“Shingles” is the name of the painful rash many people get as they get older and their immunity wanes. The rash is characterized by tiny blisters on red skin that usually occurs on one side of the body in a band-like distribution. The rash is often preceded by a 1-2 day period of intense, burning, sharp pain in the area where the rash will develop. Many people will mistake the pain as pain from muscle strain, heart attack (angina), gallbladder attack, appendicitis or kidney stones. Once the rash develops, the blisters will eventually dry up and the redness will disappear in approximately 10-14 days. The pain of shingles may last as long as the rash is present, may disappear once the rash appears, or may persist after the rash is gone. When the pain persists longer than 4 weeks after the rash is healed, the pain is called post-herpetic neuralgia. This pain can be very debilitating. It is often described as a constant burning, knife-like, throbbing, or aching sensation. It adversely affects people’s ability to move, think and sleep. Post-herpetic neuralgia can lead to depression because the pain and condition is not curable; available medicines may decrease the severity of pain periodically.
The virus that causes “shingles” is the herpes virus responsible for chickenpox. One someone contracts chickenpox, the virus travels along nerves and becomes dormant in the dorsal root (sensory) ganglia of the spinal cord. When the body is “stressed”, either by an illness, medication, emotional stressor, or physical trauma, the virus may be re-activated and travel along a nerve supplying a dermatome of skin and cause pain and a rash. Once someone experiences shingles (also known as herpes zoster,) the virus becomes dormant again. Unfortunately, the virus may re-activate more than once during a person’s lifetime. It may affect more than one dermatome, causing pain and rash in different areas of the body. When shingles occurs in specific facial nerves, it may cause blindness, deafness and diminished taste sensation.
The treatment of shingles begins with prompt and accurate diagnosis of herpes zoster. When anti-viral medications, such as acyclovir and famcyclovir, are started during the first 72 hrs of the illness and continued to for 7-10 days, the duration and severity of rash will be reduced. These medications will not stop the pain or keep the rash from forming. They will also not prevent post-herpetic neuralgia from developing. Tricyclic antidepressants (Elavil), topical anesthetics (lidocaine or capsaicin) and/or narcotic analgesics can be used to limit the pain. If post-herpetic neuralgia develops, antidepressant, anti-seizure, topical anesthetics and nerve blocks may be used to lessen the pain. The pain of post-herpetic neuralgia often requires the use of many treatment modalities, including chronic pain counseling and biofeedback, to help people cope with this chronic condition.
The best way to prevent herpes zoster from developing is keeping the immune system healthy and strong.