmetology offers many options, but, according to reviews on the Internet, the most effective are COLLOST® collagen gel injections. By injecting the gel into problem areas, you can remove scars of various origins, be it post-acne, scars after chickenpox or cuts.

How to get rid of scars and acne scars

Post-acne, or acne scars, reduce self-esteem for many. But why endure if you can get rid of scars in just a few procedures with COLLOST® gel injections. This collagen gel acts directly on the structure of the skin, being not only an implant, but also causing the skin to increase the production of its own collagen.

So, to get rid of scars and acne scars, you will need, on average, 4-6 collagen injection treatments. It would seem how easy it is to get rid of acne scars, but many are stopped by the fear of injections. We easily tolerate injections in other parts of the body, but getting rid of scars by injections in the face is scary. There's really nothing to be afraid of. Before removing acne scars using COLLOST® gel injections, the cosmetologist administers local anesthesia, which almost completely reduces the pain of the procedure.

Collagen gel injections can remove acne scars not only on the face, but also on the back and other parts of the body. There is no need to spoil your mood anymore by contemplating these skin irregularities, when you can remove acne scars easily and quickly!

How to get rid of scars and scars after chickenpox

Like acne, chickenpox can leave behind small scars that make the skin uneven. But COLLOST® gel, injected intradermally, will help quickly get rid of scars after chickenpox, removing this unpleasant memory from the face forever. In order to remove scars on the patient's skin, the cosmetologist injects collagen gel into the dermis under the scar. Filling the area with gel is the first step toward getting rid of chickenpox scars. But scar treatment does not end there. Surprisingly, your own skin helps get rid of scars. By reacting to the introduction of collagen gel, it enhances the production of its own collagen, thereby allowing chickenpox scars to be removed naturally.

Essentially, skin rejuvenation occurs from the inside and out. Thus, you can not only remove scars after chickenpox, but also remove age spots, increase skin turgor, and rejuvenate it. These effects often become additional when treating scars, as you can read about in reviews of COLLOST® gel injections.

What happens to the skin with chickenpox

Penetration of the chickenpox pathogen into the body occurs through the mucous membrane of the respiratory tract. After this, the virus invades the epithelial cells of the skin and begins to accumulate in them, spreading through the bloodstream and regional lymph nodes. The affinity of the virus for epithelial cells ends with its active reproduction, cell death and the appearance of a characteristic clinical picture of the disease.

In place of the epithelial cells, cavities begin to appear filled with inflammatory fluid (pits), which is an exudate. These are vesicles characteristic of chickenpox, rarely spreading to the forehead and wings of the nose. They are red in color, and after opening, dark crusts form. The next stage is the formation of new skin. Vesicles can appear on the surface of the entire body.

Chickenpox is characterized by a strong feeling of itching; under favorable conditions, pustules often form. After them, the scarring process begins.

How to get rid of scars and scars after cuts

Severe cuts leave scars. Sometimes these are barely noticeable, neat stripes, and sometimes they are scars that spoil life and serve as a constant reminder of what happened. And it doesn’t matter what part of the body they are on, because injections of COLLOST® collagen gel will help get rid of scars and scars after cuts, wherever they are.

The number of procedures required to effectively remove scars is determined by the cosmetologist. Usually, at least 3 procedures are required to remove scars from cuts, but much depends on the size and age of the scars.

Injections of COLLOST® collagen gel are not the only way to remove scars on the body. But it has a lot of advantages over other options:

• natural composition - the collagen in the gel is identical to human and is made from the skin of cattle;
• safety - the gel has received all the necessary quality certificates;
• long-lasting effect - with COLLOST® gel injections you can get rid of scars forever;
• lack of a rehabilitation period - within a couple of days, slight swelling and redness may be noticeable at the injection sites, but this does not require changes in the work and rest schedule;
• affordable price of procedures - when compared with other methods of removing scars, the price of a procedure with COLLOST® gel is optimal.

CHICKEN POX

Chicken pox is an acute viral infection characterized by fever, a jerky appearance on the skin and mucous membranes of a peculiar macular vesicular rash.

The causative agent of chickenpox is a large virus (from 150 to 200 nm) from the Herpetosviridae family. This virus is contained in large quantities in chickenpox blisters in the first 3-4 days of illness, then its amount quickly decreases, and after the 7th day it cannot be detected.

The identity of the virus that causes herpes zoster and the varicella zoster virus has now been established. The virus has a central core, a lipid envelope, and contains DNA. Lives and reproduces only in the human body. The main properties of the virus include its volatility and extremely low stability. In the external environment, the virus quickly dies; it persists in droplets of mucus and saliva for no more than 10–15 minutes; Heating, sunlight, and UV radiation quickly inactivate it.

