Why do acne appear on the temples and forehead? Main causes and best ways to get rid of it

Bangs or visible inflammation? We choose the third option: beautiful, smooth skin.

Anna Marukyan

Cosmetologist, dermatovenerologist, experience more than 6 years

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Small, large, red, white, subcutaneous pimples on the forehead are a common and very unpleasant skin defect. Almost every woman faces this cosmetic problem.

Such rashes should not be ignored, since there are many sebaceous glands in the forehead and temples, the inflammation of which can lead to large areas of acne.

What is neurasthenia and how does it develop?

Neurosis develops as a consequence of a disorder of the brain, namely the part that is responsible for human adaptation. The consequences of neuralgia can affect not only the mental and emotional state of the patient, but also negatively affect the functioning of various body systems and internal organs, since everything in the human body is interconnected.

Anxiety causes a strong release of adrenaline, which increases the secretion of pituitary hormones and insulin, which regulate the functioning of the thyroid gland. Such hormones increase the likelihood of panic attacks.

How to distinguish neurasthenia from other disorders?

People suffering from emotional distress experience various feelings more emotionally than others. Anger, anxiety, despair, aggression, envy - these are just some of the manifestations of neurosis in humans. During such conditions, the patient experiences an increased level of stress, so negative situations are perceived more acutely and seriously than they actually are.

Neurosis is based on traumatic circumstances, psychological trauma, stress or prolonged emotional and intellectual overstrain. Neurasthenia is often encountered by people who have recently experienced a serious emotional shock or the loss of loved ones.

People suffering from neurosis often deny their feelings, emotions, and try to distance themselves from their own reality. They find it difficult to control and manage their emotions. The disorder distorts the patient's rational thinking and does not allow him to function normally in the family, social and work spheres of life.

If the skin is dry and acne, what does this mean?

Pimples appear not only on oily and combination skin, which suffers from increased production of sebaceous secretions. Dry, dehydrated epithelium is also susceptible to acne formation. In the desire to get rid of an unpleasant defect, some women, without determining their skin type, use aggressive detergents and alcohol lotions, which only aggravate the problem.

Dry skin is by nature less resistant to external irritants, and with the thoughtless use of cosmetics, it becomes even more sensitive. A thin or damaged lipid layer protects less well from bacteria that settle in the mouths of the follicles. And under conditions of extreme drying, the sebaceous glands begin to produce more secretion, which, in turn, leads to the closure of pores.

The appearance of acne on dry skin means the need for a more thorough and differentiated approach to facial skin care.

Symptoms of neurosis

Pathology manifests itself both at the physical and psycho-emotional levels. Physical symptoms include increased sweating, rapid heartbeat, chest pain and dry mouth, headaches, blurred vision, tremors of the limbs, skin rashes, and menstrual irregularities in women.

Psychological symptoms: a feeling of loss of control, a feeling that the person is “going crazy”, fear of sudden death, excessive worry, high sensitivity and vulnerability.

• Irritability;
• Constant feeling of fatigue and apathy;
• Increased sensitivity;
• Social isolation;
• Frequent and unexpected mood swings;
• Disturbances in sleep and wakefulness;
• Loss of interest in life or certain areas of it.

It is the constant feeling of anxiety for one’s life or the lives of loved ones that causes insomnia in a person. Problems with sleep do not allow the body and nervous system of those suffering from neurasthenia to fully rest. This, in turn, further intensifies all the symptoms listed above.

Therefore, for insomnia, experts recommend several simple and effective rules:

• Follow a daily routine, that is, try to fall asleep and wake up at the same time;
• Play sports, giving the body a light load;
• Be in the fresh air more often;
• Reduce the number of drinks containing caffeine;
• Eat light foods to avoid stomach discomfort.

For what reasons does neurosis develop?

• Strong mental activity;
• Prolonged psychological distress and anxiety;
• Psychological pressure due to the inability to solve life problems;
• Long-term loneliness and problems in the personal sphere of life;
• Traumatic event in life: loss of a loved one, difficult divorce, difficult financial situation, if the person has been subjected to emotional and physical abuse, etc.;
• High expectations. In this case, the person cannot achieve the desired goal and experiences a feeling of an impossible plan;
• Psychological trauma received in childhood: humiliation or beating from peers and parents, example of a bad lifestyle from adults, harsh upbringing;
• Failure to comply with work and rest schedules.

