Shingles

Shingles begins with the sensation of burning or tingling on or under the skin. Up to a week later the rash appears, on one side of the body only, and following the line of a nerve. The rash is actually collections of blisters which eventually crust over and heal. While in the blister stage shingles is contagious, although the only way to transmit the virus is by direct contact of live virus from a fluid-filled blister. If you do transmit the virus and infect someone who has not had chicken pox they will develop chicken pox and not shingles, as this is a secondary disease and cannot happen unless the virus has got into nerves. Shingles affects 5% of all New Zealanders at some stage in their life, and up to 20% of those over 70 years.

What causes shingles?

Shingles is caused by the same virus that gives you chicken pox (Varicella zoster). Unlike other viruses that cause infections like German measles (Rubella) or the flu (Influenza), the chicken pox virus does not disappear when symptoms have gone.  Instead, it plays Trojan horse by lying dormant and being protected by the immune system. When it reactivates, and this is thought to be due to a change in the immune system, the dormant virus reawakens and begin to grow, travelling back along the nerve to the skin where it manifests as shingles.

What are the symptoms?

• Itching – burning or tingling under or on the skin.
• Painful blistering rash in one area – usually on the trunk, chest, face or neck.
• Feeling unwell – with fever and headache.
• Swollen lymph glands – in the neck or under the arms.

Complications

• Post-herpetic neuralgia – residual and persistent nerve pain that remains sometimes long after the signs of shingles infection have gone.
• Eye complications – can result if shingles appears in the eye and causes damage due to inflammation.
• Skin damage – may remain with loss of skin colour and some feeling.
• Muscle weakness (or palsy) – from damage to motor nerves which make the muscles work.

Risk factors

• Age – shingles is more common over 50.
• Immune deficiency – anything that alters the immune system, including stress, immuno-suppressant medication and chemotherapy.
• Nerve damage – such as after surgery.
• Pressure on nerves – such as following a slipped disc.
• Chicken pox – in the first year of life.

Prevention and treatment

You cannot get shingles unless you have had chicken pox, but anyone who’s had chicken pox is at risk of shingles.

1. Recognise the symptoms
If you suspect you have shingles, keep the rash covered and dry and get it treated quickly; you may be able to prevent severe symptoms like post-herpetic neuralgia.

2. Confirm with a diagnosis
Although a skin rash has many different causes, diagnosis is usually straightforward as the pattern of rash formation and blistering are characteristic of shingles. To be certain your doctor may take a sample of fluid from a blister to test for presence of Varicella zoster virus.

3. Attack the virus
Acyclovir is an antiviral medication known to be effective against a similar virus that causes cold sores. If taken in tablet form within the first few days of developing a skin rash it will stop virus growth and reduce the length of time the infection may last and your risk of severe symptoms.

4. Treating the symptoms

• Relieve itching – by applying a cool compress; using a soothing lotion like calamine or a prescription steroid cream for severe symptoms.
• Pain relief medication – paracetamol or ibuprofen (non-steroidal anti-inflammatory drug) are both available from your pharmacy and will help relieve mild pain. For strong pain and for post-herpetic neuralgia your doctor may prescribe other drugs, including narcotic drugs like tramadol or codeine, anti-seizure drugs or anti-depressant medication.
• Capsaicin cream – contains an extract from chilli peppers and is known to help severe nerve pain.
• Acupuncture – is an ancient Chinese healing known to stimulate natural pain relief chemicals in the brain (endorphins), which can help with pain.

5. Vaccination

A chicken pox vaccine is available and its use is recommended to prevent not only chicken pox, which can be a very nasty and serious disease particularly in adults, it will also prevent shingles developing in later life.

There is also a fully funded shingles vaccine available to people from 65 years old. The vaccine is still available to other people but costs apply.