Shingles – “You mean I have Herpes?”

shutterstock_134601161Shingles, also called Herpes zoster is a painful rash caused by the same virus that causes chickenpox.  The term “shingles” comes from the latin word “cingulum” which means belt or girdle; the rash usually appears in a band or belt-like pattern.

Singles can occur in people of all ages, but is more common in adults over age 50.  It can also be more common in those people with a weakened immune system.

Cause:  After chickenpox goes away, the virus retreats to cells in the nervous system and hides out there quietly for many years.  Later in life, the varicella zoster virus can become active again and cause shingles.  There are many different types of herpes virus and shingles/chickenpox are a different form of herpes than the type that cause cold sores or genital herpes.   You are not at risk for getting cold sores or genital herpes by being around someone who has shingles or chickenpox.

Risk of getting shingles:  About 20% of people will get shingles at some point in their life.  Some people actually get the recurrence of shingles multiple times.  Although it only occurs in people who have had chicken pox in the past, sometimes the chickenpox is mild enough that you might not even be aware that you have had it.

Weakened immune system:  Certain people are more at risk for developing shingles if their immune system is compromised:

1)   Chemotherapy treatment for cancer

2)   Cancer itself can lower the immune system

3)   HIV

4)   Medications that suppress the immune system – such as after an organ transplantation or medications used to treat rheumatoid arthritis

Symptoms:  Parasthesias are unusual sensations that may occur before any rash is noted.  It’s described as a tingling, itching or burning in the area of skin on one side of the body.  Some individuals develop a fever or headache, but many do not.  Within a day or two a rash of blisters occur on one side of the body in a band-like pattern.  The rash may occur on the chest, upper or lower back or even on the face.  If it occurs on the face near the eye, it can permanently affect the vision, so we will often have those patients be seen by an eye doctor.

Shingles pain can be mild, moderate or severe and is usually described as a stabbing or burning pain.  The pain usually stays in the area of the rash and can interfere with sleep and daily activities.  Older adults typically have worse pain than younger patients.

After 3-4 days the blisters usually become open sores or ulcers.  Rarely, the patient can develop a secondary bacterial infection in the area of the shingles rash.  We treat any underlying bacterial infection with antibiotics.  The sores then crust over and are not infectious after 7-10 days and the rash gradually resolves within 3-4 weeks.  Scarring or skin changes can occur.  Most of the time, no chronic problems occur after someone has a shingles outbreak.

Can I catch it from someone else?   You can’t catch shingles from someone else but you can become infected with the varicella zoster virus.  If you’ve never had chickenpox or the vaccine, you can develop it after being in contact with someone who has shingles.  Even inhaling virus particles that are in the air can spread the infection.  If you have had chickenpox or the vaccine, being near someone with shingles will not cause shingles or chickenpox.

Possible complications of shingles:  Possible complications of a shingles infection can occur:

1)   Pain called postherpetic neuralgia is the most common complication.  Is is usually described as a burning pain that affects 10-15% of patients after the rash has resolved.

2)   Skin infection from a bacteria can delay healing

3)   Eye complications can occur if the virus is on the face near the eyes

Treatment:  There are multiple medications that can be used to treat shingles.  We try to keep the skin clean and dry to decrease the chance of developing a bacterial infection.  Some options might include:

1)   Antivirals such as acyclovir, famciclovir or valacyclovir are most effective when started within 3 days after the rash appears.  They stop the virus from multiplying and speed the healing of skin lesions.  This decreases the amount of pain the patient experiences

2)   Pain medication such as Ibuprofen, Aleve or prescription pain medication may be prescribed

Return to work:  If the blisters are on the face, it is best to remain off work until the area has crusted over which is usually 7-10 days.  If the blisters can be covered, you can return to work after you are feeling well.  If you work in a healthcare facility, please consult your healthcare provider.

Prevention:  There is a vaccine to help reduce the risk of shingles.  If a shingles infection occurs after the vaccine, it is usually less severe and there is less chances of developing post-herpetic neuralgia.  We recommend the vaccine for adults over age 60.  Even if you are unsure if you had chickenpox, we recommend the vaccine.  We don’t give the vaccine to pregnant women, or those with a weakened immune system.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

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