Shingles
Shingles is an infection of a nerve area caused by the varicella-zoster virus. It causes pain and a rash along a band of skin supplied by the affected nerve. Symptoms usually go within 2-4 weeks. Pain sometimes persists after the rash has gone, more commonly in people over the age of 60. Other complications are uncommon. Antiviral medication may be prescribed to limit the severity of the condition.
What is shingles and how common is it?
Shingles is an infection of a nerve and the area of skin supplied by the nerve. It is caused by a virus called the varicella-zoster virus. It is the same virus that causes chickenpox. Anyone who has had chickenpox in the past may develop shingles.
About 1 in 5 people have shingles at some time in their life. It can occur at any age, but it is most common in people over the age of 50. It is uncommon to have shingles more than once, but about 1 in 50 people have shingles two or more times in their life.
How does shingles occur?
Most people have chickenpox at some stage (usually as a child). The virus does not completely go after you have chickenpox. Some virus particles remain dormant (inactive) in the nerve roots next to your spinal cord. They do no harm there, and cause no symptoms. For reasons that are not clear, the virus may begin to multiply again (reactivate). This is often many years later. The 're-activated' virus travels along the nerve to the skin and causes shingles.
In most cases, an episode of shingles occurs for no apparent reason. Sometimes a period of stress or illness seems to trigger it. A minor 'ageing' of the immune system may account for it being more common in older people. (The immune system keeps the virus dormant and prevents it from multiplying. A slight weakening of the immune system in older people may account for the virus 'reactiving' and multiplying to cause shingles.)
Shingles is also more common in people with a poor immune system. For example, shingles commonly occurs in younger people who have HIV/AIDS or whose immune system is suppressed with treatment such as steroids or chemotherapy.
What are the symptoms of shingles?
The virus usually affects one nerve only, on one side of the body. Symptoms occur in the area of skin that the nerve supplies. The usual symptoms are pain and a rash. Occasionally, two or three nerves next to each other are affected. The most commonly involved nerves are those supplying the skin on the chest or abdomen. The upper face (including an eye) is also a common site.
The pain is a localised 'band' of pain. It can be anywhere on your body, depending on which nerve is affected. The pain can range from mild to severe. You may have a constant dull, burning, or gnawing pain. In addition, or instead of this, you may have sharp and stabbing pains that come and go. The affected area of skin is usually tender.
A rash appears 2-3 days after the pain begins. Red blotches appear that quickly develop into itchy blisters. The rash looks like chickenpox, but only appears on the band of skin supplied by the affected nerve. New blisters may appear for up to a week. They dry up, form scabs, and gradually fade away. Slight scarring may occur where the blisters had been.
An episode of shingles usually lasts 2-4 weeks. In some cases there is a rash but no pain. Rarely, there is no rash but just a band of pain. You may also feel feverish and unwell for a few days.
Is shingles contagious?
Yes, you can catch chickenpox from someone with shingles if you have not had chickenpox before. (You cannot get shingles itself from someone who has shingles.) The shingles rash is contagious until all the blisters have scabbed and are dry. But note: most adults and older children have already had chickenpox, and so are immune. Also, if the blisters (vesicles) are covered with a dressing, it is unlikely that the virus will pass on to others. This is because the virus is passed on by direct contact with the blisters. (Therefore, if you have a job you can return to work once the blisters have dried up, or earlier if you keep the rash covered and feel well enough.)
However, as a general rule, pregnant women who have not had chickenpox should avoid people with shingles. (See separate leaflet called 'Chickenpox, Shingles and Pregnancy'.) Also, if you have a poor immune system, you should avoid people with shingles. (See below for a list of people who have a poor immune system.) These general rules are to 'play safe', as it is direct contact with the rash that usually passes on the virus.
Also, to play safe and not risk passing on the virus to others who may not have had chickenpox, you should not share towels, go swimming, or play contact sports such as rugby whilst you have a shingles rash.
Are there any complications from shingles?
Most people do not have any complications. Those that sometimes occur include the following.
Postherpetic neuralgia
This is the most common complication. It is where the nerve pain (neuralgia) of shingles persists after the rash has gone. This problem is uncommon in people aged under 50. However, up to 1 in 4 people over the age of 60 who have shingles have pain that lasts more than a month. The older you are, the more likely it will occur. The pain usually eases gradually. However, in some people it lasts months, or even longer in a few cases. The chance of pain persisting is reduced with treatment. See a separate leaflet called 'Postherpetic Neuralgia' for details.
