Shingles: Chicken Pox Redux
The majority of Americans who are adults today had chicken pox when we were kids. And if you did, that means you might get shingles later in life. Shingles disease, also known as herpes zoster, is an acute infection of the nerve roots caused by varicella zoster--the same virus that gave you chicken pox as a youngster. There are about a million cases of shingles every year in the U.S., and about half of those occur in people over 60 years of age. In fact, one of every two people who live to age 85 or beyond will experience the joy of shingles at some time in their lives.
What happens is this: the chicken pox virus never really goes away. Instead, it goes dormant and “hides” in a nerve ending, usually for many, many years. In some people, for reasons that are not fully understood--oftentimes when your immune system is compromised or you are under a great deal of stress--the virus will awaken again in the nerve and cause an outbreak of shingles. It’s important to note that not everybody who had chicken pox will get shingles; unfortunately, there is no way to determine who will get shingles or when.
What are the symptoms? Shingles appears as a rash with small painful blisters that look somewhat like chicken pox. The rash will be localized along a particular “dermatome,” or nerve band, on one side of the body (vs. an all-over breakout). For example, it may occur in a band stretching from the spine, under the arm, to the chest. The breakouts can occur anywhere, but the most common areas are on one side of the face or torso, one arm or leg, the waist or buttocks. It is possible, but uncommon, to experience a shingles breakout on one more than one part of the body.
Many people will experience an unexplained tingling, burning, stabbing, or itching pain along the affected dermatome, accompanied by flu-like symptoms including headache, fatigue, chills and nausea, several days before the rash actually appears. Then redness and swelling often occur, followed by an outbreak of blisters that continues to worsen for several days. Within about 14 days, the blisters will fill with pus and then scab before they begin to heal. A typical shingles outbreak will be over within about 30 days and usually will not recur. The pain and discomfort resolve as the rash disappears.
How is it treated? No medication can cure shingles. However, if an accurate diagnosis of shingles can be made within 72 hours, it can be treated with antiviral medications to reduce the duration of the disease and the risk of complications. Usually, once an outbreak occurs, the best your physician can do his help you manage the pain with Tylenol or narcotic pain relievers. Topical agents such as lidocaine patches can also help alleviate pain, as can calamine or colloidal oatmeal lotions and cool compresses. Don’t use steroidal creams or ointments on your shingles blisters!
What complications might occur? Unfortunately, for some people, the pain of shingles can continue long after the blisters have healed. In fact, in some cases, it never goes away completely. Postherpetic neuralgia (“PHN”), the most common complication from shingles disease, is caused by damaged nerve fibers. People with PHN have an ongoing experience with allodynia—a nerve condition whereby the slightest touch, such as the brush of clothing or a gentle breeze, causes sensation that can range from slight tenderness to acute burning, throbbing or stabbing pain. PHN can be very complicated to treat so, if you have had shingles and suspect that you may have PHN, you should talk to your doctor immediately. The pain from PHN can often be alleviated by prescription pain medications or even antidepressant medications (since they work on the chemicals in the nerve endings).
Other potential complications from shingles can be minor, such as scarring or bacterial skin infections. Or, they can include much more serious neurological problems like vision or hearing loss, paralysis on one side of the face, or even encephalitis (swelling of the brain). Therefore, it’s very important to consult with your physician if you believe you have shingles or think you might be experiencing complications from a prior bout with shingles.
Is shingles contagious? Shingles is not generally contagious—you cannot “give” shingles disease to another person. However, direct contact with shingles blisters could cause chicken pox in a person who has never had them. It is recommended that pregnant women avoid contact with the shingles rash. The virus is not airborne and cannot be transmitted by coughing or sneezing.
Should I have a vaccination? If you have never had the chicken pox, you definitely don’t want to get them as an adult! Grown-ups have a much more difficult time with this “childhood” disease. Since 1995, a chicken pox vaccine has become part of the recommended pediatric immunization routine. Even as an adult, if you have never had the chicken pox, you should consider having this vaccination.
If you’ve had the chicken pox and are over 60 years of age, whether or not you’ve had shingles, I recommend that you get a shingles vaccination to protect you from varicella zoster. Now, having the shot isn’t a 100% guarantee that you won’t get shingles. But, even if you do have an outbreak, the vaccine will decrease the likelihood of a serious complication like PHN.
Communicate with your physician. As always, I encourage you to talk openly with your physician or other medical provider about any problems or issues that may be concerning you. Ask any and all questions you have about your health, and persist until you’re satisfied with the answers. Your vitality and well-being are your responsibility and, as physicians, we are here to help and support you in living the very best possible life!