Diagnostics

There are no specific signs characteristic exclusively of infection with the omicron strain.
In a pandemic, at the first symptoms of acute respiratory infections, in order to clarify the diagnosis, experts advise performing PCR testing for COVID-19 or ICA - rapid testing for the COVID-19 antigen. To obtain reliable results, since the Omicron strain coronavirus has a short incubation period and often occurs in a mild form, the study should be carried out already on the 3-4th day after the initial signs of the disease appear. According to indications, a study of immunoglobulins of class A, M, G SARS-CoV-2 is also carried out.

Nonspecific laboratory diagnostics for omicron infection is required for persons with moderate, severe and extremely severe disease. It assumes:

• clinical blood test to determine the level of leukocytes;
• biochemical blood test (ALT, AST, creatinine), determination of procalcitonin and inflammatory markers (C-reactive protein, ferritin);
• assessment of blood clotting according to coagulogram, D-dimer;
• determination of hormone levels in the blood.

To detect pathological changes in the lung tissue, a plain chest x-ray or computed tomography of the lungs is performed. The latter is indicated only for symptoms of respiratory failure and low levels of blood oxygenation.

Features of the course of neurosis in women

Neurosis is diagnosed in a third of the world's urban population. Neurology is one of the most common ailments of the nervous system—the disease occurs in every fourth person with mental illness. A study of the incidence of neurosis has shown that neurotic disorders are common in men and women over 30 years of age. However, neurotic disorders in women usually occur in a more severe form than in men.

The reason for such conclusions is the emotionality of women. Doctors note that neurosis most often appears in expressive and emotional people. According to statistics, women are more sensitive than men.

Experts also say that, unlike men, women suffer from neurosis almost twice as much. Menopause is considered one of the causes of neurosis in women. Any hormonal changes affect our nervous system and can bring unpleasant consequences.

Perhaps, in this case, a social factor also plays a role - men are less likely to go to doctors, especially to a psychotherapist. However, today experts say that the flow of men to psychotherapists has increased, but women are still more willing to go to a doctor for help.

Also, by the will of fate and centuries-old traditions, not only a career and daily work falls on a woman’s shoulders, but also cleaning the house and raising children. The modern woman has more tasks, the principle “you need to be strong and hold on” is firmly stuck in your head. However, this unknown force will not protect you from overload and fatigue. Then for help you need to contact a psychotherapist who will prescribe treatment. Psychotherapy sessions help to influence the cause of neurosis, change the attitude towards a traumatic situation and facilitate the release of emotions, accelerating recovery.

Symptoms of neurosis in women

The signs of neurosis in women differ from the opposite sex due to our physiological characteristics of the body. For example, among women the list of symptoms of neurosis includes insomnia, frequent nightmares and sleep paralysis, but this is not observed in men. Also, in women with neurosis, there is a deviation in the menstrual cycle.

Doctors identify the following most common symptoms of neurosis in women:

• anxiety;
• irritability;
• expressiveness of behavior;
• refusal to eat;
• impairment of physical qualities: loss of strength, feeling tired, loss of endurance;
• heart and headaches;
• vestibular disorders, balance disorders
• excessive tearfulness;
• sudden mood swings.

There are several types of neurosis, one of them is hysterical, most often called hysteria. According to doctors, signs of this type of disease are most often observed in women. Experts interpret hysterical disorder as an ardent desire to attract attention to the sick person. The disease is characterized by demonstrative behavior. A person suffering from such a disease often screams loudly, makes scandals, and sobs bitterly.

Medical psychotherapists have extensive experience and all the necessary resources for the successful treatment of neuroses.

Features of the course of neurosis in children

Neurasthenia is also common in children of primary and preschool age. Symptoms of the disorder are similar to those in adults. The difficulty in determining pathology lies only in the fact that young children often cannot explain what is happening to them and how they feel.

The child's appetite decreases, sleep problems appear, and nightmares often occur, as a result of which the baby may even cry out in his sleep and wake up without understanding what is happening. Increased sweating occurs and the temperature of the extremities decreases.

In addition to all the above signs of pathology, the child may have a headache, he is sensitive to bright light and loud sounds. There is also often a sharp change from positive emotions to negative ones: crying, aggression and depression.

