Shingles - when chicken pox comes back to bite

By Dr Umberto Russo MBBS, FRACGP 

In my almost thirty years on the road visiting patients at home in the after hours, I can’t tell you how many cases of shingles I have seen. 

Shingles, also know as ‘zoster virus’ or ‘herpes zoster’, is caused by the same virus responsible for chicken pox. It is a skin rash than can be very painful, occurring mainly but not exclusively amongst older adults in the population. It is not understood exactly why, but the chicken pox virus, which lies dormant in all of us who have had chicken pox, will suddenly reactivate in some people for an ‘encore’. And for some people, it can be an extremely uncomfortable and painful encore.

Symptoms of shingles

Normally when I see patients at the beginning of this illness, they will complain of burning, stinging or sensitive skin. This may occur before any rash appears. Some patients feel distinctly unwell, with nausea, headache or fever, chills and body aches all contributing symptoms.

Then, within a day or two, a rash appears, most commonly on the torso of the body, or on the face, but only on one side of the body. This unusual feature is due to the nerve-related aspect of this illness.

The rash develops blisters and can be extremely itchy once the blisters burst. The rash can take from between two and four weeks to heal. The virus is contained in the blisters, so direct contact with the open sores of the shingles rash can pass the virus to anyone who isn't immune to chickenpox.

Contagion

There is often confusion among patients about whether shingles is contagious or not. It is contagious, but only to people without immunity to chickenpox. Once infected, the person will develop chickenpox, however, not shingles.Pregnant women who have not had chicken pox, and babies and young children should avoid contact with the shingles patient.

Treatment

Treatment for shingles includes anti-viral medication, which is most effective if taken within 72 hours of the rash appearing. It can reduce the severity of pain and duration of the condition. I also usually prescribe pain relief if pain is severe.

Some simple home remedies for the painful rash include soothing the affected area with calamine lotion, or bathing in an oatmeal bath. The patient should avoid scratching and of course keep the infected area clean and dry.

Complications from shingles are rare. It can lead to a bacterial skin infection, or the virus can attack the nerves of the face and lead to further complications. Although most people recover within a few weeks, some go on to develop chronic nerve pain called post herpetic neuralgia. This may be severe and can sometimes go on for months.

Vaccines

In Australia, the statistics show that 20-30% of people will get shingles sometime during their lifetime. Most of these people will be in their 50s and above. It is not entirely clear why this virus reactivates in some people but not others. It is believed to be linked to our immune systems getting weaker, either through age, illness or stress.

Shingles is a vaccine-preventable disease. Immunisation against shingles is achieved by a dose of the Zostavax vaccine which can be given to adults 50 years and over. The shingles vaccine is provided free for people aged 70 years under the National Immunisation Program. To receive the immunisation visit your GP.

See your doctor

While it is not life threatening – except in extreme cases – shingles can be extremely painful. It is best to seek prompt treatment from your GP, or, if your GP is closed, by calling 13SICK and arranging an after hours doctor home visit from National Home Doctor Service.

Dr Umberto Russo MBBS (Adelaide) FRACGP is Chief Medical Officer at 13SICK, National Home Doctor Service. He has more than 25 years' experience both as a General Practitioner and a visiting home doctor, with a special interest in urgent medical care.

Sources:
Mayo Clinic (Shingles)
Medicinenet.com (Shingles-Herpes-Zoster)
Australian Doctor (Shingles patient handout)

 

 

 

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