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Herpes zoster, commonly known as shingles, is a painful rash caused by the varicella-zoster virus, the same virus that causes chickenpox. After a person recovers from chickenpox, the virus remains dormant in the sensory nerves that emanate from the spinal cord. As one gets older or if the immune system becomes weakened the virus can re-activate within the nerve causing a painful blistering eruption. Shingles affects approximately 1 million people in the United States each year. Most people get shingles only once in their lifetime but rarely it can reoccur. While anyone who has had chickenpox or the chickenpox vaccine can get shingles two populations are at higher risk: individuals over age of 60 and those with a weakened immune system (e.g. individuals affected by HIV/AIDS, cancer, organ transplants, autoimmune disease or on immunosuppressive therapies).
Initially the affected person develops pain, burning and itching sensation along a patch of skin corresponding to the sensory territory of the involved nerve. After a few days this particular patch of skin develops painful, red bumps that then blister over 1 to 2 days. The blisters burst over the next 5 to 7 days leaving sores that eventually form scabs. Some patients may experience fever, chills, headaches or body aches during the episode. Shingles is only contagious to those who have never had chickenpox or the chickenpox vaccine in whom it can spread through skin-to-skin contact with the blister fluid. Most people fully recover within 4 weeks. However, a common complication of shingles, especially among older patients, is chronic pain along the patch of skin affected by shingles that can last long after the rash has resolved. This debilitating condition is called postherpetic neuralgia and affects 40% of those over age 60 who get shingles.
If you suspect shingles certain home remedies may alleviate the symptoms until you are able to seek medical care. Cool, damp compresses can help alleviate burning sensation while Advil or Tylenol may help relieve any associated pain. We advise that you seek medical care early if you experience signs and symptoms of shingles. Oral antiviral medications, such as acyclovir, valacyclovir, and famciclovir, can help reduce the duration and severity of the pain and rash but only if given within 72 hours of the outbreak. Furthermore, these medications may decrease the chances of getting postherpetic neuralgia. Additional medications may be prescribed for the treatment of the associated pain including NSAIDs and opioid analgesics such as tramadol.
In 2006 the FDA approved a zoster vaccine (Zostavaxä) to prevent shingles. This vaccine is recommended for anyone over age 60 regardless of any prior history of shingles. It is significantly effective in preventing shingles and furthermore reduces the risk of postherpetic neuralgia significantly in those who still get shingles.
If you are experiencing a painful rash we advise a consultation with one of our experienced dermatologists for a proper evaluation and treatment plan. Remember that in the case of shingles the key to success is early antiviral therapy.
Daniel Navi, MD, FAAD
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