Experts recommend immediately seeking help from a doctor, since neurosis in childhood is much more difficult to treat than in adults.

What types of neurosis exist and how do they differ?

• Depressive.
  This type of neurosis is characterized by such symptoms in a person as tearfulness, sudden changes in mood, feelings of despair and helplessness. The person suffering from the disorder loses interest in life and becomes melancholy. During depressive neurosis, a person experiences low self-esteem, guilt, and frustration.
• Anxious.
  Often has manifestations at the physical level: dry mouth, increased sweating, rapid heartbeat. Anxiety neurosis can result in panic attacks and phobias. A person constantly experiences a feeling of fear.
• Hysterical (“conversion disorder”)
  - most often manifests itself if a person has experienced a strong emotional shock or a traumatic event. There is a change or loss of motor/sensory function indicating a physical disorder that is not detected. For example, after an accident, a person may experience loss of speech, although there is no physical reason for this.
• Obsessive-compulsive.
  Intrusive thoughts and images appear. Often such thoughts have no rational grain and are catastrophic in nature. To counter the overwhelming anxiety, a person performs compulsive, repetitive actions.
• Rehearsal.
  It manifests itself as attempts to resolve an issue that in the past remained unfinished. A person suffering from rehearsal neurosis transfers conflicting relationships from the past to the present and believes that this reality still exists today.

For example, a person believes that everyone treats him badly or no one likes him. As a result, he begins to behave in accordance with his ideas about others.

• Hypochondriacal.
  The patient becomes too suspicious and overly concerned about his health; he finds symptoms of various diseases where they actually do not exist. A person invents a terrible disease, torments himself, and stress or anxiety appears. Despite negative tests and consultations with doctors, the patient remains convinced of this.
• Depersonalization.
  Fear, panic and anxiety appear. It’s as if a person lives in a dream, “disconnecting” from his own body and thoughts.
• Military or post-traumatic stress disorder.
  It manifests itself under very shocking circumstances, when a person saw death or was captured or suffered serious injuries (physical and psychological). This type of neurasthenia is manifested by very strong stress, panic attacks, and an aggressive state. Such stress is dangerous because it can lead to disability, including functional disability that negatively affects daily life.

Neurosis and memory problems

Excessive anxiety leads to decreased concentration, which means that the patient often has problems with memory and attention. In order to influence the problem, you can take vitamin complexes of natural origin, as well as conduct useful memory training.

Experts recommend engaging in light physical activity and daily exercise to relieve anxiety and excessive worry.

Try not to multitask, this will only make the problem worse. It is better to remove all distractions while working or doing what you love. Such distractions include a mobile phone or any other mobile device. Turn them off when doing important things.

To reduce the strain on your eyes and brain, take breaks from work and study. Don't overwork yourself. You can take a walk in the fresh air or do some exercise.

Neurosis and psychosis: what is the difference?

Often these concepts are confused or interchanged. But diseases are different in their manifestations and the internal feeling of a person. For example, during the development of obsessive-compulsive neurosis, a person maintains a sense of reality and looks for new ways to adapt to it. He recognizes that he is suffering from a disorder and that this suffering is a product of mental instability.

During psychosis, a person perceives the world around him differently. He adapts reality according to his personal perception (often delusional), experiences hallucinations and delusions. And the main thing is how psychosis differs from neurosis: the patient is not aware of his problem.

Neurosis and vegetative-vascular dystonia

As we mentioned above, during neurosis signs appear on the physical level, such as rapid heartbeat, fluctuations in blood pressure, chest pain, difficulty breathing, etc. All these symptoms are similar to the signs of a disease such as vegetative-vascular dystonia.

VSD is a complex of symptoms of different localization that occur when there is a malfunction in the autonomic nervous system. And neurosis is a disorder of the central nervous system caused by the psyche (stress, depression, etc.). Since the nervous system is connected, disturbances in one department provoke disruptions in the functioning of another.

How is neurasthenia diagnosed?

To diagnose and identify the disease, you need to consult a neurologist, and sometimes a psychologist and psychiatrist. At the city clinic, you can contact your primary care physician, who will write a referral to a neurologist. However, this takes time. You often have to wait 2 weeks for an appointment with a doctor. In some cases, this is simply impossible, since it is necessary to quickly conduct an examination and prescribe treatment before the situation becomes critical.

