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    Shingles

    Dr. James Gutmann, Family Medicine Physician at Deaconess Clinic Mt. Pleasant 09/04/2015

    In my 26 years of practicing family medicine, I have treated hundreds of patients with shingles and seen how painful and debilitating it can be. My goal in writing this article is to help people either learn how to potentially avoid shingles, OR help them know what to do if they get shingles.
     
    What is Shingles?
    Shingles (herpes zoster) is a painful, blistering skin rash. It is caused by the varicella-zoster virus becoming active in certain nerves in the body.
     
    Varicella-zoster is the virus that also causes chickenpox. Chickenpox is a viral infection in which a person develops extremely itchy blisters all over the body. It used to be one of the classic childhood diseases, but is now usually prevented through childhood vaccines. Once you have chickenpox, the varicella-zoster virus becomes dormant and remains inactive in certain nerves in the body. Shingles occurs when the virus becomes active again after many years. The reason the virus suddenly becomes active again is not clear. Often only one attack occurs, but people can develop shingles multiple times.
     
    Do shingles only affect elderly people?
    Shingles can develop in any age group. However, you are more likely to develop the condition if:

    • You are older than age 60
    • You had chickenpox before age 1
    • Your immune system is weakened by medications or disease

     
    If an adult or child has direct contact with the shingles rash and did not have chickenpox as a child or get the chickenpox vaccine, they can develop chickenpox, not shingles.
     
    What are the symptoms of shingles?
    The first symptom is usually pain, tingling, or burning that occurs on one side of the body. The pain and burning may be severe and are usually present before any rash appears. Red patches on the skin, followed by small blisters, form in most people. The rash usually involves a narrow area from the spine around to the front of the abdomen or chest.
     
    HOWEVER, the rash may involve the face, eyes, mouth, and ears. It can also involve the hands/arms/limbs. Rashes in these areas—with more nerve endings—are often more painful.

    Other symptoms of shingles may include:

    • Fever and chills
    • General ill feeling
    • Headache
    • Joint pain
    • Swollen glands (lymph nodes)

    Your health care provider can make the diagnosis by looking at your skin and asking about your medical history. Tests are rarely needed.
     
    What is the treatment for shingles?
    Your health care provider may prescribe a medicine that fights the virus, called an antiviral drug. This drug helps reduce pain, prevent complications, and shorten the course of the disease. The medicine should be started within 72 hours of when you first feel pain or burning. It is best to start taking it before the blisters appear.
     
    Strong anti-inflammatory medicines called corticosteroids, such as prednisone, may be used to reduce swelling and pain. These medicines do not work in all patients. Other medicines may include:

    • Antihistamines to reduce itching (taken by mouth or applied to the skin)
    • Pain medicines
    • Zostrix, a cream containing capsaicin (an extract of pepper) to reduce pain

     
    Follow your health care provider's instructions about how to care for yourself at home. Stay away from people while your sores are oozing to avoid infecting those who have never had chickenpox -- especially pregnant women.
     
    Is there a vaccine for shingles?
    A herpes zoster (shingles) vaccine is available. The vaccine for shingles was licensed in 2006. In clinical trials, the vaccine reduced the risk of shingles by 50%. It can also reduce pain in people who still get shingles after being vaccinated.
     
    A single dose of shingles vaccine is recommended for adults 60 years of age and older.
     
    A person who has the following should not get a shingles vaccine:

    • Has ever had a life-threatening allergic reaction to components of the vaccine. Tell your doctor if you have any severe allergies.
    • Has a weakened immune system because of current:◦AIDS or another disease that affects the immune system,
      • Treatment with drugs that affect the immune system, such as prolonged use of high-dose steroids,
      • Cancer treatment such as radiation or chemotherapy,
      • Cancer affecting the bone marrow or lymphatic system, such as leukemia or lymphoma.
    • Is pregnant, or might be pregnant. Women should not become pregnant until at least 4 weeks after getting a shingles vaccine.

     
    Someone with a minor acute illness, such as a cold, may be vaccinated. A vaccine, like any medicine, could possibly cause problems, such as allergic reactions. However, the risk of a vaccine causing serious harm, or death, is extremely small. No serious problems have been identified with shingles vaccine.
     
    Does a single vaccine allow for lifetime protection?
    The shingles vaccine has only been around for nine years, so it’s still too early to know the long-term efficacy. We do know that the vaccine has been proven to reduce the risk of recurrence of shingles in those who’ve had a prior episode and it can reduce the severity of future episodes.
     
    Are there any side effects of the shingles vaccine?
    Mild problems may include:

    • Redness, soreness, swelling, or itching at the site of the injection (about 1 person in 3).
    • Headache (about 1 person in 70).

    Like all vaccines, the shingles vaccine is being closely monitored for unusual or severe problems.
     
    Can the shingles vaccine be given to someone under the age of 60?
    The vaccine was initially approved by the FDA for ages 60 and older. More recently it’s been approved by the FDA for ages 50 and older, however, not all insurance companies cover the vaccine at younger ages.
     
    What does reoccurring shingles say about my immune system?
    A weakened immune system certainly leads to a higher risk of shingles, but it doesn’t necessarily mean that you have a weakened immune system because of recurring shingles.
     
    Is shingles communicable?
    No. However, someone with shingles can theoretically spread the chickenpox virus to those who have not been vaccinated or had chicken pox. Because of this, those afflicted by shingles are advised to stay away from pregnant women, little babies or others they might affect.
     
    When is the contagious period over?
    The general medical belief is that once the rash is fully crusted over, you are no longer contagious. Overall, as I mentioned earlier, those with shingles should avoid those who haven’t had chickenpox or been vaccinated.
     
    Does having chickenpox increase the chance of getting shingles later in life? What if you have the varicella vaccine?
    If you get the varicella vaccine, you are not expected to get shingles.  However, having had the chickenpox illness, itself, means the virus is in your body and dormant, which often leads to shingles later in life.
     
    Can shingles cause nerve damage to the eyes if the outbreak occurs on the face?

    The virus potentially damages nerves including those of the eye. Because ocular (vision) nerves are sensitive, damaging them can lead to reduced vision. If you have a shingles outbreak on the face, you need to see your primary care physician immediately. Early care of shingles can lead to much better outcomes when it comes to both short-term and long-term pain.
     
    Postherpetic Neuralgia
    The earlier treatment can take place, the less likely it is for someone to have ongoing pain from shingles. Sometimes the pain in the area where the shingles occurred may last from months to years. This pain is called postherpetic neuralgia. It occurs when the nerves have been damaged after an outbreak of shingles. Pain ranges from mild to very severe. Postherpetic neuralgia is more likely to occur in persons over age 60.
     
    My colleagues at the Deaconess Comprehensive Pain Center offer treatment that can help with the immediate pain of shingles, and it has been proven to significantly reduce the likelihood of developing postherpetic neuralgia.
     
    For more information about the DCPC.
     
    Additional Resources:•For more information about my practice.
     

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