Shingles – Symptoms, Causes and Treatments

Shingles (herpes zoster) is a painful rash caused by the reactivation of the chickenpox virus.

The first sign is a sensation varying from a tingling feeling to a severe pain or a burning sensation on the skin, limited to the body area where the rash will appear. This can be anywhere, but it mostly occurs somewhere on the trunk (chest, abdomen, back).

Who’s at risk?

  • People who have had chickenpox.
  • People over the age of 50 who have had chickenpox.
  • Babies born to women who have chickenpox during pregnancy will have shingle in the first two years of life.
  • People with compromised immune systems brought on by diseases such as HIV or diabetes.
  • People with elevated levels of stress or trauma.
  • People taking medicines to reduce the effects of tumor necrosis factor.
  • Babies who get chickenpox in the first year of life.
  • Cancer patients and those on cancer treatments.

Prevalence

Shingles incidence in Australia has doubled over the past decade, and a high proportion of people who attend pain clinics at large hospitals attend because of post-herpetic neuralgia (nerve pain following shingles), according to virology experts at Sydney’s Institute of Clinical Pathology and Medical Research.

Local hospital emergency departments have also reported between two and six percent increases in shingles cases every year.

Causes

The culprit is a germ called the varicella zoster virus (VZV), the chickenpox virus. When it first enters the body, as it does in the case of 90 percent of all children, it leads to chickenpox. But the body is never totally rid of VZV, which belongs to a family of viruses known as the herpes viruses that become latent in their host after causing the first infection.

Herpes viruses manage to hide in certain types of nerve cells near the spine and brain. They lie dormant, literally for decades, because chickenpox is a childhood disease and shingles occurs mostly among people over 50. When the virus is reactivated it will cause shingles, not chickenpox.

Why the virus reawakens after so many years is not exactly known. In clear-cut cases, the virus reappears in people with leukaemia, HIV/AIDS and chemotherapy patients because of the weakening of their immune systems.

But generally shingles is ascribed to the weakening of the immune system that accompanies old age and poor diet. It has also been linked to stress, emotional trauma and injuries to the spinal cord – or it may follow a serious illness.

Symptoms

  • A general feeling of discomfort, itchiness and a slight fever.
  • Pain, which can be very intense, on one side of the body. It is sometimes felt in the chest and could be mistaken for a heart attack.
  • Within two to three days after the first pains, a rash appears in a horizontal “belt” of reddened, inflamed skin. Small blisters appear, resembling chickenpox.
  • The rash lasts for 10 to 14 days before the blisters, which have filled with clear fluid, crack and start to heal.
  • Pain can continues after the rash has cleared is symptomatic of post-herpetic neuralgia and varies in intensity and type.
  • Sometimes pain can be a continuous burning or aching, sometimes as intermittent stabbing pains.
  • Pain can be so intense that it leads to depression and suicidal thoughts.
  • In rare cases of post-herpetic neuralgia, damage to the nerves during shingles can also lead to loss of muscle control in the affected area.
  • Although post-herpetic neuralgia mostly lasts for four months, in two to three percent of cases it lasts for more than a year.
  • In rare cases, sufferers live with the pain for the rest of their lives. The older the patient, the worse and the longer lasting the pain tends to be.

Diagnosis

The doctor will look for the signs of shingles as listed under “symptoms”. Usually the diagnosis is made on the grounds of the tell-tale band-like rash.

However, the infection can sometimes manifest in a way that causes some initial confusion. The pains that go along with shingles can be intense and can even be mistaken for a heart attack or backache.

Sometimes the rash never appears, and the patient only suffers pain. In such uncertain cases tests can be done to establish the presence of the chickenpox virus.

The following tests help diagnose shingles:

  • A Tzanck smear of the fluids in the blisters
  • A skin biopsy
  • A blood test

Treatment

There is no known cure for shingles. The virus runs its course and usually disappears after two to three weeks. However, evidence suggests that certain treatments in the first three days after appearance of the virus can significantly reduce the duration and complications involved.

Evidence suggests that treatment with antiviral and anti-inflammatory drugs can shorten the duration of the rash and reduce the severity of post-herpetic neuralgia. Early treatment with antiviral medication such as Famvir or Zelitrex (both available in Australia) may shorten the course of the disease and diminish the severity and risk of post-herpetic neuralgia. Treatment must however be started within three days of the outbreak.

Medication in the treatment of shingles is mostly for the relief of pain for the duration of the rash and the subsequent post-herpetic neuralgia. Always speak to your doctor before self-medicating.

Home treatment

Try the following while the rash is still active:

  • Wear light clothing over the infected skin or keep it open.
  • Wash the area with soap and water.
  • Bandage the area at night to avoid touch irritation.
  • Apply ice to help to relieve itching and burning.
  • Apply a mixture of crushed aspirin and rubbing alcohol to the area.
  • Do not be brake or scratch the blisters.

The following can be tried for post-herpetic neuralgia:

  • Regularly apply Capsaicin cream to prevent nerves from sending pain messages to the brain.
  • Desensitise the affected area with ice or a hard rubbing.
  • Invest in a TENS unit to help alleviate pain. Speak to your doctor about this.

As a last resort, surgery is performed to relieve continuous and unbearable pain. The procedure involves cutting the damaged nerve from the spinal cord so that pain messages can no longer be transmitted to the brain. The procedure is risky and should be considered only as a very last resort.

Supplements

  • Growth of herpes viruses may be slowed by L-lysine. Consider taking an L-lysine supplement that also contains zinc and vitamin C, and at the same time, reduce your intake of arginine-rich foods such as nuts and chocolate. 
  • Echinacea helps strengthen the immune system and may assist your body in fighting infections
  • The antioxidants vitamins C and E and the mineral zinc may also be of assistance.
  • Magnesium helps maintain normal nerve function.

When to see a doctor

A health care professional should be called when you experience any of the following symptoms:

  • Severe pain on one side of the body.
  • A sensitive, tender patch of skin on one side of the body.
  • Small blisters on the skin, resembling chickenpox.
  • An outbreak of shingles that involves your forehead and nose – make sure you are examined by an ophthalmologist to prevent eye damage.
  • Inflammation of the rash and the appearance of red streaks – it could mean that you have contracted a secondary bacterial infection, which requires treatment with antibiotics.

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