Shingles
What is Shingles ?
Shingles is otherwise known as "Herpes Zoster" This is the posh medical name, which whilst being the correct name, is somewhat misleading as contrary to what was thought years ago. The virus that causes Shingles is not a Herpes-virus and is in no way related to any Herpes-virus. However unfortunately we are stuck with the name. The causitive virus is actually the Varicella virus. The same one that causes Chickenpox.
Shingles is a nasty painful skin rash associated with a feverish flu like illness. It is caused by a virus.The rash is unusual in that it affects the area of skin that gets its nerve supply from a particular nerve. Whilst the rash may look odd being a stripe around the chest or abdomen, or a segment of the face. The area anatomically matches the distribution of the particular nerve. Usually onle one side is affected.
Before shingles appears the person will often experience some pain or burning sensation in the area that will be involved, however at this stage there is nothing to see. The feverish flu-like symptoms usually come next then the rash. First of all there are sherply demarkated red patches, these may be tender or there may be altered skin sensation. Over the next few days the red patches will become raised, then will blister. Eventually the blisters burst and dry leaving a painful scabby mess after about ten days. The rash resolves over the next 2-3 weeks though it frequently leaves a permanent mark with de-pigmented skin. As the rash resolves, so usually does the pain though this may not be complete and severe pain can persist long after the rash has gone ( or may be permanent) This is known as Post Herpetic Neuralgia.
How do you catch Shingles ?
The smart answer to this is that you don't catch it. When a person catches Chickenpox, despite the disease going away the Varicella virus that causes it stays with you. It takes up residence in the nervous system, shielded from the immune system it lies dormant in the nerve cells of one or more nerves. It stays here doing no harm for the rest of your life. Bearing in mind how common Chickenpox, it follows that there are very few adults who do not have the virus tucked away in a nerve somewhere.
Years later for some reason the imunity to the virus gradually wanes until a point is reached when the virus can re-activate. Usually it is some other illness that makes the immune system drop its guard, a severe infection or a cancer ( often as yet un-diagnosed).
When the virus re-activates it causes an inflammation in the nerve cells that it is in ( hence the pain) and then passes along the nerve fibre to the skin that nerve serves, where it causes the rash. Post Herpetic Neuralgia happens when the nerve inflammation persists.
As it is a re-activation of the Chickenpox virus that is already present, you do not catch Shingles. However a non-immune person can catch Chickenpox from a person with Shingles.
So, for a person to develop Shingles they MUST have had Chickenpox at some time in the past. Usually the Chickenpox was many years previously, immunity wanes with old age, so older people are more at risk. However anybody who has had the Pox can get Shingles. Whilst unusual, it is not unheard of for young children to develop Shingles. Particularly if they have to have immune supressive drugs ( Steroids, Cancer chemotherapy) or a severe illness. Also it is possible to get Shingles more than once though this is very unusual. Provided that enough years elapse after the first episode, the immunity may wane again by the time old age is reached allowing a second re-activation of the virus.
Treatment
There are specific anti-viral drugs that will target the Varicella virus. These include Acyclovir, Famcyclovir and Valcyclovir amongst others. These drugs are very effective if started in time. If treatment is started as soon as any sign of the rash develops, then the Shingles will be much milder and shorter in duration than it would have been. If treatment is really quick off the mark the attack may be aborted altogether.
Shingles whilst being a nasty painful condition, is not life threatening, so what can be acheived with treatment is limited if looked at just in terms of the acute symptoms. However there is evidence that patients treated with an anti-viral drug are less likely to develop Post Herpetic Neralgia (PNH). PNH can be a constant severe pain, unrelieved by any sort of conventional pain-killer, people have been known to be driven to suicide.
If even one case of PNH can be prevented, then treating the other 99.9% of cases is worthwhile, even though nobody else actually benefits from it.
As well as anti-viral treatment, most patients will need a painkiller. Unfortunately because the pain is generated from inflammation of the nerve, traditional painkillers are of limited use, however the pain is bad and they help a bit. Most people with Shingles will gladly take anything that may help a bit with the pain. Anti inflammatory drugs such as Diclofenac are worth a try. Sometimes they help, sometimes they done. However nothing is lost by trying.
Once the skin blisters have burst and the rash is a bit of a soggy mess, applying Calomine Lotion can help it to dry and crust. Unfortunately, apart from this , there is not a whole lot that can be done to help. It is often just a case of tea and sympathy whilst the poor sod gets through it.
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Complications
People who get Shingles are frequently old, frail and with other medical problems. The Shingles can just be one illness too far and they end up being overwhelmed by it. So whilst not technically correct one could regard death as a complication.
Post Herpetic Neuralgia. As described above, this is a debilitating, distressing problem, and the chronic often severe pain takes over peoples lives. Sufferers do suffer, and can think of little else but the constant pain. There is nothing that they can do or not do that gives them any sort of relief from the pain. With such a condition it is perhaps not suprising that many people are driven to suicide as they can no longer stand the pain with no hope of its going away.
If Shingles affects the face this can be nasty. If the upper segment of the nerve to the face is involved then the skin rash will include the eye. In particular it is the cornea, (The clear front of the eye ) that is affected. This can result in scarring of the cornea with resultant loss of sight. It is obvious that the eye is involved as it goes bright red and is incredibly painful. This is an emergency situation and to save the sight it is essential that the person is seen by an eye specialist without delay. This normally means calling the on call " duty" Opthalmologist. Promp anti viral and anti inflammatory treatment directly into the eye can avert damage to the sight.
