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SHINGLES - HERPES ZOSTER

What is Shingles ?

This is a relatively common condition caused by a virus. Herpes zoster or shingles is mainly a disease of adults who previously had chickenpox. It affects the nerves and other tissues of the skin. It is estimated that in Western Europe up to one in five adults suffer from shingles at some time during their life, usually just once. The condition usually starts with a mild fever and pain in the areas connected with the affected nerve. Four to five days later, a skin rash appears usually on one side of the trunk or face. The rash consists of blisters on a red area of the skin. These fluid filled blisters on the skin later form scabs which drop off in two weeks. The disease will tend to be more severe if your body defences against infection are poor, for example in the elderly. Usually the condition clears in a month but some patients may suffer from pain for more than two months after the beginning of the disease. In severe cases, sleep may be disturbed and you may feel depressed. You may also have fatigue and muscle weakness. Sometimes the disease may involve the cornea at the front of the eye. This can affect the eyesight. In some people, the disease may last longer than a month and these people often have continuing pain. This is called “post herpetic neuralgia and is more common in the over 60s. Shingles cannot be passed on to others as shingles, but it is possible to catch chickenpox from someone suffering from shingles. Laboratory tests are not usually needed to diagnose the illness.

How does Shingles occur ?

The virus is thought to remain hidden in the nerve after an attack of chickenpox which had occurred many years previously. When the virus travels from the nerve hideout to the skin and multiplies there, it then causes the skin problems.

Why does Shingles occur ?

The body's defence against infection are reduced as people live longer. This makes the elderly more likely to get the infection. The exact way this happens is not known. There are many other conditions which weaken the body's defences. The doctor may test for these disorders.

Treatment involved for Shingles

The treatment depends on the severity of the disease, your general health as well as your age. If you are under 60 and if your attack is mild then all you may need is some simple pain relief such as aspirin, paracetamol or codeine. Calamine lotion put on the rash may help. In severe cases, or if you are over 60 and your general health is poor you may be prescribed an antiviral drug such as acyclovir. If given within 72 hours of the first symptoms, it may help to shorten the illness and make it less severe. If the eye is affected, the doctor may refer you to an eye specialist. The cornea of the eye is particularly susceptible and could be damaged if the eye problem is not carefully treated. If you are elderly, some doctors may prescribe antidepressant drugs (the tri-cyclic group). This is because these drugs may reduce the length of time the pain lasts. In the condition known as post herpetic neuralgia, drugs used for epilepsy have sometimes been found to help the pain.

During treatment for Shingles

The blisters usually take 2 weeks to heal. They may last longer, with more severe illness, in people with reduced body defences to infection. Infection of the blisters with bacteria may occur. This may require other antibiotics to be used.

After Treatment

It quite often happens that the pain of shingles lasts for many months after the rash and blisters have completely healed, due to damage to the nerves. This is post herpetic neuralgia and is more common in those over 60. The pain can be very wearing and can get you down quite badly. In this case, antidepressant drugs or drugs for epilepsy may be prescribed. If you continue to have pain, your doctor may refer you to a pain relief clinic. It is important to let the doctor know if the pain relieving tablets are not working: do not just put up with it.

If Shingles is left untreated

The rash clears up in most healthy patients. Treatment is mainly directed at pain relief.

Effects on the family of Shingles

People with shingles may be in a great deal of pain. They may require considerable support from family and friends. It is possible to catch chickenpox from somebody suffering from shingles, so that you should try not to let anyone else, particularly children, come into contact with the affected areas. Remember that you can also spread the virus with your hands if they have touched the open blisters. Once the skin has healed, there is no further risk of spreading the infection to others.