Therefore, we recommend contacting the Medunion medical clinic. We employ practicing neurologists, and you don’t have to wait several weeks for appointments. Sign up today for a time convenient for you, not for the remaining time, and get tested tomorrow.

Patients choose us because we provide the service of a specialist coming to your home if you cannot come to the clinic on your own. You can also take samples directly at home.

Diagnosis includes interviewing the patient or his immediate family (guardians), collecting anamnesis and studying the medical history. To make a diagnosis, the doctor needs to know the symptoms that bother the patient.

To exclude other pathologies, the neurologist prescribes laboratory tests:

• Blood analysis;
• Analysis of urine;
• Ultrasonography;
• CT scan;
• Magnetic resonance imaging.

The specialist will also conduct psychological tests. For example, color technique. It consists in the fact that the patient is offered a palette of colors from which he must choose the color he likes. Colors such as purple, gray, red, brown, black indicate a high probability of developing neurosis.

Herpes zoster and herpes-associated pain

Herpes zoster (HZ) is a sporadic disease that is the reactivation of a latent viral infection caused by the herpes virus type 3 (Varicella zoster virus (VZV)). The disease occurs with primary damage to the skin and nervous system.

VZV is the etiological agent of two clinical forms of the disease - primary infection (varicella) and its recurrence (herpes zoster). After a primary infection (chickenpox), usually in childhood or adolescence, the virus enters a latent state, localizing in the sensory ganglia of the spinal nerves. The commonality of the causative agent of chickenpox and herpes zoster was established even before the isolation of the virus using serological reactions in which liquid obtained from blisters on the skin of patients was used as an antigen. Later, using genomic hybridization, it was proven that in the acute period of herpes zoster, the detection rate of VZV is 70–80%, and in individuals without clinical manifestations, but with antibodies, viral DNA is detected in 5–30% of neurons and glial cells.

The prevalence of herpes zoster in different countries of the world ranges from 0.4 to 1.6 cases per 1000 patients/year in people under 20 years of age and from 4.5 to 11.8 cases per 1000 patients/year in older age groups. The lifetime risk of contracting herpes zoster is up to 20%. The main risk factor for its occurrence is a decrease in specific immunity to VZV, which occurs against the background of various immunosuppressive conditions.

Clinical picture of OH

The clinical picture of OH consists of skin manifestations and neurological disorders. Along with this, most patients experience general infectious symptoms: hyperthermia, enlarged regional lymph nodes, changes in the cerebrospinal fluid (in the form of lymphocytosis and monocytosis). Approximately 70–80% of patients with OH in the prodromal period complain of pain in the affected dermatome, which subsequently develops skin rashes. The prodromal period usually lasts 2–3 days, but often exceeds a week. Rashes with OH have a short erythematous phase, often completely absent, after which papules quickly appear. Within 1-2 days, these papules turn into vesicles, which continue to appear for 3-4 days - the vesicular form of herpes zoster. At this stage, elements of all types may be present on the skin. Elements tend to merge. Pustulation of vesicles begins a week or even earlier after the appearance of the first rash. After 3–5 days, erosions appear at the site of the vesicles and crusts form. If the period of appearance of new vesicles lasts more than one week, this indicates the possibility of an immunodeficiency state. The crusts usually disappear by the end of the 3rd or 4th week. However, peeling and hypo- or hyperpigmentation may remain for a long time after the resolution of OH.

Pain syndrome is the most painful manifestation of OH. While some patients experience rash and pain of relatively short duration, 10–20% of patients experience postherpetic neuralgia (PHN), which can last months or years, significantly reduces quality of life, causes great distress, can lead to loss of independence, and is associated with significant financial costs . Effective treatment of pain associated with OH is an important clinical goal.

Herpes-associated pain

According to modern concepts, pain syndrome in OH has three phases: acute, subacute and chronic. If in the acute phase the pain syndrome is mixed (inflammatory and neuropathic) in nature, then in the chronic phase it is typical neuropathic pain (Fig.). Each of the listed phases has its own treatment features, based on the pathogenetic mechanisms of pain and confirmed by controlled clinical studies.

