Few people realize that a severe case of shingles—a viral infection characterized by a rash, blisters and sometimes excruciating pain—can lead to serious complications, such as blindness or hearing impairment.
That's why physicians are doggedly pursuing new ways to prevent shingles, and stressing the importance of early treatment to lessen its severity and duration.
Latest development: In 2006, the FDA approved a new vaccine, called Zostavax, that promises to reduce the risk of developing shingles in adults age 60 or older. However, the vaccine may not be appropriate for everyone who is at risk for the condition.
Here's what you need to know…
Signs And Symptoms
Shingles is caused by the varicella-zoster virus, the same virus that causes chicken pox. After an attack of chicken pox (usually in childhood), the virus remains dormant in nerve tissue until it is reactivated by the onset of a serious illness, such as leukemia or lymphoma...weakened immunity, even from a bad cold...or normal aging.
Each year, approximately one million Americans develop shingles. The virus primarily attacks people over age 60, but it also can occur in children and teenagers. Half of all people age 80 or older can expect to develop shingles.
The first signs of shingles are easy to miss because they can mimic flu symptoms—chills, fever, nausea, headache, even difficulty urinating Within a week, the virus spreads to the skin, causing the emergence of fluid-filled blisters in a band on one side of the body. The location of the blisters and pain correlates with the area of skin served by the infected nerve. While the rash and blisters usually appear on the trunk, they can appear on the face, near an eye, in the genital area or anywhere else on the body. The blisters usually dry and begin to scab about five days later. But the pain can continue for weeks, months or even years.
Shingles itself is not contagious. However, anyone who has never had chicken pox can develop chicken pox if he/she is exposed to the live virus in the skin of a shingles patient. The virus primarily is transmitted via direct contact with blisters that haven't completely dried. Airborne transmission, while rare, may occur.
Although the reason is unclear, doctors tend to see multiple patients with shingles at the same time—coinciding with a seasonal outbreak of chicken pox in grade-school children, typically in the fall or spring.
If Shingles Is Suspected
If you suspect that you may have shingles (based on the signs and symptoms already described), you should seek prompt medical attention (within 72 hours) either from your family doctor, a dermatologist or a neurologist.
Antiviral medication, which is generally taken for seven to 10 days, can be an extremely effective treatment for shingles. The antiviral agent acyclovir (Zovirax) is now available in a generic form, so it is the least expensive antiviral available. However, some people find acyclovir inconvenient to use because it must be taken five times a day. Both famciclovir (Famvir) and valacyclovir (Valtrex) can be taken three times a day. They are not available in generic forms and cost about $255 to $270 for a seven-day supply. If you start the medication right away, you'll decrease the odds of needing a painkiller later on. Side effects of antivirals may include nausea, headache and diarrhea.
When shingles pain does occur, sufferers describe it as itching, burning or cutting. At its extreme, the pain can be so severe that people contemplate suicide or are willing to undergo radical surgery (which entails cutting the infected nerve's roots) to relieve it. The standard painkillers used for shingles include topical and systemic steroids, the antidepressant amitriptyline (ElaviD and the antiseizure drug gabapentin (Neurontin).
A New Vaccine
As people grow older, their immunity tends to decrease. The new shingles vaccine contains a small dose of a live but weakened varicella-zoster virus. With exposure to the varicella-zoster virus, the recipient's immune system is stimulated to create antibodies against it. This helps protect people who receive the vaccine from developing shingles. The vaccine costs about $150 per dose, not including your physician's fee for the office visit.
Recent finding: In a study of almost 40,000 people age 60 or older, half of whom received a placebo, the vaccine reduced the occurrence of the virus by about 50%. The vaccine reduced postherpetic neuralgia (PHN), extreme nerve pain that can last for months or years after the rash is healed, by 66%. About 20% of shingles patients develop PHN, according to the VaricellaZoster Virus (VZV) Research Foundation. However, in my experience, the incidence rate and the severity of PHN symptoms have decreased since the introduction of antiviral drugs to treat them.
Who should get the vaccine? That still hasn't been clearly established. The chance for a recurrence is low (about 5%), so people who have already had shingles do not need the shingles vaccine.
Because shingles responds well to treatment when it is initiated within the first 72 hours, I recommend using the new vaccine for adults over age 80 who are generally in good health but very frail. They are most likely to contract shingles and develop PHN.
The studies conducted thus far suggest that the vaccine has only mild side effects, such as redness, pain and tenderness, swelling at the site of the injection, itching and headache. However, many doctors—myself included—are prescribing cautiously because, like other live-virus vaccines used for other conditions, the live varicella-zoster virus can infect others.
Those who are at greatest risk of becoming infected after exposure to a person who has received the varicella-zoster virus vaccine include people with weakened immune systems due to cancer or AIDS and pregnant women, whose fetus could be harmed by a chicken pox infection. Anyone who gets the shingles vaccine should avoid the people mentioned above for about three months following vaccination.
Although doctors are optimistic about the potential of Zostavax, many of us are waiting to see whether widespread use results in yet-unreported adverse side effects.
Best Way to Relieve Shingles Pain
Shingles often causes severe pain. In a new survey conducted by the American Pain Foundation, 35% of 401 shingles sufferers reported "severe" pain...11% said it was "very severe"...and 6% called the pain intolerable" during the first few weeks of the illness.
Suggested recommendations…
- Take an over-the-counter (OTC) painkiller. Some doctors recommend a nonsteroidal anti-inflammatory drug (NSAID), such as aspirin or ibuprofen (Advil), to help curb skin and nerve cell inflammation as well as pain. Because these medications are known to cause stomach problems, many shingles patients take acetaminophen (Tylenol). It has little effect on inflammation but is a very effective pain reliever.
To avoid possible liver damage: Do not exceed the maximum daily dose of 4 g (eight extra-strength tablets)—or 2 g daily if you're age 70 or older.
- Use topical steroids. Skin inflammation as well as burning and itching can be relieved with OTC creams and lotions that contain hydrocortisone (199). These treatments can be used up to three times daily and do not cause side effects, such as weight gain, that are generally associated with oral steroids. If you must take oral steroids for an extended period, you should be closely supervised by your doctor.
- Take warm baths. Do this several times daily, if necessary. Warm baths are soothing and help relieve pain.
- Go to a pain clinic. People who cannot get adequate pain relief on their own should consider going to a pain clinic, where anesthesiologists, neurologists and other specialists will recommend different pain relief methods. Acupuncture also may be helpful.
