Shingles prevention and treatment
Shingles is a painful rash that is caused by Herpes Zoster, the same virus that induces the childhood illness Chickenpox. Eventually, the virus hangs out in the lining cells of the nerves.
By John Brusch, MD, primary care physician and medical director at CHA Primary Care, Cambridge Hospital.
Here, they remain dormant protected from the body’s defenses. For various reasons, the virus can reactivate and damage the nerves in which they reside. Nerves are basically “electrical wires” that carry signals to the muscles as well as a variety of sensations. When their “insulation” is damaged, they “short circuit” resulting in severe pain and loss of function of the organs they supply.
Initial symptoms of Shingles may include itching, burning and severe pain. These symptoms are usually on one side of the body and may be accompanied by a fever. Within two days, blisters appear in the initially affected area of the body. Usually, this is the chest, back or occasionally the face. Pain ranges from mild to very severe and may be described as burning or stabbing. After four days, the blisters ulcerate. In healthy individuals these ulcerations crust over. By day ten, individuals with Shingles are not infectious to others. In uncomplicated cases, the rash and pain clears in around four weeks.
Shingles is far more common among adults, ages 50 and above, and in people who have weak immune systems, such as transplant patients or those with underlying forms of cancer. As many as 30% of Americans will suffer from Shingles at some point in their life and the disease is becoming more common. This may be due to the fact that the vaccine is given to children to prevent Chickenpox results in lower adult immunity to Herpes Zoster.
Complications
Complications may occur in up to 12% of patients. Persistent pain is the most common and it can last for months or even years.
In 2% of patients, the eye may become inflamed resulting in retinal damage and/or drooping of the eyelid. Similarly, various nerves in and around the ear may be impacted. These problems may produce facial paralysis, ear pain and vesicles in the auditory canal or on the earlobe. This can result in an alteration in taste associated with tongue lesions and hearing abnormalities and disruption of balance (vertigo). The ulcerations may be infected by surface bacteria and result in fever or spreading infection of the skin or of the bloodstream.
Treatment
There are a variety of antiviral medications which are effective against Shingles. They appear to be most effective when given within 72 hours of symptoms. Usually, they are given by mouth. For those who have weak immune systems and others with complications, the medications are administered intravenously.
At the first sign of possible Shingles infection, call your health care provider and ask for an evaluation. The sooner antiviral medications are administered, the better the outcome.
Prevention
Herpes Zoster vaccine is recommended for all adults, ages 50 and above. There are two vaccines available. Zostrix has been around for a number of years and appears to prevent Shingles 50% of the time. The vaccine is more effective in preventing complications associated with Shingles, but immunity does decrease in some cases. The other vaccine is Shingrix, approved in 2017, and it has been shown to be effective in the prevention of initial cases and reduces the rate of complications. Shingrix has longer lasting immunity compared to Zostrix.
It is highly recommended that all adults (50+) be immunized. Contact your health care team for specifics. Please note that, due to unprecedented high demand, there have been some shortages of the Shingles vaccines.
Disclaimer
This articles provide general information for educational purposes only. The information provided in this article, or through linkages to other sites, is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider.