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Shingles

Shin­gles, or Her­pes Zoster (HZ) as it is known med­ical­ly, is the diag­no­sis of a rash that fits this descrip­tion. It is caused by the same virus that is respon­si­ble for chick­en­pox (vari­cel­la). Most peo­ple are infect­ed with chick­en­pox dur­ing child­hood. After the infec­tion sub­sides, the virus becomes inac­tive and remains in our ner­vous sys­tem. In some peo­ple, the virus is reac­ti­vat­ed in the future and man­i­fests itself in the rash known as shingles.

For most peo­ple, shin­gles tends to occur lat­er in life and some may expe­ri­ence more than one episode in a life­time. Increas­ing age, being on immuno­sup­pres­sive med­ica­tions, fatigue, emo­tion­al stress, and radi­a­tion ther­a­py have all been thought to be impli­ca­tions for re-acti­va­tion of the virus.

Patients may expe­ri­ence headaches, sen­si­tiv­i­ty to light, or a gen­er­al feel­ing of being tired pri­or to the erup­tion of the rash. Some peo­ple expe­ri­ence a swelling of the lymph nodes, pain, itch­ing, or a burn­ing sen­sa­tion in a cer­tain area of the skin. The virus gen­er­al­ly fol­lows a lin­ear pat­tern down a sin­gle spinal nerve. This explains why the rash usu­al­ly only affects one side of the body. The vesi­cles may begin as clear but become cloudy or filled with yel­low pus by the third to fourth day. They may rup­ture and form crusts that fall off with­in two to three weeks.

A com­pli­ca­tion of shin­gles may be post her­pet­ic neu­ral­gia, the resid­ual pain that can last more than thir­ty days since the onset of the rash. The inci­dence of this usu­al­ly increas­es with age, with most cas­es occur­ring after age thir­ty. If shin­gles occurs around or over the eyes, it is a more seri­ous con­cern and patients must see an oph­thal­mol­o­gist for a con­sul­ta­tion to check to make sure there are no com­pli­ca­tions with­in the eye such as swelling or inflam­ma­tion that could affect the vision.

Depend­ing on the sever­i­ty, we can treat shin­gles with cool wet dress­ings, oral steroids, and/​or oral antivi­ral med­ica­tions. The oral antivi­ral ther­a­py is the most com­mon form of treat­ment and works best if it is ini­ti­at­ed with­in the first forty eight hours of the onset of the symp­toms. Pain man­age­ment varies depend­ing on the sever­i­ty of the symptoms.

If you sus­pect you have shin­gles, it is impor­tant to make an appoint­ment for eval­u­a­tion so that treat­ment may be ini­ti­at­ed if appropriate.