Chickenpox is ubiquitous and is an extremely contagious disease with 100% susceptibility. The source of infection is patients with chickenpox, sometimes with herpes zoster. Patients with chickenpox become infectious at the end of the incubation period (48 hours before the appearance of the rash) and continue to pose a danger to others until the 5th day from the moment the last element of the rash appears. The transmission mechanism is airborne, with the virus released in large quantities when coughing, talking, or sneezing. A vertical mechanism of transmission of the virus to the fetus from a mother who had chickenpox during pregnancy is possible. Chickenpox primarily affects children aged 1 to 10 years, with the peak incidence occurring at 3-4 years of age.

The entry point for infection is the mucous membrane of the upper respiratory tract. Reproducing on the mucous membranes, the virus enters the blood at the end of the incubation period, causing viremia. It is carried throughout the body through the bloodstream. The pathogen is fixed primarily in the epithelium of the skin and mucous membranes, where, multiplying, it leads to the appearance of a rash pathognomonic for chickenpox.

The virus is not only dermatotropic, but, to a certain extent, also neurotropic, which is manifested in its ability to cause damage to the nervous system. Vesicles in chickenpox are formed as a result of vacuolation of cells with very little meshwork. In the early stages, the nuclei of the affected cells contain spherical eosinophilic inclusions (Titzer bodies). During the process of nuclear degeneration, these bodies enter the cytoplasm. Cellular vacuoles quickly merge with adjacent ones, forming a vesicle. Initially, the vesicle is multi-chambered, consisting of small cavities separated from each other by cellular strands, which subsequently quickly rupture due to the filling of the vesicles with liquid. The malpighian layer is mainly affected. Changes in the mucous membranes are of the same nature as in the epidermis. Elements of the rash on the mucous membranes of chickenpox do not leave scars, since necrosis of the epithelium in chickenpox usually does not penetrate deeper than the germinal layer.

During chickenpox, there are 4 periods: incubation, prodromal, periods of rash and crust formation. The incubation period for chickenpox is 10–21 days. Prodromal phenomena can be observed within 1-2 days before the onset of the rash. In this case, the patient experiences malaise, decreased appetite, headache, nausea, and sometimes vomiting. If there is no prodromal period, then the disease begins with the appearance of a rash. The period of rash in most patients proceeds without any significant disturbances in the general condition. The fever coincides with the period of mass appearance of the rash, and in adults it reaches significant numbers. The rash appears in spurts, so the fever can be wavy.

The first elements of the rash can appear on any part of the body, but more often on the face, scalp, back, and less often on the stomach, chest, shoulders, and thighs. There is usually no rash on the palms and soles.

Clinical example: patient S., 23 years old, student, consulted his local doctor with complaints of fever up to 38.8°C, headache, weakness, malaise, rashes on the face, scalp, torso and limbs. According to the patient, he fell ill two days ago; malaise, weakness occurred, and the temperature increased to 37.4°C. The next day, the condition worsened, the temperature rose to 38.0°C, a headache was noted, and vomiting occurred once. By evening, a profuse rash appeared (Fig. 1).

Objectively: the condition is of moderate severity. Body temperature - 39.0°C. There is a profuse polymorphic rash on the skin of the face, scalp, torso, and limbs. In one area you can find papules, vesicles, pustules. Skin itching bothers me. The mucous membrane of the oropharynx is hyperemic, and a small number of vesicles and erosions are noted on the soft palate and uvula. Enlarged, painful lymph nodes in the neck are palpated. In the lungs there is vesicular breathing, no wheezing. NPV - 22/min. Heart sounds are muffled, the rhythm is correct. Heart rate - 92/min. Blood pressure - 90/60 mm Hg. Art. The tongue is dry, covered with a white coating. The abdomen is soft and painless on palpation in all parts. The liver and spleen are not enlarged. Urinary excretion is not impaired. There are no meningeal or focal neurological symptoms. In the group where the patient is studying, similar cases of illness were noted.

Considering the acute onset of the disease, the presence of fever, symptoms of intoxication, as well as a polymorphic rash on the scalp, face, torso, limbs and oropharyngeal mucosa (Fig. 2), the patient can be given a preliminary diagnosis of chickenpox.

