“Shingles” is a common or lay term for what physicians call herpes zoster. Herpes zoster
is a disease caused by a reactivation of a latent, or hidden virus that is already present in our cells. This is the varicella zoster virus, the virus that causes chicken pox during childhood.1 After a person gets chickenpox, the varicella zoster virus remains in a dormant form in nerve cells near the spinal cord. This virus may reactivate after years or decades, causing a painful rash similar, but not identical to that of chickenpox.1 Although most people will get chickenpox during childhood, only 10–25% of individuals will develop reactivation of the virus, or herpes zoster.1,2
Shingles becomes more common with age due to the decreasing immunity that occurs as we get older, specifically a type of immunity called cell mediated immunity.2 People with HIV infection and patients with cancers such as leukemia and lymphoma also have low cell mediated immunity and often develop shingles as well.1 As we age beyond 50 years, the probability of developing shingles doubles with each decade, and people over the age of 55 account for 30% of cases of shingles.2
One of the most important concerns for people who develop shingles is a phenomenon known as postherpetic neuralgia. Postherpetic neuralgia is a burning or sharp pain that is thought to be related to damage to the nerves during the acute reactivation of the varicella virus.2 Up to 50% of people over the age of 60 who develop shingles will also develop postherpetic neuralgia.3 People with this complication may have severe pain just from the weight or movement of clothes or bed sheets over the body. They may develop an addiction to painkillers, they may have trouble sleeping, and they may even commit suicide. Although 1 in 20 cases of postherpetic neuralgia has resolved by a year, early and correct treatment of herpes zoster is important in decreasing the incidence of postherpetic neuralgia.2
Recognizing Shingles:
The rash associated with shingles is usually unilateral, that is, on one side of the body only, and often located on the thorax. In only very rare cases will shingles cross the midline and appear on both sides of the body.3 The lesions are red and very painful and become fluid-filled as they mature. Pain may often precede the appearance of the rash. The individual lesions usually persist for 3–5 days and then scab over.1,3 Early recognition is important in order to start early treatment.
Treating Shingles:
There are three common antivirals that are used in the treatment of shingles: famcyclovir, acyclovir, and valacyclovir. They are given in different dosages at different frequencies, but all are given for a duration of 7 days.4 The most important factor affecting the resolution of the pain associated with the rash, and in decreasing the incidence of postherpetic neuralgia is the time when therapy with these medications is initiated—antiviral therapy is most effective when initiated within 48 hours of the onset of symptoms. These drugs must be used with caution in people who have kidney problems, but are otherwise relatively safe to use.3 Again, the most important factor is to initiate therapy early, while the virus is still multiplying, after 72 hours the effectiveness of antiviral therapy is much decreased.1
Have you had shingles and gotten quick treatment? Did it prevent herpetic neuralgia?
Are you dealing with the pain of herpetic neuralgia now?
Tell others your story and help them decrease the chances of having this devastating complication of shingles.
References:
- Wareham DW, Breuer J. Herpes Zoster. BMJ 2007;334;1211-1215.
- Stankus SJ, et al. Management of Herpes Zoster (Shingles) and Postherpetic Neuralgia. Am Fam Phy.
- Anderson W, et al. Varicella Zoster. From: emedicine.com
- Treatment of Herpes Zoster. Clinical Question. Am Fam Physician.
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