The burning, itching, tingling shingles

SHINGLES, also known as herpes zoster, is a painful skin rash caused by the varicella zoster virus, the same virus which causes chicken pox.

Internist Dr Lori-Mae Fisher explained that the term shingles derives from the Latin “cingulum” which means girdle, and the disease was so named because the rash of shingles occurs in a band or belt-like pattern on the skin.

She pointed out that shingles is common, with up to a third of people developing the condition in their lifetime, and said that the disease affects people of any age. She, however, said it is more common in those over age 50 and in people whose immune system is weakened.

Dr Fisher said after an episode of chicken pox, the varicella zoster virus retreats to cells of the nervous system where it eludes destruction by the host and remains dormant for years.

But later in life, or if the immune system is compromised, the virus becomes active again and causes shingles.

“Shingles begins often with burning, itching or abnormal sensations such as numbness or tingling (paraesthesias) in an area of skin on part of the body. Pain can occur early in the disease course and can be mild to severe. It is usually limited to the area of skin affected,” she said.

“Some people will develop fever, headache, and some may feel unwell. Within one to two days a blistering rash will occur in an area of skin. The chest, upper and lower back are usually affected but it can occur on the face. If it occurs near the eye it can permanently affect vision. Within three to four days, the shingles blisters can become open sores or ‘ulcers’.”

She explained that these ulcers can sometimes become infected with bacteria. In individuals with a healthy immune system, the sores crust over and are no longer infectious by day seven to 10, and the rash generally disappears within three to four weeks. Scarring and changes in skin colour may persist long after shingles has resolved.

Of note, the internist said it is impossible to get shingles from another person, but one becomes infected with the varicella zoster virus from exposure to people with shingles. The virus can be transmitted by skin-to-skin contact with the rash or can be inhaled in the air. As a result, she said if a person has never had chicken pox or the vaccine, exposure to a person with shingles can lead to chicken pox.

Further, Dr Fisher said in most individuals shingles runs its course without any lasting health problems. But the condition can be associated with complications.

“These complications include Postherpetic neuralgia which causes long-standing pain or abnormal sensations months to years after the rash develops, eye inflammation (herpes zoster ophthalmicus) and skin infections,” she said.

In relation to treatment, Dr Fisher said shingles is treated by a combination of therapies which include antiviral medications and pain relieving medications such as acyclovir, valacyclovir and in the event of pain after the rash and blisters, medications such as amitriptyline, gabapentin (neurontin), or pregabalin can be used.

With regard to prevention, Dr Fisher said shingles can be prevented through vaccination.

“In people over age 50, this vaccine is recommended to reduce the chance of developing shingles. If shingles occurs after vaccination the disease is less severe and the chances of developing Postherpetic neuralgia are far less. The vaccine is in two formulations — one with a single injection, or the other which requires a booster injection six months after the first,” she said.