What Is Shingles?
Shingles, commonly known as the herpes zoster virus is a late manifestation of the chicken pox virus known as varicella zoster.
Although shingles affects millions of adults by the time they reach 80, it is not uncommon for younger people to develop the virus. When the virus activates it travels along nerve fibers, usually breaking out on one side of the body into small blisters called vesicles. Within a few days the blisters rupture forming scabs. Shingles is associated with severe pain, itching, redness, numbness, and the development of a rash.
Shingles can affect the eyes. This is due to the fact that the eyes are connected to nerves that may be infected with the virus. Early diagnosis and treatment is important to minimize the symptoms and reduce the risk of complications that may compromise vision.
Symptoms Of Shingles
The first sign is often a tingling feeling on the skin, itchiness or a stabbing pain. After several days, a rash appears beginning as a band or patch of raised dots on the side of the trunk or face. It then develops into small, fluid-filled blisters which begin to dry out and crust over within a few days. When the rash is at its peak, symptoms can range from mild itching to extreme and intense pain. The rash and pain usually disappear within three to five weeks.
Causes of Shingles
The pain of shingles is caused by an inflammation of the nerve that lies just beneath the skin’s surface. Shingles originates from the same virus which causes chickenpox. The virus, after infecting the person with chickenpox, retreats to the nervous system where it remains dormant for many years. It reappears in the form of shingles, only if the immune system is weakened, or as a result of a more severe or lengthy illness, extreme stress, or a therapy involving suppression of the immune system. Herpes zoster is common in people with a weakened immune system, such as AIDS patients or people taking anticancer or immunosuppressant drugs. Shingles is more common in the elderly, who tend to have less efficient immune systems. Overall health and nutrition often determine the severity of illness and length of recovery.
Treatment of Shingles
Antiviral Medication : For most patients with shingles, oral antiviral medication should be prescribed for 7 days. The earlier this medication is taken, the better the chance of stopping the virus from causing more damage to the nerves. Early treatment with antiviral medication can lessen the intensity and duration of shingles pain (but, as mentioned above, there is no definite proof that these medications will stop the patient from getting PHN). Once the rash has healed, the patient should stop taking antiviral medication.
Steroids: Some studies have shown that early treatment with a short course (usually 2-3 weeks) of steroids can decrease the intensity and duration of pain associated with acute shingles.
Nerve Blocks: Pain specialists can inject numbing medications (called local anesthetics) directly into certain nerves to help with shingles pain. As mentioned above, these nerve blocks have not been proven to reduce the chances of developing PHN, but nerve blocks may provide good temporary pain relief for the shingles.
Opioid Medication : Opioid medications, such as morphine, oxycodone, codeine, hydromorphone, and methadone, can provide good pain relief without side effects for many patients. In most cases, there should be no concern about developing “addiction” when these drugs are used to treat the severe pain of shingles. Patients can be safely taken off of the narcotic medication if it is no longer needed.
Tricyclic Antidepressantsy : One study has shown that giving tricyclic antidepressants during the early shingles phase can help reduce the pain and help reduce the chance of developing chronic PHN pain. When used in this way, tricyclic antidepressants are not given to treat any kind of depression they are prescribed for pain relief and perhaps to reduce the chance of getting PHN.