Acute herpetic neuralgia

Pain in acute herpetic neuralgia usually occurs in the prodromal phase and lasts for 30 days - this is the time required for the rash to resolve. In most patients, the appearance of a rash is preceded by a burning sensation or itching in a specific dermatome, as well as pain, which can be stabbing, pulsating, shooting, paroxysmal or constant. In a number of patients, the pain syndrome is accompanied by general systemic inflammatory manifestations: fever, malaise, myalgia, headache. Determining the cause of pain at this stage is extremely difficult. Depending on its location, differential diagnosis should be made with angina pectoris, intercostal neuralgia, acute attack of cholecystitis, pancreatitis, appendicitis, pleurisy, intestinal colic, etc. The cause of the pain syndrome becomes obvious after the appearance of characteristic rashes. In typical cases, the prodromal period lasts 2–4 days, no more than a week. The interval between the onset of the prodrome and the onset of rash is the time required for reactivated VZV to replicate in the ganglion and be transported along the cutaneous nerve to nerve terminals at the dermoepidermal junction. The replication of the virus in the skin takes some more time, followed by the formation of inflammatory reactions. The immediate cause of prodromal pain is subclinical reactivation and replication of VZV in neural tissue. Experimental studies on animals have shown that at sites of VZV replication, the concentration of neuropeptide Y in nervous tissue, which is a marker of neuropathic pain, increases [1]. The presence of severe pain in the prodromal period increases the risk of more severe acute herpetic neuralgia and the likelihood of subsequently developing postherpetic neuralgia.

In most immunocompetent patients (60–90%), severe, acute pain accompanies the appearance of a skin rash. The severity of acute pain syndrome increases with age. Severe pain is also observed more often in women and in the presence of a prodrome. A characteristic feature of acute herpetic neuralgia is allodynia - pain caused by a non-painful stimulus, such as the touch of clothing. It is allodynia in the acute period that is a predictor of the occurrence of postherpetic neuralgia [2, 3]. The absence of allodynia, on the contrary, is a good prognostic sign and may suggest recovery within three months.

Subacute herpetic neuralgia

The subacute phase of herpetic neuralgia begins after the end of the acute phase and lasts until the onset of postherpetic neuralgia. In other words, this is pain that lasts more than 30 days from the beginning of the prodrome and ends no later than 120 days (Fig.). Subacute herpetic neuralgia can develop into postherpetic neuralgia. Factors predisposing to the continuation of pain include: older age, female gender, the presence of a prodrome, massive skin rashes, localization of rashes in the area of ​​innervation of the trigeminal nerve (especially the eye area) or brachial plexus, severe acute pain, the presence of immunodeficiency [3, 4 ].

Postherpetic neuralgia

The International Herpes Treatment Forum defines PHN as pain lasting more than four months (120 days) after the onset of the prodrome. PHN, especially in older patients, can last for many months or years after the rash has healed. With PHN, three types of pain can be distinguished: 1) constant, deep, dull, pressing or burning pain; 2) spontaneous, periodic, stabbing, shooting, similar to an “electric shock”; 3) pain when dressing or lightly touching in 90%.

Pain syndrome is usually accompanied by sleep disturbances, loss of appetite and weight loss, chronic fatigue, and depression, which leads to social isolation of patients.

PHN is considered to be a typical neuropathic pain resulting from damage or dysfunction of the somatosensory system. Several mechanisms are involved in its pathogenesis.

• Nerve damage disrupts the transmission of pain signals, which leads to increased activity of higher order neurons (deafferentation hyperalgesia) [6–8].
• Nerve fibers damaged by VZV may generate spontaneous activity at the site of injury or other sites along the nerve (spontaneous ectopic activity of injured axons).
• Damage or inflammation of the nerve as a result of virus reactivation leads to a decrease in the threshold for activation of nociceptors, activation of urinary nociceptors—peripheral sensitization [5, 9].
• As a result of these changes in the peripheral parts of the somatosensory system, the activity of central nociceptive neurons increases and new connections are formed between them, provided that the pain continues—central sensitization [10–12]. The systems for recognizing pain and temperature stimuli are characterized by increased sensitivity to minor mechanical stimuli, causing severe pain (allodynia).