Elements of chickenpox go through the following stages of development: spots, papules, vesicles, crusts. First, a red spot appears, ranging in size from the head of a pin to a round or oval-shaped lentil grain. Within a few hours, the spots acquire the character of papules with a clearly defined contour. After a few hours or the next day, a vesicle-bubble with smooth edges and transparent serous contents forms in the center of the elements. In the case of suppuration of the vesicles, pustules are formed, and deep damage to the skin is noted, which can lead to the formation of small depressions in the center of the pustules, which leave scars. Often there are rashes on the conjunctivae of the eyes, the mucous membrane of the mouth (hard palate, mucous membrane of the cheeks, gums, uvula, posterior wall of the pharynx), sometimes the larynx and genitals. Chickenpox vesicles resemble aphthae, but the vesicles quickly become damaged, forming small superficial ulcers (erosions). Chickenpox is characterized by multiple rashes that appear in several stages, sequentially, over 2–5 days. Such a wave-like rash leads to the fact that on the same limited area of ​​​​the skin elements of chickenpox are noted that are at different stages of development, which gives chickenpox a polymorphic character. In addition to a specific rash, in some cases, in the prodromal period of chickenpox, a prodromal rash appears on the skin, its English name is “rash”, which precedes the chickenpox rash. A prodromal rash usually appears on the chest, occasionally on the upper extremities, and less commonly on the face. It is not abundant, ephemeral, can be scarlet-like, measles-like, and less often is hemorrhagic or erythematous in nature.

Depending on the course, the following clinical forms of chickenpox are distinguished.

Typical and atypical. Among the atypical ones, in turn, the following forms are distinguished: rudimentary, hemorrhagic, bullous, gangrenous, generalized.

The severity of the disease can be mild, moderate or severe. The latter are: a) with severe general intoxication; b) with pronounced changes in the skin.

In the typical form, the patient's general condition rarely suffers; the temperature briefly rises to 37-38°C, usually during a period of massive rash. The polymorphism of the rash is well expressed. The total duration of the rash in the typical form is 3–5 days. Enanthema is observed in 70% of cases. Complications are rare.

With an atypical course of chickenpox, deviations from the usual are possible both in the direction of mild (rudimentary) and rare severe forms of the disease with unusual skin manifestations, often with a fatal outcome.

The rudimentary form occurs without a rash or with a scanty rash, while the elements of the rash do not reach their full development, limited only to the appearance of small red spots. Sometimes the rash may consist of only a few papules and small, barely noticeable blisters, while the polymorphism of the rash is weakly expressed. Rashes on the mucous membranes are also rare.

In the hemorrhagic form, on the 2-3rd day of the rash, accumulation of hemorrhagic contents in the vesicles is observed with the simultaneous appearance of petechiae and large hemorrhages on the skin and mucous membranes. Bleeding from the gums, nose and gastrointestinal tract is possible. The crust that forms with this form is black, located deep in the skin, and often ulcerates (Fig. 3).

This form of the disease is observed in patients with previous hemorrhagic phenomena - with capillarotoxicosis, Werlhof's disease.

In the bullous form, along with typical chickenpox blisters, large flabby, thin-walled blisters with yellowish-turbid contents are observed on the skin, which dry out more slowly than usual and form a crust or, bursting, turn into long-term non-healing weeping surfaces. In the bullous form, self-formed blisters, quickly increasing along the periphery, can merge into large blisters.

The gangrenous form is characterized by progressive necrosis. A few days after the appearance of the vesicles, gangrenous rims appear around some of them, spreading along the periphery. The blisters are round, large, several centimeters in diameter, filled with purulent-bloody contents. After opening, a necrotic scab forms in their place, when rejected, long-term non-healing ulcers of varying depths with undermined edges and a dirty purulent bottom are discovered. This form is characterized by severe intoxication and high mortality. The gangrenous form is rarely observed, mainly in children with reduced body reactivity.

The generalized (visceral) form occurs during treatment with steroid hormones in people weakened by severe diseases. Damage to internal organs is typical. The course of the disease is very severe, often fatal.

Complications

Chickenpox is considered a benign disease, but in some cases complications can develop (in about 5% of patients), sometimes very severe.

Among the complications of chickenpox, the most common are various purulent skin lesions - abscesses, boils, phlegmon. The basis of purulent skin complications is superinfection with staphylococci or streptococci. One of the common causes of infection is the patient scratching itchy areas of the skin. In most cases, the entrance gate of a purulent infection becomes a damaged chickenpox vesicle.

Less common complications: encephalitis, myocarditis, pneumonia, keratitis, nephritis, arthritis, hepatitis.

The clinically expressed picture of chickenpox pneumonia is one of the features of chickenpox in adults. In this case, immediately before the rash, often simultaneously with a massive rash and an increase in temperature, the patient develops shortness of breath, cyanosis, cough with bloody sputum, and chest pain. Physical changes are often absent or very minor. The x-ray shows abundant small lesions throughout. Clinical manifestations of pneumonia are observed within 7-10 days, radiological changes - up to 1-2 months.

