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What You Need to Know About Shingles

By Chris Iliades, MD

If you had chicken pox when you were a child, there is about a 10 to 20 percent chance that you will develop shingles and that chance increases with age. The medical term for shingles is herpes zoster, and it is caused by the same virus that causes chicken pox. The first time you get infected with the virus, it causes chicken pox, but the virus can then enter the root of one of your nerves and wait there to be reactivated. When the herpes zoster virus "wakes up" after many years, the result is shingles.

"Persistent pain or postherpetic neuralgia may be severe and life altering condition and occurs with increasing frequency with advancing age." - Journal of Infection

A Rash Of Shingles Symptoms

Shingles occurs most frequently in people over age 50 and becomes more common the older you get. When the virus is reactivated in nerve cells it travels along the course of the nerve towards the skin and causes pain followed by a rash. Anything that weakens your immune system can cause the virus to awaken. Some common factors may be cancer, illness, stress, or trauma.

     
  • The first shingles symptom is burning, itching, tingling, or extreme sensitivity of the skin on one side of your body.
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  • Several days later a red rash appears in the same area as the pain. The rash follows the path of the nerve and is most common in the trunk or hip area. The rash may be accompanied by headache and fever.
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  • Blisters form in the rash area and turn from clear to yellow before crusting over and clearing. The rash phase may last for two to three weeks during which the pain may be severe enough to require narcotic pain medication.

Pain After Shingles

A recent study published in the Journal of Infection states that pain may last for months or years after shingles has cleared. This condition, called "post herpetic neuralgia," can be debilitating and is more common in seniors. Studies show long-term pain after shingles is 15 times more common if you get shingles after the age of 50. About 10 to 20 percent of people who get shingles will have post herpetic neuralgia.

What Can You Do About Shingles?

In most cases shingles runs its course, goes away and never comes back. Treatment is aimed at controlling the pain of the infection and preventing the long-term pain of post herpetic neuralgia.

     
  • Oral anti-viral medications such as acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex) have been shown to decrease the severity and duration of the rash and shingles pain, but only if they are started within 72 hours of the appearance of the rash.
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  • Some studies show that when given early, the anti-viral medications may decrease the chances of post herpetic neuralgia, but others do not. The jury is still out, but all the studies agree that the earlier these medications are started, the better they work.
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  • Steroid medications used along with anti-viral medications have been shown to help reduce shingles pain. The long-term pain of post herpetic neuralgia may be controlled with narcotics, antidepressants and anticonvulsant medications.

Special Concerns for Caregivers

The most important thing about shingles is starting treatment as soon as the rash appears:

     
  • If a senior is complaining about one-sided burning pain or skin sensitivity, look for a red rash under clothing. The rash has been described as "belt-like" because it follows the course of the nerve.
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  • Be aware that herpes zoster can also affect the nerves of the face. A rash in the area of the ear can indicate can indicate infection of the facial nerve and a rash at the tip of the nose can indicate infection of the eye. Shingles in these areas can be especially dangerous and can cause ear pain, facial paralysis, vertigo and blindness.
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  • Ask your senior’s doctor about the possibility of a vaccination against shingles. The FDA has approved a vaccine for seniors over age 60. Some studies show that the vaccine may reduce shingles by 50 to 75 percent.