In most patients, pain associated with PHN improves within the first year. However, in some patients it can persist for years and even throughout the rest of their lives, causing considerable suffering. PHN has a significant negative impact on the quality of life and functional status of patients, who may develop anxiety and depression.

How to reduce the risk of PHN?

This issue is the most important for any doctor treating a patient with OH, and includes early initiation of etiotropic (antiviral) therapy and adequate pain relief in the acute stage.

Antiviral therapy. The results of many clinical studies have shown that the administration of antiviral drugs reduces the period of viral shedding and the formation of new lesions, accelerates the resolution of the rash and reduces the severity and duration of acute pain in patients with OH. Thus, in controlled studies using recommended dosages, the time to complete cessation of pain when prescribing famciclovir was 63 days, and when prescribing placebo - 119 days. Another study showed greater effectiveness of valacyclovir compared to acyclovir: pain syndrome when prescribed valacyclovir (Valavir) disappeared completely after 38 days, and when prescribed acyclovir after 51 days. Valacyclovir and famciclovir have similar effects on herpes-associated pain in immunocompetent patients [13, 23]. Thus, antiviral therapy is indicated not only for the rapid relief of skin manifestations, but also for the acute phase of the pain syndrome.

In all controlled clinical trials of antiviral therapy (

) it is recommended to start therapy within 72 hours of the onset of rash [1, 14].

The effectiveness of the anti-pain effect of antiviral therapy started at a later date has not been systematically studied, however, numerous clinical data suggest that late-started therapy can also affect the duration and severity of acute pain.

Antipain therapy. Effective relief of acute pain syndrome in OH is the most important stage in the prevention of PHN. It is advisable to stage-by-stage treatment of zoster-associated pain syndrome in all its phases. Thus, in the treatment of acute and subacute herpetic neuralgia, pain therapy consists of three main stages:

• Stage 1: Aspirin, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs);
• Stage 2: opioid analgesics, including tramadol;
• Stage 3: drugs with a central analgesic effect (tricyclic antidepressants, anticonvulsants).

Considering that in our country there are known organizational difficulties in prescribing opioid analgesics, if simple analgesics and NSAIDs are insufficiently effective, it is necessary to move on to prescribing drugs with central action.

Treatment of postherpetic neuralgia

Currently, there are 5 main groups of medications: anticonvulsants, tricyclic antidepressants, lidocaine patch, capsaicin, opioid analgesics [21].

Anticonvulsants: Gabapentin and pregabalin are the two most commonly used anticonvulsants for the management of neuropathic pain associated with PHN. Drugs are more often used at the beginning of the development of PHN to reduce the acute component of neuropathic pain. In one study [15], in patients taking gabapentin, 43.2% had a decrease in pain perception, compared with 12.1% in the placebo group. In a similar trial [16], pregabalin also reduced the number of patients with PHN, especially in those aged 65 years and older. Gabapentin and pregabalin appear to be equally effective in reducing neuropathic pain [17]. Gabapentin is the drug of first choice for the treatment of any type of neuropathic pain; it is one of the most well-studied and widely used drugs in neurologist practice for the relief of pain in PHN. It is a structural analogue of gamma-aminobutyric acid (GABA). Gabapentin enhances the synthesis of GABA by stimulating the activity of glutamate decarboxylase; modulates the activity of NMDA receptors; blocks a-2-d-subunits of voltage-dependent calcium channels and inhibits the entry of Ca2+ into neurons; reduces monoamine release and sodium channel activity; reduces the synthesis and transport of the excitatory neurotransmitter glutamate; helps reduce the frequency of action potentials in peripheral nerves. The concentration of gabapentin in the blood plasma reaches its peak 2–3 hours after administration, the half-life is 5–7 hours. The dosing interval should not exceed 12 hours, bioavailability is 60%. Eating does not affect the pharmacokinetics of the drug; antacids reduce its concentration in the blood, so gabapentin should be taken no earlier than 2 hours after taking antacids. Excreted in breast milk; The effect of the drug on the child’s body has not been studied. Adverse reactions develop extremely rarely: slight dizziness, drowsiness. Gabapentin enhances the effect of lidocaine and antidepressants. You should refrain from combining it with alcohol, tranquilizers, antihistamines, barbiturates, sleeping pills, and drugs. The drug has important advantages in the treatment of neuropathic pain: safety, low potential for interaction with other drugs, good tolerability, and is not metabolized in the liver. Gabapentin is the drug of choice for the treatment of elderly people during polypharmacotherapy; it is convenient to use and has been proven to be highly effective.

