April 26, 2012 12:00 AM
Shingles is caused by the same virus that causes chickenpox. following resolution of chickenpox, the virus — varicella zoster virus, or VZV — lies dormant in the spinal dorsal root ganglia until a decrease in cellular immunity triggers the reactivation of the virus, resulting in herpes zoster, otherwise known as shingles. Herpes zoster is not caused by the same virus that causes genital herpes, a sexually transmitted disease.
People who have medical conditions that weaken their immune systems, such as certain cancers and human immunodeficiency virus, and people who receive immunosuppressive drugs such as steroids and drugs given after organ transplantation, also are at greater risk of getting shingles.
There are an estimated 1 million cases each year in the U.S. Anyone who has recovered from chickenpox may develop shingles. Half of all cases occur among men and women age 60 years and older. People who develop shingles typically have only one episode in their lifetime. Widespread vaccination for varicella has reduced the incidence of primary VZV infection in the U.S. by up to 90 percent since its introduction in 1995.
Shingles usually starts as a painful rash on one side of the face or body. the rash forms blisters that typically scab over in seven to 10 days and clear up within two to four weeks.
Before the rash develops, there is often pain, itching or tingling in the area where the rash will develop. this may happen one to five days before the rash appears.
Most commonly, the rash occurs in a single stripe around either the left or the right side of the body. in rare cases, usually among people with weakened immune systems, the rash may be more widespread and look similar to a chickenpox rash. Shingles can affect the eyes and has the positional to cause loss of vision.
Other symptoms of shingles can include fever, headache, chills and an upset stomach.
Postherpetic neuralgia, the most common complication of shingles, is characterized by severe pain in the areas where the shingles rash occurred, and can take place even after the rash has cleared up.
Very rarely, shingles can also lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis) or death.
Diagnosis of shingles is based primarily on patient history and a physical examination. in select patient populations, the presentation of shingles can be atypical and may require additional testing.
A person with shingles can spread the virus when the rash is in the blister phase. a person is not infectious before blisters appear. once the rash has developed crusts, the person is no longer contagious.
Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low, if the rash is covered.
If you have shingles:
- keep the rash covered.
- Do not touch or scratch the rash.
- Wash your hands often to prevent the spread of the virus.
- until your rash has developed crusts, avoid contact with pregnant women, newborn babies and immune compromised persons.
The only way to reduce the risk of developing shingles and the long-term pain that can follow shingles is to get vaccinated. the Center for Disease Control recommends a onetime dose of the Zoster vaccine for people 60 years of age and older to help prevent shingles. this vaccine is not advised for immune-compromised patients.
Several antiviral medicines — acyclovir, valacyclovir and famciclovir — are available to treat shingles. these medicines will help shorten the length and severity of the illness. but to be effective, they must be started as soon as possible after the rash appears. thus people who have or think they might have shingles should call their health care provider as soon as possible to discuss treatment options.
Pain medicine may help relieve the pain caused by shingles. Wet compresses, calamine lotion and colloidal oatmeal baths may help relieve some of the itching.
Dr. Mazhar Jakhro specializes in family medicine, providing health care for families and individuals of all ages. Board certified in family medicine, Dr. Jakhro is part of Southcoast Physicians Group, practicing at Southcoast Health System, a full-service medical practice in Wareham. Dr. Jakhro is accepting new patients and can be reached at 508-273-4950.
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