SHINGLES:
 A Blistering Rash

Shingles is a rash on the skin that is caused by the same virus that causes chickenpox – the varicella-zoster virus. Often the rash begins simply with pain or burning in a limited area of skin – typically on only one side of the body. A few days later, a rash of blisters appears. The most common presentation of shingles is as a blistering rash in a stripe on one side of the trunk and back.

Shingles is essentially a second outbreak of the same virus that causes chickenpox. After a person has chickenpox, the virus stays in the body in certain nerve cells where it can become reactivated later in life, often in response to aging, HIV/AIDS, other infections, certain medications, or stress. Once the virus is reactivated, it travels along the path of a nerve and causes the pain and one-sided rash characteristic of shingles. Although the virus that causes shingles and chickenpox is also known as “herpes zoster,” it cannot lead to other types of herpes infections like genital herpes or cold sores.

More than one in 10 adults who had chickenpox as a child will develop shingles. Furthermore, more than half of adults over 80 are estimated to develop shingles at some time in their lives.

Shingles are not actually contagious although a person who has never had chickenpox or received the varicella-zoster vaccine may catch chickenpox. If you have shingles, you should stay away from babies under 12 months old and pregnant women. The virus lives in the fluid that fills the blisters and so you are less contagious after the blisters have dried up and crusted over.

Although it is frequently painful, shingles is usually not a dangerous illness. However, if shingles appear on your face, it can lead to problems with your vision or hearing, sometimes even threatening your sight. In this case, it is important to contact your doctor immediately.

Shingles can be treated with antiviral medications like acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex). In order to be most effective, these medications should be started within the first 72 hours after the rash appears. Sometimes, if the rash is particularly severe, steroids like prednisone might be used although this therapy is somewhat controversial.

The rash of shingles typically resolves within seven to 10 days and the pain usually subsides within three to five weeks. However, for some people, the pain may take months or rarely years to go away. This condition is called post-herpetic neuralgia (PHN) and is most common in older people. Many cases of PHN can be prevented by treating shingles early with antiviral medications or by use of a vaccine as described below. There are many drugs available to treat PHN – including antidepressants, pain medications including narcotics, and anti-seizure medications – although these are not always successful.

The FDA approved a vaccine in 1995 to prevent chickenpox and now more than 60 percent of American children have received the vaccine. This vaccine contains a small amount of the varicella-zoster virus and so typically causes a child to develop a more mild form of the chickenpox. Because the vaccine is so new, it is not known whether wide-spread vaccination of our children will protect them from contracting shingles and post-herpetic neuralgia later in life.

In May 2006, the FDA approved the use of a vaccine to prevent shingles – the Zostavax vaccine. This vaccine is recommended for adults aged 60 or over who have had chickenpox but who have not had shingles. Although the Zostavax vaccine does not prevent all cases of shingles, it may reduce the incidence by 50 percent. In addition, for vaccinated patients in a research study who did develop shingles, the pain and discomfort were slightly reduced and the incidence of post-herpetic neuralgia was reduced by two-thirds.

Dr. McMahon, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny County and Pennsylvania Medical Societies. She is in solo practice in the North Hills of Pittsburgh.