Gabapentin dosage regimen. Initial dose: 1st day 300 mg in the evening; 2nd day 300 mg 2 times (day and evening); Day 3: 300 mg 3 times. Titration: days 4–6 300/300/600 mg; 7–10 days 300/600/600 mg; Days 11–14 600/600/600 mg. Daily therapeutic dose 1800–3600 mg, maintenance dose 600–1200 mg/day.

Pregabalin has a mechanism of action similar to gabapentin, but does not require slow titration and is therefore more convenient for clinical use. The drug is prescribed twice a day. The initial dose is 75 mg twice, the daily therapeutic dose is 300–600 mg. Several randomized clinical studies of the effectiveness of pregabalin in postherpetic neuralgia have been conducted, which showed the rapid development of an analgesic effect (during the first week of administration), good tolerability, ease of use and a reduction in sleep disturbances associated with pain [22].

Antidepressants. Drugs in this group, especially tricyclics (nortriptyline and amitriptyline), are important components in the treatment of pain in PHN. Due to the activation of descending serotonin and norepinephrine antinociceptive systems and the ability to block sodium channels, antidepressants block the perception of pain. In clinical trials of the effectiveness of tricyclic antidepressants in reducing pain in PHN, 47% to 67% of patients reported “moderate to excellent” pain relief, with equivalent effects reported for amitriptyline and nortriptyline [17]. However, nortriptyline does not cause many anticholinergic effects and may therefore be preferable to amitriptyline.

A patch with 5% lidocaine is applied to the affected area at the beginning of chronic pain or immediately after the diagnosis of PHN is made. The patch is applied to intact, dry, non-inflamed skin. It is not used on inflamed or damaged skin (i.e. during active herpetic eruptions). Lidocaine is an antagonist of sodium ion channels, the analgesic effect develops as a result of preventing the generation and conduction of neuronal activity potentials, by binding sodium channels of overactive and damaged nociceptors. A patch with 5% lidocaine has a local effect and has almost no systemic effects. Several studies have shown that the lidocaine patch reduces pain compared with placebo [18]. Comparative studies of the effectiveness of 5% lidocaine and pregabalin showed their equal effectiveness [19]. Capsaicin, which is made from red peppers and is an irritant, is used as an ointment or patch. When applied to the skin, it depletes peptidergic neurotransmitters (eg, substance P) in primary nociceptive afferents. The drug should be applied to the affected area 3-5 times a day to maintain a long-term effect. Despite the fact that a number of studies have shown the effectiveness of capsaicin against PHN, many patients often experienced significant adverse reactions: for example, a third of patients reported the development of an “unbearable” irritant effect of the drug, which significantly limits its clinical use in PHN.

Opioid analgesics (oxycodone, methadone, morphine) can also be used in the treatment of PHN. They reduce neuropathic pain by binding to opioid receptors in the central nervous system or inhibiting the reuptake of serotonin or norepinephrine at peripheral nerve endings - nerve synapses. According to research results, oxycodone, compared with placebo, provides greater pain relief and reduces the severity of allodynia, but causes the development of adverse reactions such as nausea, constipation, drowsiness, loss of appetite, and drug dependence [20]. Comparative studies of the effectiveness of opioids and tricyclic antidepressants have demonstrated their equivalent effectiveness.

In the section “Treatment of postherpetic neuralgia” in the 2009 European guidelines [21] for the treatment of neuropathic pain, first-line therapy is distinguished (drugs with proven effectiveness - class A): pregabalin, gabapentin, lidocaine 5%. Second-line drugs (class B): opioids, capsaicin.

When treating patients with PHN, it is advisable to follow certain steps.

Initially, first-line drugs are prescribed: gabapentin (pregabalin), or TCAs, or local anesthetics (plates with 5% lidocaine). If it is possible to achieve good pain reduction (VAS pain score – 3/10) with acceptable side effects, then treatment is continued. If pain relief is not sufficient, another first-line drug is added. If first-line drugs are ineffective, second-line drugs can be prescribed: tramadol or opioids, capsaicin, non-pharmacological therapy. In the complex therapy of postherpetic neuralgia, non-pharmacological therapy is also used: acupuncture, TENS anesthetic device, the most promising and effective method is neurostimulation.

