Have you or someone you know ever had shingles? Up to 20% of people get shingles at some point during their lifetime, so it is a good idea to know something about this painful disease.
What is shingles? And where did the name come from? Shingles is certainly a strange name for a medical illness!
What is shingles?
Shingles is a disease that causes a painful, blistering rash along the path of a body's nerve. Often the rash is on the chest or back. The medical term for shingles is Herpes Zoster. It is caused by virus known as varicella-zoster, the same virus that causes chickenpox.
The varicella-zoster virus is rather unusual. After someone has chickenpox, the varicella-zoster virus becomes "dormant" and stays quietly in the body's nerve tissue. Years or decades after the chickenpox infection, the virus may reactivate. The cause for the "reactivation" is usually not clear. Only people who have had chickenpox (which includes over 90% of adults in this country) can get shingles.
Where did the name come from?
The name "shingles" comes from the Latin word "cingulum," which means belt or girdle. Many times the rash of shingles encircles part of the body like a band orÂ belt, which is how it got its name.
Who gets shingles?
It is estimated that there are about one million cases of shingles in this country each year. Anyone, including children, can get shingles if they have had chickenpox. But it is much more common in older people. About half of all cases in this country occur in people over the age of 60. If you live to age 85, you have a 50/50 chance of getting shingles.
Besides advanced age, other risk factors for shingles include conditions that cause a weakened immune system such as HIV infection, cancer, and taking certain drugs including chemotherapy medicines and immunosuppressive drugs. Still, most people who get shingles are healthy.
What are symptoms and signs of shingles?
Usually the first sign of shingles is a tingling sensation or burning pain of the skin on one part of the body, on one side only. Sometimes you also get a fever and feel sick. One to three days later, a blistering rash appears in the affected area. The blisters follow along the path of a nerve on that side of the body. The pain usually comes before the rash. This makes it difficult to diagnose at the early stages, before the rash is present.
The rash can be painful, it may be severe, and may last for weeks. The blisters gradually crust over and heal, and the rash usually disappears within four to six weeks. Unfortunately, the pain may last long after the rash heals. This is known as "postherpetic neuralgia".
Are shingles catching?
You cannot "catch" shingles from someone else with shingles. However, people who have never had chickenpox can get chickenpox after direct contact with a broken shingles blisters. If someone has had chickenpox, there is no risk. Once all the blisters are crusted over, the virus can no longer be spread to someone else.
About 10% of people with shingles develop a complication. Postherpetic neuralgia, or long-lasting nerve pain, is the most common complication. Generally the pain gradually lessens, but it may last for years after the rash disappears, and it can be quite severe. It is more common in the elderly patients.
If shingles affects the face, it can lead to eye complications and vision loss. If you have shingles on your face, see your doctor right away.
Treatment of shingles
There are a number of treatments available for shingles. Usually antiviral medicines (such as Famvir, Zovirax, Valtrex) are used to limit the spread of shingles, speed healing, and reduce the pain. The medicines are most effective when started early, within 3 days of the onset of symptoms. But their benefits are limited. Sometimes doctors prescribe steroids as well.
Pain medicines may be needed to treat the pain during the attack. If someone has postherpetic neuralgia, other medication may be required to control symptoms. Medicines such as neurontin, elavil, lyrica, and tegretol are often used. Sometimes doctors also recommend a cream made from hot chili pepper, called capsaicin cream, or Zostrix. This can help reduce the pain of postherpetic neuralgia. You must wait until all the blisters are healed before trying capsaicin. A similar approach is the use of a lidocaine pain patch applied directly on the painful skin. Lidocaine can temporarily numb the nerves affected by shingles.
In addition to these medications, some people find that acupuncture can help the pain following a shingles attack.
Vaccine for shingles
There is now a vaccine available to reduce the likelihood of developing shingles. This vaccine appears to cut the chance of getting shingles by half. It also reduces the severity of infection for people who get the vaccine and do develop the disease. The vaccine is currently recommended for adults over age 60 who have never had shingles. It is not recommended for people whose immune systems are impaired. You should speak with your doctor if you think the vaccine would be appropriate for you.
Hopefully you will never get shingles. Perhaps you are someone who should get the vaccine to reduce your chances of getting a shingles attack. Check it out!
Have you ever had shingles or known someone who did? How was it treated? Let me know what it was like and what worked.
Diana Post, M.D.,Â is an Assistant Professor of Medicine at Harvard Medical School and a
practicing internist at Brigham and Women's Hospital in Boston, MA. She is also a rheumatologist.