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Shingles: What it Is and What it Isn't and How Its Treated

One doctor reported a patient with shingles he evaluated in the emergency room. The man had intense chest pain on his left side. The patient was a heavy man with high blood pressure. He was convinced he was having a heart attack. He described the pain as intense and throbbing. The doctor gave this man the typical medications for angina (pain experienced from a heart attack), and the medicines did not work.  He then admitted the patient to evaluate him for a heart condition. But the next day, in the exact location of his chest pain, the patient broke out with a striped cluster of painful blisters. He never had a heart problem. He had shingles.


What Exactly is Shingles?


Shingles is a painful condition caused by the varicella zoster virus. Varicella is the organism that causes chicken pox when it first infects a person. The typical presentation of chicken pox is a systemic illness, often with fevers or cough, and widespread blisters that are intensely itchy. However, unless it becomes severe and leads to meningitis, chicken pox resolves on its own and almost always is without recurrence.
In some cases, the virus that causes chicken pox takes up residence in a structure called a nerve cell body. After entering this structure, the virus typically lays dormant and causes no symptoms. This latency can last months, years or even decades.  For some people, the virus never does come out of hibernation. But for others it does.


What Triggers Shingles?


Any number of factors can trigger an episode of shingles.  Stress.  Fevers.  Other infections.  Sunburn.  Trauma.  And sometimes it just happens. When it does, the varicella virus comes out of “hiding” from the nerve cell body and generates an outbreak of painful skin lesions. The lesions are typically confined to the section of skin whose sensation is controlled by that particular nerve.


Our body’s skin sensation is enabled by sensory nerves that exit the spinal cord. The spinal cord’s nerves branch off like branches on a tree. Each nerve is responsible for a separate strip of skin. In a sense, if each nerve root distribution was color-coded we’d look like zebras. Those particular strips of skin are known as dermatomes. It is within a dermatome that a shingles outbreak occurs.


How do I Know I have Shingles?


The most common pattern of symptoms during a shingles outbreak is pain that precedes skin lesions. A sensation of burning or aching often starts first.  Then, a day or even a few days later, an eruption of skin lesions follows. The lesions are small blisters, usually the size of raindrops, sitting on top of a tender, red patch of skin. They develop in the form of a stripe or band. The pain usually persists when the lesions are present. Sometimes the pain can be so intense that literally the pressure of light clothing or even blowing wind can be excruciating.


Does Shingles Hurt Forever?


Most of the time the skin lesions associated with shingles will dry up, and within a month, the pain resolves. Unfortunately, there is the possibility of recurrence, as once the varicella virus has taken up residence in a nerve body, it never leaves. In some cases, however, the pain does not resolve either.  This is a stubborn condition known as postherpetic neuralgia.


Studies have shown that the likelihood of developing postherpetic neuralgia increases with age. One study suggested that more than 5% of elderly patients with shingles have pain at least one year after their outbreak. In addition to the sensory problems, postherpetic neuralgia can also impact motor nerves and lead to motor impairment as well.


So I Got It, How do I Get Rid of It?


There is no cure for shingles, but there are treatments. Antiviral medications have been proven effective at decreasing the intensity of the pain, and the duration of the shingles outbreaks. Reports suggest that the newer generation of antiviral medications seem to be superior to the older ones. In addition to the treatment of the virus, certain medications can help aid in the protection of nerve tissue during and after shingles outbreaks, thereby treating the pain of postherpetic neuralgia. These medications are specific antiseizure and antidepressant medications.


It may seem odd that antidepressants and antiseizure drugs may help with pain. Nevertheless, these medications are clinically promising for the treatment of postherptetic neuralgia from shingles. Models have shown that the chemicals that help expedite messages down nerve tissues in cases of depression or epilepsy overlap with the chemicals that transmit pain signals down nerves.  As such, treatment with these meds can actually lead to a lesser chance of developing postherpetic neuralgia.  For this reason, many doctors put all elderly patients with shingles on one of these medications for at least one month starting at the initiation of their shingles outbreak.


How Can I Prevent Shingles?


Shingles can be prevented in many cases.  A vaccine (Varivax) was approved in 2006 and has been shown to decrease the risk of a shingles outbreak by over 50%.  In addition, it has been shown to decrease the incidence of postherpetic neuralgia by almost 70%. This vaccine increases your body’s antibodies such that they tamp out resurging varicella, and it is effective for around a decade after being given. For these reasons, the Varivax vaccine is well worth considering, especially for older individuals.
Shingles is not contagious. Rather, it is a chronic condition that is a direct result of an old infection.  However, during an outbreak, patients with shingles can shed the varicella virus, so it is possible for unimmunized patients to contract chicken pox from shingles exposure. This risk is very low, especially if the lesions are covered, but most experts suggest avoiding contact with pregnant women and those with weak immune systems if you have a shingles outbreak.


Conclusion


According to one recent research study, ten people per thousand will have shingles by the time they are 80 years old. Chances are that you know someone who’s had it. Now is the time to think ahead about vaccination and to arm yourself with information. This way, if you feel that characteristic pain, or have an outbreak of a rash, you know what you’re dealing with (NINDS, 2013).


References


CDC (2013). Shingles vaccination. Retrieved from:                                                      http://www.cdc.gov/vaccines/vpd-vac/shingles/vacc-need-know.htm


Johnson, R.W. & Whitton, T.L.  Expert Opin pharmacother. 2004 Mar;5 (3): 551-9
NINDS (2013). Shingles Information Page. Retrieved from:  http://www.ninds.nih.gov/disorders/shingles/shingles.htm#What_research_is_being_done

 

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