Skin infection
Sometimes the rash becomes infected with bacteria (germs). The surrounding skin then becomes red and tender. If this occurs you may need a course of antibiotics.
Eye problems
Shingles of the eye can cause inflammation of the front of the eye. In severe cases it can lead to inflammation of the whole of the eye which may cause loss of vision.
Weakness
Sometimes, the nerve affected is a 'motor' nerve and not a usual sensory nerve (ones for touch). This may result in a weakness (palsy) of the muscles that are supplied by the nerve.
Various other rare complications
For example, infection of the brain by the varicella-zoster virus, or a generalised spread of the virus throughout the body. These are very serious, but rare. People with a poor immune system who develop shingles have a higher than normal risk of developing rare or serious complications. (For example, people with HIV/AIDS, people on chemotherapy, etc, - see below.)
What are the treatments for shingles?
General measures
Loose fitting cotton clothes are best to reduce irritating the affected area of skin. Pain may be eased by cooling the affected area with ice cubes (wrapped in a plastic bag), wet dressings, or a cool bath. A non-adherent dressing that covers the rash when it is blistered and raw may help to reduce pain caused by contact with clothing. Oily calamine lotion may be helpful if the rash is itchy.
Painkillers
For example, paracetamol, or paracetamol combined with codeine, may give some relief.
Antiviral medicines
Antiviral medicines include aciclovir, famciclovir, and valaciclovir. An antiviral medicine does not kill the virus but works by stopping the virus from multiplying. It may limit the severity of the shingles episode and may reduce the risk of pain persisting into postherpetic neuralgia. It is most useful when started in the early stages of an episode of shingles (within 72 hours of the rash appearing).
A course of antiviral medicine is often prescribed to adults with shingles when the rash is less than 72 hours old. Even though in many cases the shingles episode is mild, soon goes, and causes no complications, an antiviral medicine helps to prevent the few cases that would have become more severe or developed complications. Basically, the older you are, the more risk of severe shingles or complications developing, the more you are likely to benefit from treatment.
However, many people consult a doctor when the rash is more than 72 hours old. In most of these cases the rash and pain are mild, particularly if you are under 50. It is unlikely that an antiviral medicine taken at this stage will have much effect, and is not usually advised. However, antiviral medication may still be advised in the following situations, even if started more than 72 hours after the rash started. In these situations, even a delayed course of medicine may have some effect. That is, if:
shingles affects your eye or inner ear.
you have a poor immune system.
you have a severe, extensive rash.
you are elderly.
Antiviral medicine is not usually prescribed to children with shingles who are otherwise healthy as severe shingles and complications in healthy children are very rare.
Antidepressant and anticonvulsant medicines
if the pain during an episode of shingles is severe, or if you develop postherpetic neuralgia, you may be advised to take:
an antidepressant medicine in the 'trycyclic' group. An antidepressant is not used here to treat depression. Tricyclic antidepressants such as amitriptyline, imipramine, and nortriptyline ease neuralgia (nerve pain) separate to their action on depression. OR:
an anticonvulsant medicines such as gabapentin and carbamazepine. They also ease neuralgic pain separate to their action to control convulsions.
If an antidepressant or anticonvulsant is advised, you should take it regularly. It may take up to two or more weeks for it to become fully effective to ease pain.
People with shingles and a poor immune system
If you have a poor immune system (immunosuppression) and develop shingles, then see your doctor straight away. You will normally be given antiviral medication whatever your age, and will be monitored closely for complications. People with a poor immune system include:
People taking high dose steroids. (This means adults taking 40 mg prednisolone (steroid tablets) per day for more than one week in the previous three months. Or, children who have taken steroids within the past three months, equivalent to prednisolone 2 mg/kg per day for at least one week, or 1 mg/kg per day for one month.)
People on lower doses of steroids in combination with other immunosuppressant medicines.
People taking anti-arthritis medicines that can affect the bone marrow (for example, adalimumab, anakinra, azathioprine, ciclosporin, cyclophosphamide, etanercept, gold, infliximab, leflunomide, methotrexate, penicillamine, sulfasalazine).
People being treated with chemotherapy or generalised radiotherapy, or who have had these treatments within the past six months.
People who have had an organ transplant and are on immunosuppressive treatment.
People who have had a bone marrow transplant and who are still immunosuppressed.
People with impaired cell immunity (for example, severe combined immune deficiency syndromes, DiGeorge syndrome).
People with HIV infection who have symptoms, or have a low
2007-10-23 03:44:20
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answer #10
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answered by Anonymous
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