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Shingles: Chickenpoxs Ugly Alter Ego


Shingles (herpes zoster) is an outbreak of a skin rash or blisters caused by the same virus that leads to chickenpox — the varicella-zoster virus. The first sign of shingles is pain, often burning or tingling, numbness and/or itching. This occurs at one particular location of the body and on only one side. After a few days, a rash with fluid-filled blisters (similar to chickenpox) appears on that one particular area. Shingles pain can be minor or severe. While some people have mostly itching, others feel pain from the gentlest touch or breeze. Shingles is chiceknpox’s ugly alter ego that presents at the most inconvenient times. Read here to find out all about this form of the varicella virus (National Institutes of Health, 2013).


Where do shingles usually occur?

The most common location for shingles is a band (known as a dermatome) which spans from one side of your trunk around to your waistline. This observation led to the name, shingles, which is a Greek word meaning girdle.  In 1887, scientist von Bokay observed that children, exposed to adults with shingles, often developed the chickenpox. The relationship was confirmed in 1952 by Weller and associates who showed that the viruses associated with each disease were identical (Rockley and Tyring, 1994).


Who is at risk for shingles?

Anyone who has had chickenpox is can get shingles. Experts believe that in the initial battle with the varicella-zoster virus, some of the virus particles cause your skin to blister. These particles move into you nervous system, too.  When the varicella-zoster virus restarts, the virus migrates back down the long nerve fibers that range from the sensory cell bodies to the skin.  As the viruses multiply, the tell-tale rash erupts, and the person then has shingles (National Institutes of Health, 2013).


How common is shingles?

According to shingles researchers Insinga and associates (2005), the shingles is more common in women than men. The frequency increases with age, as a person’s immunity decreases. Demographically, people older than 60 years of age and Caucasians are more likely to develop shingles. Also, people with compromised immune systems are at risk, like those who have HIV or those on chemotherapy. The only way that you can get shingles is if you have already had the chickenpox, and the leftover virus becomes reactivated. This occurs in about 20% of people who have had the chickenpox.


What are the risk factors for shingles?

While researchers are not clear on exactly what makes some people more susceptible than others, there are several factors that may make some people more likely to get shingles than others.  Some of those factors include:
• a weakened immune system
• Hodgkin’s disease, lymphoma and leukemia
• a childhood history of cancer
• diabetes
• radiation therapy
• chemotherapy
• steroid medications
• medicines designed to suppress the immune system (cyclosporine and azathioprine)
(Aurora Healthcare, 2013)


What are the complications of shingles?

While shingles goes away on its own for most people, complications do occasionally occur.  In rare cases, damage to the eyes occurs, as well as stroke and Ramsay-Hunt syndrome (hearing loss, vertigo or paresis). In some elderly individuals, cognitive deficiencies occur from damage to the brain (Johnson & Whitton, 2004).


How can I prevent shingles?

In 2006, the U.S. FDA approved a vaccine for shingles called Zostavax (Merck) for use in non-immunocompromised adults at least 60 years of age. At the time of approval, this vaccine was expected to reduce the incidence of herpes zoster reactivation (shingles) by approximately 50% (Mitka, 2006). In 2010, shingles doctors Simberkoff and colleagues performed a large, multi-center clinical trial evaluated the use of the shingles vaccine in 38,546 subjects. Although injection-site reactions were reported in nearly half of the subjects receiving the vaccine, only 16% of those receiving the dummy injection had a similar outcome.  In terms of serious adverse events and side effects, there was no difference in the occurrence of events when comparing those who received the Zostavax vaccine to those who did not receive it. The vaccine appears to be effective, with shingles occurring in 7 of the subjects who received the vaccine compared to in 24 subjects who received the dummy injection.


How is shingles treated?

If prevention fails, you could succumb to shingles. Therapy revolves around treating the pain, speeding up the healing of the rash and working to prevent complications. In many cases, antiviral drugs, such as acyclovir or famcyclovir are effective at meeting all of these objectives.  Although some practitioners may suggest the use of steroids, there are clinical studies showing both benefit and non-benefit.  Due to the additional potential complications of using these agents, this practice is controversial. In order to treat your pain, your doctor could prescribe acetaminophen or non-steroidal anti-inflammatory drugs. Occasionally, narcotic analgesics are needed (Johnson & Whitton, 2004).


What are researchers doing to cure shingles?

According to the National Institutes of Health (2013), there are 59 active studies conducting research on shingles. These include: Vitamin D supplementation to prevent shingles, acupuncture for shingles, Zostavax effectiveness, effect and safety of vaccines and antivirals for people with chronic diseases, and the effect of various medications on the pain associated with shingles.


Will my shingles reoccur?

According to a recent study published in Mayo Clinic Proceedings, recurrences of shingles may be more common than doctors previously thought. Shingles researchers Yawn and associates studied the medical records of 1,700 people over the age of 22 years who had an episode of shingles. This data showed that the recurrence rate was over 5% - the same rate expected for a first case of shingles. Also, many of the people studied had as many as 3 recurrences within the eight year time span. Yawn reported that women were more likely than men to have recurrence, but age did not make people at risk for recurrence. Instead, the main determinant for recurrence was the person’s pain characteristics during the first episode. People with pain lasting more than 30 days after the onset of shingles were more likely to have another bout of the breakout.


References

Aurora Healthcare Organization. (2013). Retrieved from: http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp?URLhealthgate=%2220146.html%22

Insinga RP,  Itzler RF, Pellissier JM, et al.  The Incidence of Herpes Zoster in a United States Administrative Database.  J Gen Intern Med. 2005; 20: 748–753.

Johnson RW, Whitton TL. Management of herpes zoster (shingles) and post-herpetic neuralgia. Expert Opin Pharmacother. 2004; 5:551-559.

Mitka M. FDA approves shingles vaccine. JAMA. 2005; 296: 157-158National Institute on Health. (2013). Retrieved from:  http://www.ninds.nih.gov/disorders/shingles/shingles.htm

National Institute on Health (2013). Retrieved from: http://www.clinicaltrials.gov/ct2/results?term=shingles&Search=Search

Rockley PF, Tyring SK. Pathophysiology and clinical manifestations of varicella zoster virus infections. Int Journ Derm. 1994; 33: 227-232.

Simberkoff MS, Arbelt RD, Johnson GR, et al. Safety of Herpes Zoster Vaccine in the Shingles Prevention Study. Ann Intern Med. 2010;152:545-554.

Yawn, BP, Wollan, PC, Kurland, MJ et al. Herpes Zoster Recurrences More Frequent Than Previously Reported. Mayo Clinic Proceedings, 2011; 86 (2): 88 DOI: 10.4065/mcp.2010.0618


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