What is Shingles? Causes, Symptoms and Treatment
Shingles is an acute, painful inflammation of the nerve ganglia, with a skin eruption, often forming a girdle around the middle of the body.”
What Causes Shingles?
Shingles is a condition caused by the herpes varicella-zoster virus, also known as the zoster virus. The zoster virus is the same virus that causes chickenpox (the herpes varicella zoster virus is different to genital herpes, which is caused by the herpes simplex virus).
The term “shingles” comes from the Latin word “cingulum” which means belt or girdle, due to the belt-like pattern of the shingles rash.
Most of us get chickenpox as children, what we don't realize is that the virus that causes chickenpox does not entirely go away. Some virus particles remain in the nerve root, next to the spinal cord, harmless; the virus lays dormant and inactive after the chickenpox has gone.
The virus is believed to be rendered harmless by the immune system that keeps it under control.
Later in life, however; usually when the body and the immune system has become stressed or weakened, the zoster virus can once more become active. The reason for this is not clear, the reactivation of the virus usually happens years later.
The reactivated virus moves along the nerve to the skin resulting in inflammation of the nerve and area of skin around it to cause Shingles.
Around one in five people will experience shingles sometime in their life, it can happen at any age but most commonly occurs in people over the age of 50. The effects of aging on the immune system may be responsible.
Shingles occur when the body's natural defense, the immune system, is compromised and no longer works efficiently.
Factors that may compromise the immune system include:
Aging, our immune system produces antibodies that help to protect the body from foreign or harmful substances such as toxins, bacteria, and cancer cells. However; our immune system changes with age, it becomes less efficient, leaving the body open to various attack.
HIV/AIDS, sufferers are more than 25 times more likely to get shingles than the rest of the population.
Suppression of the Immune system, shingles is common in people who are undergoing treatment such as, chemotherapy, steroids, or certain drug for the prevention of rejection in organ transplant where around 25 to 45% of people may develop shingles.
Physical and emotional stress, when the body is stressed it produces chemicals that can prevent the immune system from working properly.
Bone marrow transplant, chemotherapy and radiation treatment given before the operation can weaken the immune system to cause shingles
Although it is unusual to have shingles more than once, 1 in 50 people will suffer from this condition two or more times in their life. In most cases, shingles happen for no apparent reason, but can be triggered by an episode of stress or illness.
Is Shingles Contagious?
Someone who has shingles is contagious until the last blister has scabbed over. It is not possible to catch shingles as such, however; people who have never had chickenpox, or the chickenpox vaccine, can develop chickenpox from contact with someone with shingles.
Infection can spread through direct “skin to skin” contact with someone displaying an open blister. Through contact with something containing fluid from blister such as wound dressings, towels, flannels, bedclothes or by inhaling the varicella-zoster virus from the air.
To prevent the virus spreading to people who have not had chickenpox; it is important to refrain from sharing towels or flannels, go swimming or take part in contact sports when shingles rash is infectious.
Most older children and adults should already have immunity to the chickenpox virus, either through immunization or having had the condition.
Chickenpox is very common in childhood, 90% of adults raised in the UK are immune. However; we recently experienced a chickenpox epidemic where all travelers entering the country were urged to get vaccinated against chicken pox.
Before the chickenpox vaccine, 11,000 people were hospitalized each year for chickenpox in the US, with annual deaths of 100. Getting the chickenpox vaccine is safer than getting chickenpox or shingles.
Barbara Walters famously caught chicken pox after a New Year's kiss with an old friend, actor Frank Langella.
Mr. Langella, an aging actor, who would later develop a severe case of shingles, were unaware of his condition at the time.
Barbara Walters was subsequently hospitalized after fainting and hitting her head on a marble floor. The actress suffered a concussion and realized that she also happened to have chickenpox that she had never had before.
Symptoms of Shingles
An episode of shingles typically lasts about three to four weeks. The first sign of the condition begins with pain and the unusual sensation known as paresthesias; a sense of tickling, tingling, itching, burning in the area that is affected. Paresthesias sensation is typically followed by a rash that changes to form blisters.
Rash or reddening of the skin becomes blistered and ulcerated within three to four day. The area of ulceration can become infected with bacteria, which can delay healing, this complication happens in 2% of cases.
In people with a healthy immune system; the ulcers will form a crust and are no longer infectious after 7 to 10 days. The rash often disappears within three to four weeks. However; the scarring and discoloration of the affected skin may persist for much longer.
Although the abdomen and chest are the most common areas affected; shingles rash can appear on any part of the body including the face when a rash occurs close to the eyes it can seriously affect vision.
Shingles can cause early symptoms lasting from one to four days before a rash appears, they includes:
Myalgia or muscle pain
A fever or high temperature of 38C or over, (this is uncommon)
A feeling of being unwell
Postherpetic neuralgia (PHN) is the most commonly occurring complication of shingles. Patients often described PHN as burning that can be mild to severe. PHN affects 10 to 15 percent of shingles sufferers, around half are older than 60 years of age. The nerve pain can last for more than three months after the rash has gone.
Treating the Rash
There is no cure for shingles, but good management and early treatment can relieve the symptoms:
Reduce risk of infection by keeping rash as clean and dry as possible
Use non-adhesive dressing that will not stick to the blisters, this will also lessen the risk of passing the virus to others
Do not use topical antibiotics or plasters, they can prolong healing
Contact doctor, Although the symptoms of shingles are often mild in the initial stage, medical intervention should be as soon as possible; preferably, at the first sign of the condition. Early treatment with antiviral medication can help to prevent the shingles virus from multiplying. It reduces the risk of complication and pain during the active stage of shingles. Early treatment is especially relevant where the face and eyes are affected.
The wearing of loose-fitting clothes may help to reduce irritation from the rash to maintain comfort. Calamine lotion will contribute to cooling and soothing the skin and can be used to relieve itching as will antihistamine medication. However; before taking medications please read the manufacturers instruction or seek advice from the pharmacist.
Doctor may prescribe medicine for pain including-:
Anti-viral, such as Zovirax, Famvir, or Valtrex
Paracetamol, available without a prescription, read instruction carefully
Non-steroidal anti-inflammatory drugs (NSAIDs), e.g., ibuprofen, avoid in cases of stomach, kidney, or liver problems, gastric bleeding or peptic ulcers, asthma or airway and breathing conditions, pregnancy or breastfeeding. Always check with doctor or pharmacist when in doubt.
Opioids, such as codeine may be prescribed by doctors in conjunction with paracetamol
antidepressants and anticonvulsants may be used in cases of postherpetic neuralgia.
Treatment for pain can also be in the form of:
Transcutaneous Electrical Nerve Stimulation (TENS)
Diet rich in lysine such as meat, fish, cheese, sardines, eggs, soybeans and various legumes may help to prevent an attack of shingles.
Essential vitamins to boost the immune system and manage shingles includes:
Vitamin B12, study shows this to be useful in the treatment of shingles, when given intravenously or intramuscularly, it goes to the nerve root to attack the virus.
The doctor should be contacted at the first sign of shingles, always discuss treatment and medication including vitamin therapy.
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© 2013 Jo Alexis-Hagues
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