Rash - Patients ask, Dr. Ringpfeil answers
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Shingles, is a viral disease causing a blistering skin rash that appears as stripes. Usually the rash only occurs on one side of the body and is preceded by general itching and headache. The virus that causes shingles, called herpes zoster, also causes the short duration rash, chickenpox. The chickenpox virus never leaves the body once an individual has the disease but instead remains dormant in the spinal nerves. Unexpectedly, in old age the herpes zoster virus flares-up and manifests as shingles. Usually shingles occurs in patients fighting an infection that has weakened the immune system. Patients with HIV or receiving anti-cancer therapy are at an especially high risk of developing the disease. Approximately five out of every thousand adults over the age of 65 contract shingles. The main clinical sign is the rash, but most people report intense pain that lasts for four weeks as a result of nerve irritation from the virus. Since the nerves are mainly affect by the virus, some people even report eye pain and temporary losses of vision as a result of a rash on the face. Most symptoms depend upon the location of the body presenting the rash.
Since the rash is distinct a doctor can easily diagnose shingles with a physical examination. Often, a patient history is necessary to confirm that the individual had chickenpox. If the rash is not present or the rash is not the distinct line form on one side of the body, biochemistry tests can reveal the virus circulating in the body.
Similar to chicken pox, the virus must run its course in the body before disappearing. Most treatment options focus on lessoning the pain, fever, and itching that accompanies shingles. Antivirals commonly reduce the spread of the virus in the body and decrease the duration of the rash but do not treat the residual nerve pain. Lotion helps relieve the itching while pain medications such as morphine or steroids can lesson the pain and help stop the inflammation. If the itching and pain does is not reduced with lotions, local anesthetic such as lidocaine can often reduce the irritation from the rash.
After taking medication, the patients should stay out of direct sunlight which can irritate the rash. Proper rest is essential since stress is one of the main factors promoting further inflammation and outbreaks. The shingles virus is contagious to people who have never had chicken pox. Therefore, young children and adults who never had the virus should stay away from the individual with shingles.
A new vaccine called Zostavax was recently developed and has been proven to reduce the occurrence of herpes in half of the people who are infected. Since 2007, adults over the age of 60 who have had chickenpox as a child are recommended to take the vaccine. Some research has also shown that adults who have had chickenpox develop some immunity to shingles by being around children who have chickenpox. Most importantly, a healthy immune system greatly decreases the chances of developing shingles and low stress environments minimize the risk of outbreaks.
Chicken Pox / Shingles (Varicella - zoster)
VZV Research Foundation
36 East 72nd St
New York, NY 10021