Treatment of PHN is extremely challenging. Even with the use of various pain medications and referral to a specialist algologist, it is not always possible to achieve the disappearance of the pain syndrome.

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E. G. Filatova, Doctor of Medical Sciences, Professor First Moscow State Medical University named after. I. M. Sechenova, Moscow

Contact information about the author for correspondence

Table.

Methods for treating neurosis

Experts suggest fighting the disease using an integrated approach. This includes drug therapy, physical activity and proper nutrition, sleep and wakefulness, and moderate mental stress.

Drug therapy

Medicines, first of all, are antidepressants that are involved in the uptake of serotonin, dopamine, and norepinephrine. In addition, such drugs help block the enzyme that destroys these hormones. This allows you to increase their volume in the general bloodstream and thereby improve your mood.

These medications do not affect a person’s condition while driving a vehicle and are not addictive, but their effect occurs only a few weeks after the start of use. The duration of the course of therapy can reach 2-3 months.

There are also newer generation antidepressants that are considered safer and have fewer side effects. The duration of therapy and daily dose are determined only by the attending physician. Taking medications on your own without consulting a neurologist is highly undesirable.

Another effective remedy is drugs from the group of tranquilizers, which affect the transmission of nerve impulses in the brain, which makes it possible to slow down the activity of the nervous system and reduce a person’s reaction to a specific stimulus. The drugs have a sedative and anti-anxiety effect on the body.

Psychotherapeutic treatment

Personal psychotherapy allows a person suffering from a nervous disorder to build a picture of his personality and establish the cause that led to neurosis. A doctor helps change a person’s view of the world around him. Recovery occurs if the patient, with the help of a specialist, understands the cause of his fears and worries.

Meditation is also often used. With the help of psychoanalysis you can understand your inner world. Meditation can reduce anxiety and create new beliefs about specific situations.

Diet therapy

A proper diet during neurosis can reduce the load on the body. It is worth eating small portions 4-5 times a day, adding vegetables and fruits to your diet. They contain a high concentration of vitamins and fiber, which is a building material for all body systems.

It is also best to exclude sweets, flour, fried, and highly salty foods. Avoid strong and carbonated drinks. And also do not forget about the drinking regime, at least 1.5 liters of clean water per day.

Breathing exercises and massage

Physical exercise helps normalize the activity of parts of the brain such as the cortex and subcortex, as well as stimulate and calm the nervous system.

At the initial stage of gymnastics, simple exercises are performed that do not involve impact on the muscles and do not require concentration. Over time, the load must be increased. And breathing exercises improve blood circulation in the internal organs and in the brain, which allows you to get rid of pain.

Prevention of the development of neurosis

To prevent the development of neurosis, you need to exclude stressful situations and emotional overloads. Take breaks from work when you are doing heavy mental work.

Do things that are enjoyable and relaxing or soothing. Also suitable for prevention are meditations, which completely relax the body and mind and lift your spirits.

And don’t forget, if you feel constant panic attacks, a decline in emotional state, or other alarming symptoms of neurosis, consult a specialist.

Complications

The disease caused by the omicron strain, as in cases of infection with other variants of SARS-CoV-2, may be accompanied by increased thrombus formation with subsequent thrombosis of the veins of the lower extremities, pulmonary embolism, heart attack and stroke.
Post-Covid syndrome can develop within three months after recovery, even if the disease was mild or asymptomatic, and persist for up to eight months. It is associated with persistent inflammation, excessive activation of the immune system, and neurological disorders. It is more pronounced in women who have been infected with Omicron or other strains of coronavirus.

Symptoms of this condition include:

• weakness and fatigue;
• dyspnea;
• increase in body temperature to 37-37.5 ° C;
• disruption of the digestive system;
• sleep disorder;
• anxiety;
• depression;
• decreased concentration.

Possible complications of the infection also include pneumonia, meningoencephalitis, autoimmune lesions of the peripheral nervous system, hyperreaction of the immune system - cytokine storm. In children, infection with Omicron can also lead to the development of bronchiolitis, an inflammatory process in the bronchioles, leading to their blockage.