HEALTH TALK: Shingles

At first glance, some of you may be wondering why the doctor is talking about roofing materials. Unfortunately, it’s one of the imperfections of the English language that one word can be used to describe a million different things.

OVERVIEW

Shingles is a common condition that is caused by a virus.  It is the same one that causes chickenpox (the varicella-zoster virus).  Shingles is herpes zoster.  Chickenpox may be correctly referred to as – though it isn’t in all medical texts, as such – herpes varicella.  So it’s sort of a two-faced virus.  At first, it will cause chickenpox.  Then it lies dormant (hides) in nerve cells (dorsal ganglia) in your body and reactivates some time later to cause pain and tingling and a rash of short-lived blisters.

Caught the word ‘herpes,’ didn’t you? We’ll come back to that later.

Shingles normally isn’t serious, but when the eye is involved, of course it could be.  Postherpetic neuralgia is a complication that can cause the skin to remain painful and sensitive to touch for months or years.  When caught early, shingles can be treated with medications that can help shorten the infection and reduce the risk of complications.

SIGN AND SYMPTOMS

These may include
•    A feeling of pain, burning, tingling, itching, numbness or extreme sensitivity in a limited area of your body.
•    A rash with fluid-filled blisters that begin a few days after the pain and lasts two to three weeks before scabbing over and healing.
•    Fever
•    Headache
•    Chills
•    General feeling of unease and discomfort (malaise).

The rash of shingles commonly occurs on one side of the trunk of your body.  It often appears as a band of blisters that wraps from the middle of your back around one side of your chest to your breastbone, following the path of the nerve where the virus has been dormant.  In fact, your body is nicely marked out in sections we call dermatomes, from head to toe, that are each supplied by a set of nerves.  So shingles will affect a single dermatome, so that what you get is a well-defined one-sided rash with pain, etc., rather than having a rash and pain and itching all over the place.

The rash can occur around one eye or on your face or neck.  When it involves the top of your nose, a situation has occurred which can have serious implications for your eye, especially the cornea.  If not caught early, scarring and possibly temporary or permanent blindness can occur.  The shingles rash may resemble chickenpox, but is usually more itchy and painful.  A case of shingles, though painful, usually heals completely within about a month.

WHAT CAUSES SHINGLES?

Remember I said it’s the varicella-zoster virus (refer to ‘Overview’).  It is one of a group of viruses called Herpes viruses.  Yes, chickenpox and shingles are caused by a herpes virus, just like the cold sore you get on your lip, called Herpes labialis or Herpes simples Type I, or herpes in your genitals, called Herpes genitalis, Herpes hominis or Herpes simplex Type II. You may know that cold sores and genital herpes keep recurring.  It’s for the same reason you get shingles; the virus hides in nerve cells and reactivates on occasion, travels down your nerve cells to your skin to cause symptoms.  Many herpes viruses operate this way.

About 20% of persons who have had chickenpox will get shingles.  Sometimes the immune system does not kill the initial chickenpox virus, causing it to hide in nerve cells to re-emerge years later.  The reason for the re-emergence is unclear but seems to be linked to certain factors, such as age, and when the immune system is weakened.

WHAT ARE THE RISK FACTORS?

Being 50 or older, and having a weakened immune system, as just mentioned.  Most people get shingles only once, but repeated episodes are possible.

Shingles isn’t contagious, per se, but the shingles (Zoster) virus can cause chickenpox in anyone who has not had it, chickenpox, before.  This is very interesting to note.  Once you have had chickenpox, you cannot get it again.  But whereas you get chickenpox and later shingles, obviously I’m saying the reverse CAN occur, that is, one can have shingles and cause you to get chickenpox.  These herpes viruses are funny buggers; herpes on you lips (cold sores) and genital herpes are interchangeable if persons engage in fellatio or cunnilingus (oral sex).

Anyway, if you have shingles blisters, avoid physical contact with:

•    Anyone who’s never had chickenpox
•    Anyone with a weakened immune system
•    Newborns.  A variety of complications can develop – pneumonia, meningitis, encephalitis, as well as chickenpox.
•    Pregnant women, the infection being dangerous to a growing fetus.

Once your blisters scab over, you’re no longer contagious.

SEEK MEDICAL ADVICE

Do so as soon as you notice symptoms.  Prompt intervention can curtail the infection and possibly decrease your chance of complications.

If a rash develops anywhere near your eyes, see your doctor immediately.  Remember, your cornea can become infected and lead to temporary or permanent blindness

COMPLICATIONS OF SHINGLES

Shingles pain can continue in the same spot long after your blisters have cleared.  This is called POSTHERPETIC NEURALGIA, and results from damage to you nerve fibers and can be severe.  This occurs in the 20% of persons who get shingles and in 40% of those over 60.  The pain of this complication tends to lessen over time, and several treatments may provide pain relief.  It can be so bad that the touch of clothes on skin can cause significant pain.  Pain medications can include antidepressants and antiepileptic drugs.  See, just like in the English language, where one word can be used for different things, so it is in medicine that one drug can be used for a bunch of different conditions.

Other complications:
•    Inflammation of the brain (encephalitis)
•    Other neurological problems
•    Hearing problems
•    Blindness – mentioned twice already
•    Paralysis of parts of the face
•    Bacterial skin infections if blisters aren’t properly treated

By now you have guessed that I want you to pay particular attention to what may appear to be shingles anywhere above your neck.

TREATMENT OF SHINGLES

It usually gets better on its own without treatment but oral medication can lessen pain, speed up healing of blisters and reduce the severity and duration of complications.  But medications need to be taken as early as possible to be effective. Sometimes corticosteroids may be used to reduce swelling and pain.  These are all prescription drugs, by the way.

Postherpetic neuralgia will need potent pain killers or some of those dual-purpose drugs I mentioned not long ago.  Discomfort can be lessened by an ointment called Capsaicin or a skin patch that contains the anesthetic Lidocaine.

PREVENTION

A vaccine to prevent chickenpox has been in use for the last many years.  Children between 12 and 18 months can receive it; see your pediatrician. No chickenpox, no shingles, is the idea.  Adults who have not had chickenpox may also receive it.

HOW TO CARE FOR YOURSELF

Wash the blisters of shingles regularly to prevent a bacterial infection.  You can also try soothing self-care strategies:
•    Get plenty of rest
•    Take an over – the – counter pain reliever, such as Advil, Motrin, Tylenol, and others
•    Apply cool, wet compresses of water to relieve pain and dry out blisters
•    Soak in a tub of lukewarm water or rub on calamine lotion for itching and discomfort.

One final point: chickenpox is VERY contagious.  So if you’ve never had it, stay far from people who have it at any point in time, especially if you’ve not had a vaccine.  Because if you get chickenpox, you can later get shingles.

See you next week.