Even if you have never been affected by shingles, you probably know that it is an extremely painful skin rash with blistering. However, what you may not know is that shingles is caused by the reactivation of the virus that causes chicken pox, known as the varicella zoster virus.
Chicken pox is a childhood viral disease that about 50 per cent of children get by age nine. Common symptoms include a red, itchy rash with blisters that develop crusts. By age 30, more than 95 per cent of Canadians have had chicken pox, and the older you are when you are affected, the more severe the symptoms tend to be, including fever, nausea, and a more extensive, severe skin rash.
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When you contract chicken pox, your immune system develops antibodies to the virus and you acquire immunity against reinfection. Chicken pox vaccines also give you immunity. While you may not have the disease, however, the varicella zoster virus does remain in your body, lying dormant in nervous tissues and kept in check by your immune system.
If the virus becomes active again, it is known as herpes zoster or shingles. Reactivation is thought to be the result of reduced immunity. As you age, your immune system does not work as well as it once did, and in the presence of disease conditions like HIV infections or drugs like those used to treat cancer, your immune system is not as robust as it once was.
Shingles is characterized by a stripe of rash and blisters wrapped around the left or right side of your torso (that is, along the pathways of nerves). Indeed, the word zoster means girdle in Greek, and the rash appears as a girdle around your abdomen. There is severe pain, burning, numbness, tingling and itching.
You can be contagious for chicken pox, but only to individuals who have not had chicken pox, and they must come directly into contact with the open blisters.
If nerves near your eyes are affected, your sight can also be impacted, and there is always the risk of bacterial infection of open blisters.
Because shingles is caused by a virus, antiviral drugs are used to treat the condition, for example valacyclovir and famciclovir. But the trick is to start treatment as quickly as possible, that is within 72 hours of the first symptoms, so that the viruses have not multiplied to numbers too large for the antiviral drugs to handle. These antiviral drugs can reduce the severity and duration of shingles, but are not a cure.
Cool compressed, oatmeal baths and even creams containing local anaesthetic can help. For pain, drugs that work through the nervous system like gabapentin or amitriptyline can be used, and of course pain relievers such as narcotic analgesics. Within a month the rash is usually gone, but scarring can occur.
Pain that remains after more than a month is called postherpetic neuralgia. Researchers believe that the reactivated virus has damaged the affected nerve fibres which sends out confusing and inaccurate messages which you perceive as pain. Anywhere from 10 to 70 per cent of people who get shingles will also have postherpetic neuralgia, and the incidence increases dramatically with older age.
The aim of treatment is to stop the pain with drugs like gabapentin, amitriptyline, and narcotic analgesics. Capsaicin, a cayenne pepper derivative, is a cream that depletes substance P from the nervous system. Without substance P, nervous system messages of pain are not transmitted, but it can take weeks for a maximum effect.
The most recent approach to shingles is a varicella zoster vaccine which boosts immunity. While it may not prevent shingles and post-herpetic neuralgia, it can certainly reduce the course and severity of the condition.
The key is early recognition of symptoms and early treatment. Be vigilant, especially if you are older!
