Learning how to manage shingles is essential as it can be a very debilitating condition. Shingles or herpes zoster is an acute viral infection affecting the skin and nerves. Shingles vaccine helps in reducing the severity and complications of the disease.
According to CDC, every year there are one million cases of herpes zoster in US alone. Shingles is caused by varicella zoster virus, the same virus that causes chicken pox. When the virus first infects a person, he or she gets chickenpox. After recovery from chickenpox(14-21 days), the virus travels along the nerve and finds a resting place in the nerve called nerve ganglion. The viral particles enter the nucleus of the nerve cells and remain in a latent (sleepy) state as a part of the human cell.
The sleeping shingles virus can be reactivated after months or years when the host immunity is lowered due to some illness. Once reactivated, the virus travels along the nerve to the skin causing an outbreak of shingles . The lesions of shingles almost always occur along an area of the skin known as dermatome supplied by the affected nerve branch. Zoster(Gr) means girdle denoting the segmental distribution of the skin lesions.
How Does Shingles Manifest?
One to two days before the skin eruption, the patient gets a burning sensation along the nerve route on the skin. Some patients complain of severe pain from within the body. This is because the same nerve supplies the internal organs as well. Doctors call this pain a referred pain.
The intense burning pain and the angry red background of the skin eruption has earned herpes zoster the pseudonyms of hell fire or firebelt. The skin lesion in shingles consists of fluid filled, painful or itchy vesicles. The fluid inside is clear to start with and within 2-4 days this becomes turbid, with healing starting in the centre as dark brown crusts. As the healing progresses, the skin becomes more itchy. The entire course of shingles runs for a period of 2-3 weeks depending upon the age, immune status, presence of other diseases like diabetes, HIV, timely treatment etc.
In rare cases more than one nerve can be affected and herpes can have a generalized or disseminated appearance. It is imperative to rule out serious immune suppressing diseases like AIDS or Cancer in such patients.
Can I Get Shingles?
Yes you can, if you have had chickenpox earlier in life. Age above 50 years and low immune status will make you more vulnerable to shingles.
Is it Possible to Get Shingles More Than Once in My Life Tme?
Usually no. But there have been reports of some immune compromised individuals getting repeated attacks of shingles.
Is Shingles Infectious?
Shingles is infectious; but those coming in contact with the patient contract chickenpox, not shingles, if they have not had chickenpox before. Herpes does not spread
What Are The Complications of Shingles?
Post herpetic neuralgia (PHN) is the most feared complication of shingles. In around 10-15% of cases of herpes zoster, patients continue to feel shingles pain along the nerve distribution even after the skin lesions have healed. This pain can be very severe and debilitating. Incidence of PHN increases dramatically with increase in age. Other neurological and eye complications may also occur in severe shingles.
How to Manage Shingles?
In mild cases, symptomatic treatment for pain and itching with cool compresses and application of silver sulfadiazine cream will suffice.
Severe cases of shingles require expert help from a dermatologist. The earlier you get treatment for shingles , the better. The dermatologist will prescribe systemic antivirals like acyclovir, pencyclovir or valacyclovir. Remember, though, If the treatment is initiated 72 hours after the eruption, the medications will not alter the natural course of the disease.
Post herpetic neuralgia or shingles pain relief is sought with tricyclic antidepressants, cooling sprays, capsaicin ointment, trans-cutaneous electric nerve stimulation, and when the pain is severe, even surgery to cut off the neural pain transmission. Hypnosis and bio-feed back therapy may help some patients.
Is There Any Vaccine For Shingles?
Oxman et al from the Shingles Prevention Study Group after a study on herpes zoster vaccine reported in an original article A Vaccine to Prevent Herpes Zoster and Post herpetic Neuralgia in Older Adults in The New England Journal of Medicine , June 2, 2005 that the shingles vaccine does indeed reduce the severity of herpes zoster and the incidence of post herpetic neuralgia among older adults. In 2006 the FDA licenced the shingles vaccine for use in adults aged 60 or more.
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
Reference:
J.C.Sterling, Varicella-Zoster. Rook’s Textbook of Dermatology, 7th Ed, 2004: 25.22-9
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