Shingles, a form of herpes caused by the chicken box, must be treated to avoid debilitating conditions such as blindness and nerve pain which can last indefinately
What is shingles?
Each year, an estimated one hundred thousand Canadians are afflicted with herpes zoster, a painful viral infection commonly called shingles, which is caused by the chicken pox virus. Shingles can develop in anyone who has had chicken pox.
What causes shingles?
Varicella zoster virus, the same virus that causes chicken pox, causes shingles. This virus is in the herpes family. Shingles is also called herpes zoster. Shingles is not a new infection; rather, it is a second outbreak of the chicken pox virus. Some of the virus germs that cause chicken pox stay in the body, remaining inactive in the nerve cells near the spine for many years. Then the herpes zoster virus suddenly wakes up from the dormant state and grows. Once active, the germs travel along the nerve paths to the skin, leaving a path of destruction along the nerves in which they travel. The result is the pain and rash of shingles.
What are the symptoms of shingles?
In some people, the virus "awakens" within the nervous system to cause shingles. Shingles may include a blistering rash and severe burning pain, tingling or extreme sensitivity to the skin, usually limited to one side of the body and lasting about a month. The first sign of shingles usually is a tingling feeling or itchiness of the skin, which can occur up to 1 week before the rash. Some people have stabbing pain at the beginning, but others have pain only after the rash begins. When the rash is worst, the pain may be extremely severe. Before the rash comes out, some people are misdiagnosed as having a heart condition or gallbladder attack because of the pain. The rash begins as a band or patch of raised dots on one side of the trunk, face, abdomen, arms, or legs. The location of the rash is a clue that the infection is shingles. The rash occurs on only one side of the body, like a band or belt. (The word shingles comes from a Latin word meaning belt or girdle, and zoster is Greek for belt.) The most common sites of shingles are on one side of the chest (front or back, like half of a belt) and on one side of the forehead and scalp. If a person gets herpes zoster in the forehead region, an emergency evaluation with an ophthalmologist is crucial, since the infection can at times cause serious eye problems. After a few days, the spots become blisters filled with fluid. When the blisters dry out and crust, within 2 weeks, they no longer contain the virus. A typical case of shingles lasts about a month. However, the pain associated with herpes zoster may continue for months or years in people who develop post-herpetic neuralgia (PHN).
Who can get shingles?
Anyone who has had chicken pox can get shingles. The varicella zoster virus that stays in the body after a case of chicken pox is usually kept inactive by the body's natural immune system. As people get older, their immune system naturally weakens to some germs, such as herpes zoster. Most people with shingles, therefore, are 65 years or older. Typically, but not always, shingles occurs in elderly people who are in some stressful situation. It is important to realize that just because a person develops shingles, the entire immune system is not necessarily having problems.
Is shingles contagious?
Shingles is not contagious. Shingles occurs only when the virus in a person's body becomes active. Contact with an infected person will not cause shingles. However, although shingles is not contagious, contact with a person with shingles could lead to chicken pox in someone who has never had chicken pox and has not received the varicella vaccine.
What is the treatment for shingles?
Treatment goals for shingles are to reduce pain and discomfort, to hasten healing of blisters and to prevent the disease from spreading. Early treatment (within 2 or 3 days of developing the rash) reduces the severity of shingles and can perhaps reduce the risk of developing PHN. A patient with herpes zoster on the face should see a physician immediately, because infection of the eye could lead to blindness. Because a virus causes shingles, the main treatment is antiviral medication: acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex). These pills are taken three to five times a day for 7 to10 days. Other drugs such as prednisone may be given to relieve the inflammation. Prescription pain relievers and low doses of antidepressant medication should be given to ease the pain. When the pain is severe, at times a nerve block is ordered.
Is home care helpful for shingles patients?
Sometimes the rash from shingles requires special treatment at home prescribed by a patient's health care professional. Consult with a physician on the appropriateness of home nursing care to determine if skilled nursing care may be helpful regarding instructions on caring for the rash of shingles. Home care must be ordered by a physician, and there are several modes of reimbursement. Check with the community Visiting Nurse Association regarding specific guidelines for care and reimbursement.
What can be done to reduce the risk of post-herpetic neuralgia?
Unfortunately, there is no treatment that will definitely prevent the occurrence of chronic pain or PHN. However, studies have shown that antiviral medication that is taken immediately can lessen the severity and duration of shingles and may reduce the possibility of getting PHN in the future.
