Shingles

Shingles
Shingles, or Herpes Zoster as it is sometimes called, is a painful reactivation of the Chickenpox virus. These outbreaks usually appears as a local rash to one specific area of the body, what doctors call a dermatome distribution. It usually does not cross the midline of the body (i.e. left versus right side). The rash follows the dermatome nerve root pattern from the ganglion to the tip at the end of the nerve. Most of us have had the chicken pox virus at some point in our lives. Chicken pox is usually self limited though it can vary from mild to severe requiring hospitalization. This very sturdy virus can remain dormant in the areas in and around the ganglions being kept under control by the immune system.
Ganglions are junction boxes of the nervous system where they connect to other nerves. A patient may have particularly higher stress levels, decreased immunity due to old age or disease, excessive sunlight, acidy foods as pizza, grape fruit, orange juice or some unknown reason the virus can suddenly become active in a nerve root on one side of the body. There is some evidence that acidy or spicy foods as tomatoes, pineapple, peppers, pizza, spaghetti, lemons, limes, grapefruit, oranges, orange juice, pepper, red sauce, drugs, immune suppressors, medicines or steroids can also affect outbreaks. The virus wakes up and it travels up from the ganglion in a peripheral nerve where it really starts "raising cane." The initial symptoms are benign enough usually a patient will begin to feel tingly and painful in that area. A day or so later, a vesicular chickenpox-like rash develops. The pain level experienced fluctuates and can increase until it is almost unbearable in some cases. Shingles can be frustrating because nothing seems to work well enough to stop it.
Generally the earlier in the shingles outbreak you are treated the better the outcome and the duration is usually shortened. Taking oral anti-viral medications has been shown to shorten the duration of the outbreak but more importantly they lower the incidence of the very painful post shingles neuralgia experienced by some patients. This neuralgia can be severe and cause an almost permanent pain area when the rash goes away; Doctors term this sequelae post-herpetic neuralgia. It can set up really odd pain syndromes such as severe pain when even a breeze blows across it (allodynia). This can last a long time or remain a constant reminder of the shingles outbreak over a lifetime. Shingles usually do not cross the midline of the body and swell the nerve root. Sometimes a local anesthetic cream or oral pain medicine can help, but like many things in life, time is the curative treatment. Shingles generally resolve in four to six weeks. Interestingly, it has been seen in some teenagers and young adults who only received one chickenpox immunization in childhood
L-Lysine tablets decrease pain and decreases healing time and may work well with a low dose on a daily basis to help prevent re-infection. New infections get a dose pack of high to low doses over approximately 10 days (i.e. 10 day 1, 10 day 2, 10 day 3, 8 day 4, 6 day 5, 4 day 6, 2 day 7). You should never just stop this medication suddenly once given as it may precipitate a new or worse flare. Never use steroids with this diagnosis--it could be disastrous. Steroids decrease inflammation and suppress the immune system both of which help the virus dramatically grow and spread greatly, worsening the disease.
We now have a preventive vaccination for shingles. It is a vaccination of an attenuated virus, which builds the body's immunity to shingles. It is a bit pricey but has had some excellent results. It is approved now for people over 60 years old. It is a onetime shot which is safe if you are not allergic to gelatin or neomycin. You should not have it if you are pregnant or may become pregnant, have significant immune deficiency, or are on high doses of corticosteroids.
If you develop shingles or think you have developed them, see a physician. The earlier a physician prescribes you an antiviral, the better. The duration will be shorter and you decrease your chances of developing post herpetic neuralgia. You are most contagious when you first develop the start of a new eruption. Keep the rash clean and dry, and watch for any signs of secondary bacterial infection. Use caution that you do not touch or spread the shingles to your eyes. If you have an outbreak in your eye it is imperative that you immediately see a physician. Your physician can treat shingles and can usually give you something for pain if necessary. Remember the shingles rash could actually spread the disease and have serious consequences to someone who is pregnant, anyone with HIV/AIDS, cancers, bone marrow or organ transplant patients or anyone with other immune deficiencies. Exposure to these people can have disastrous or even deadly results.
So, before the misery strikes, get your shingles prevention vaccine and see your doctor ASAP with any new eruptions as symptoms.
Douglas Beatty M.D.
Doctors Medical Center