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“In Jerusalem, it was reported that Premier Golda Meir is over the worst of her shingles at-tack she suffered three weeks ago, but still has an irritating rash on her midriff. Doctors from as far away as California and Italy have offered diagnostic consultation to Mrs. Meir’s physi-cian and, according to the Jerusalem Post, sympathizers have been sending her medical advice and remedies for shingles through many Israeli embassies abroad.”
– New York Times, January 24, 1975.
hingles is an inflammation of a nerve that causes pain, itching, a rash, or all three. It affects an estimated 1.2 million people in the United States each year, usually in people aged fifty or older.
The word shingles comes from the Latin cingulus meaning a girdle. It has been known from biblical times as the creeping eruption that girdles the body.
Shingles has nothing to do with “nerves” in the emotional sense. You might hear someone say, “Oh! She’s a nervous wreck. That’s why she came down with the shingles.” Nonsense. Because shingles affects a nerve, many people mistake this to mean that it is a nervous condition.
The condition has affected its share of celebrities – the late Golda Meir, Arthur Rubinstein, and President Nixon immediately come to mind – and that notoriety also has led to many miscon-ceptions about it.
A virus causes shingles, the technical name for which is herpes zoster. It’s the same virus that’s responsible for chicken pox; it actually represents a reactivation of latent chicken pox viruses from an earlier infection. The virus remains in a quiescent state in certain nerve cells in the body and then reactivates, causing shingles. About twenty percent of those people who had had chicken pox will get shingles at some time in their lives.
No one knows why the virus “awakens” to cause shingles, but the prevailing theory is that there may be a temporary deficiency in the body’s ability to fight off disease, such as may occur dur-ing periods of physical or emotional stress. This allows the shingles virus to proliferate and set up housekeeping along the nerve fibers toward the skin. Newborns, people taking cortisone-like drugs for long periods, and those who have diseases that weaken the body’s immune system – such as AIDS – are highly susceptible to the shingles virus. Chemotherapeutic agents, radiation therapy, and drugs to prevent rejection of transplanted organs may also lower immunity to precipitate shin-gles.
Like chicken pox, shingles is usually a once-in-a-lifetime condition. Unlike chicken pox, however, it is only slightly contagious.
Although shingles can affect any age group, it’s more prevalent and more painful in older people. And since shingles can attack any nerve, no area of the body surface is immune. Depending upon the severity of the pain and the location of the nerve involved, one can mistake shingles in its early stages for attacks of appendicitis, kidney stones, gall-bladder trouble, pleurisy, and even facial neuralgia and toothache.
The virus of shingles attacks a nerve root in the brain or spinal cord and follows the course of that nerve only. Early symptoms include a feeling of fatigue, headache, a slight fever, and a mild drawing pain over the involved area. The pain characteristically involves only one side.
The infected areas of the skin become red and itchy, and a rash, made up of small blisters, often follows, usually in groups, along the path of the affected nerve. These blisters last for about two weeks and then rupture, forming crusts and scabs that slowly heal.
Because each nerve extends to a very specific part of the body on either the left or right side, the blisters usually have a ribbon-like or branching configuration, forming a band like semi-circle on one side of the body.
In children and young adults, shingles usually runs a mild and quick course, and the average sufferer will recover without any therapy. In older people, however, the pain may be excruciating, the itching may be intense, and the blisters may become crusted and infected.
Complications can arise from even the mildest form of shingles, so it is important that a physician examine any suspected case. Your doctor can prescribe various internal medications, such as antibiotics, cortisone-like drugs, analgesics and antihistamines, to relieve the pain, itching and in-flammation, as well as soothing salves and ointments to relieve the dermatitis and possibly prevent spread of the disease.
When shingles involves the eye, you should consult an ophthalmologist (a physician who specializes in diseases of the eye) to prevent severe damage to the cornea. Arthur Rubinstein, one of the century’s greatest pianists, had to retire from the concert stage in 1976, when an attack of shin-gles left him nearly blind.
Other complications of shingles that may occur are scarring where the blisters had been, extreme fatigue and malaise during the period of recovery, and persistent dull or severe pain (postherpetic neuralgia) that may linger for months or longer after the rash has disappeared.
Occurring in more than half the patients over the age of 50, this oftentimes exquisite pain that follows an episode of herpes zoster, can be extremely disabling. A variety of attempts to control or reduce this relentless torment has met with variable success. A topical medication, capsaicin, of-ten helps in relieving some of this distressing symptom. This over-the-counter product, called Zos-trix, should be applied 3 or 4 times a day, with relief of the pain anticipated in about 2 or 3 weeks. It should be continued for a period of several months, and for those who have been suffering from chronic pain, treatment over several years should be expected.
While there are no cures, as such, for shingles, many dermatologists have been prescribing any of three different antiviral medications to reduce the pain, to shorten the duration of the infec-tion and, possibly, to diminish some of the complications. These oral medications are acyclovir (Zovirax), famciclovir (Famvir) and the newest “kid on the block,” valacyclovir (Valtrex). Some dermatologists will often give a “cortisone” injection if the symptoms are relatively new. This, cou-pled with one of the oral medications, will frequently provide quick relief of the pain and itching.
It has also been shown that if valacyclovir (Valtrex) is given early enough – within a few days of the symptoms – the incidence of postherpetic neuralgia will be diminished.
One of the latest methods being used for relieving postherpetic pain is injecting the affected areas with European honeybee venom.
There are no measures known to prevent shingles. You may save yourself some worry, however, by avoiding direct contact with someone who has shingles. If you are older, and therefore more susceptible to shingles, you should also avoid young children who have chicken pox. Doctors will sometimes prescribe injections of gamma globulin for patients who are otherwise very ill and who have been exposed to persons who have either chicken pox or shingles.
If you do have shingles – some dermatologists call this “second-time” chicken pox – re-frain from contact with infants and children who have never had chicken pox, and avoid people who are undergoing chemotherapy.
Shingles almost always limits itself to one side of the body. So, if you have a rash on both sides, chances are that shingles is not the culprit.
Some advice for those who have shingles:
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For more information about shingles, contact VZV Research Foundation 40 East 72nd Street – New York, NY 10021 www.glaxowellcome.com www.healthylives.com or www.aad.org 1-888-462-DERM x22 |
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| TREATING SHINGLES |
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For the early, blistery rash, use soothing compresses to help relieve the inflammation, control the itching, and dry up the blisters. Follow the directions for applying compresses using the following:
Domeboro or
BluBoro Powder
Directions for use are on the package.
After using the compresses, and when the blisters have begun to dry up, use either of the following anti-itch medications whenever necessary:
Cort-Aid Cream
Cortizone 10
Quitch
Directions for use are on the containers.
If the itching persists, take either of the following antihistamines every 4 hours as necessary.
Chlor-Trimeton
Benadryl
See directions and cautions on the labels for proper dosage.
For the severe pain of post-herpetic neuralgia, try Zostrix and use according to directions on the package
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