Late chickenpox encephalitis appears more often during the fading of the rash from the 5th to 15th day of illness, but can also occur later. For late chickenpox encephalitis, a smoother development and independence from the nature of the rash and the severity of chickenpox is common. Along with short-term rises in temperature, towards the end of the chickenpox rash, patients experience lethargy, headache, vomiting, and after a few days the main symptoms. Encephalitis can be of different localization: ataxic forms, myelitis and encephalomyelitis, encephalitis with mental damage, isolated nerve damage, meningoencephalitis, with ataxic syndrome being more often recorded. Late chickenpox encephalitis with paresis of the limbs and complete temporary loss of vision was observed. Among encephalitis, which gives a less favorable prognosis, we can mention forms with lesions of the subcortical nodes. The extremely rare consequences of chickenpox meningoencephalitis include mental damage followed by idiocy. Chickenpox encephalitis and other neurological complications of chickenpox are characterized by reversibility of the process.

Kidney damage is a rare complication. Nephritis with chickenpox most often appears in the 2nd week towards the end of the rash. It begins acutely: with a rise in temperature to high levels, vomiting, headache and abdominal pain. Changes in urine are moderate and are expressed in the appearance of a small amount of protein, slight hematuria, and single cylinders. This complication is mild and disappears by the 12th–15th day of illness.

Chickenpox poses a significant risk to expectant mothers, especially in the first months of pregnancy. There may be a pathological effect on the development of the fetus, sometimes miscarriage; in the later stages, severe visceral forms of chickenpox in newborns may occur, which can lead to death.

Diagnosis of chickenpox in typical cases is not difficult. The diagnosis is established mainly on the basis of the clinic, taking into account the data of the epidemiological anamnesis. Among the laboratory methods used are virusoscopic, virological, molecular biological and serological. The viruscopic method involves staining the contents of the vial with silver; the virus is detected using a conventional light microscope.

PCR can be considered the main virological method, as it is very informative. This method is used to determine the DNA virus. It is also possible to isolate the virus in tissue culture, but this method is very expensive and time-consuming. Among the serological methods, RSK, RIMF and ELISA are used.

Differential diagnosis

Chickenpox should be differentiated from smallpox, herpes zoster, erythema multiforme, impetigo, and vesicular rickettsiosis (Table 1).

Treatment

An important place in patient therapy is occupied by hygienic measures, the purpose of which is to prevent secondary infection. During the period of rash and fever, bed rest is required. The elements of the rash are lubricated with a solution of aniline dyes: 1-2% aqueous or alcohol solutions of brilliant green, gentian violet, methylene blue. It is very good to lubricate the elements of the rash with aqueous solutions of potassium permanganate diluted 1:5000 or 2-3% iodine tincture. If the mucous membranes of the oral cavity are affected, rinsing with a weak solution of potassium permanganate is necessary. The aphthae is lubricated with a solution of brilliant green. Treatment with a 3% hydrogen peroxide solution is effective. To reduce itching, the skin can be lubricated with glycerin and wiped with water and vinegar or alcohol. Antihistamines (psilo-balm, fenistil) are indicated. In severe cases of the disease with severe symptoms of intoxication, detoxification therapy is carried out. Antiviral drugs (acyclovir, vidarabine) are effective in treating chickenpox (Table 2). Antibiotics for chickenpox are prescribed in case of secondary bacterial infection and purulent complications.

General prevention of chickenpox consists of timely diagnosis, early isolation of the patient, followed by ventilation and wet cleaning of the room. Isolation of the patient stops 5 days after the appearance of the last fresh element of the rash. Children under 7 years of age who have come into contact with chickenpox patients, who have not been sick and who attend childcare facilities, are isolated until the 21st day from the date of contact.

Literature

1. Zubik T.M. et al. Differential diagnosis of infectious diseases. - L., 1991.
2. Guide to infectious diseases // Ed. Yu. V. Lobzina. - St. Petersburg, 2001.
3. Yunusova Kh. A., Shamsiev F. S. Chicken pox. - M., 1999.
4. Baran V. M., Talapin V. I. Pharmacotherapy of infectious diseases. - Minsk, 1995.
5. Children's infectious diseases // Ed. V. V. Fomina. - Ekaterinburg, 1992.
6. Berenbein B. A. et al. Differential diagnosis of skin diseases. - M., 1989.
7. Sorinson S. N. Emergency conditions in infectious patients. - L.: Medicine, 1990.

T. K. Kuskova, Candidate of Medical Sciences E. G. Belova, Candidate of Medical Sciences T. E. Migmanov, Candidate of Medical Sciences Moscow Medical and Dental University

Note!

• The main properties of the virus include its volatility and extremely low stability.
• Chickenpox is ubiquitous and is an extremely contagious disease with 100% susceptibility. The source of infection is patients with chickenpox, sometimes with herpes zoster.
• A vertical mechanism of transmission of the virus to the fetus from a mother who had chickenpox during pregnancy is possible.
• Elements of the rash on the mucous membranes of chickenpox do not leave scars, since necrosis of the epithelium in chickenpox usually does not penetrate deeper than the germinal layer.
• The incubation period for chickenpox is 10–21 days.
• The period of rash in most patients proceeds without any significant disturbances in the general condition.