Shingles is almost always an adulthood recurrence of chickenpox, but differs from the original disease in that it involves inflammation of a peripheral sensory nerve that originates in the spinal cord. The varicella zoster virus, which causes chickenpox and shingles, is related to herpes simplex, the virus that produces cold sores and genital herpes. As with these herpes infections, the varicella virus remains in the body after chickenpox clears up, taking refuge in certain nerve cells. Thus, shingles is characterized by nerve pain and the eruption of painful blisters along the pathway of a root nerve. (The varicella virus can be transmitted from someone who has shingles and become the cause of chickenpox.) A typical case of shingles begins with general discomfort, gastrointestinal upset, fever, and pain in the part of the body that is supplied by the affected root nerve, most often the upper torso. In a few days, the skin becomes red and slightly swollen, and a spotted rash appears. The red spots turn into small blisters that dry up and crust over within a week. Permanent scarring is rare, and for many people recovery is complete in two weeks. Sometimes, however, an attack of shingles will be followed by persistent and intractable pain, or neuralgia, along the nerve pathway, a complication known as postherpetic neuralgia. Another complication is ophthalmic herpes zoster, also called zoster kerati tis, which can occur if shingles affects the face. Blisters break out along the forehead, the eyelids swell, and, in the most serious cases, the cornea becomes inflamed and ulcerated. Since ulceration may lead to scarring and irreversible damage to vision, a physician should be consulted without delay at the first sign of facial shingles. What triggers shingles is not known, but the incidence increases with advancing age. Stress and reduced immunity also appear to playa role. For example, widespread shingles that lasts for more than two weeks is some times associated with Hodgkin’s disease, a cancer of the lymph system. Patients undergoing cancer chemotherapy, long term treatment with steroids, or immunosuppressive therapy also have an increased incidence.
Diagnostic Studies And Procedures
A diagnosis of shingles is usually based on the characteristic distribution of blisters along the path of a nerve on one side of the body. If there is any doubt, a laboratory culture may be ordered. Because shingles sometimes develops in people with Hodgkin’s disease or other conditions marked by reduced immunity, blood studies and other tests may be ordered.
Although there is no medical cure for shingles and its consequences, treatments can reduce discomfort and prevent some of the complications. If the condition is diagnosed early, acyclovir (Zovirax), an antiviral drug, may be prescribed to hasten healing of blisters and perhaps lower the likelihood of postherpetic neuralgia. Early use of acyclovir is especially critical if the eyes are involved or if the patient has a condition that lowers immunity. Dexamethasone, a cortisone like drug, may be prescribed as an eye ointment and/or a salve to speed the healing of blisters. Drugs that can diminish the pain of postherpetic neuralgia include codeine combined with aspirin or acetaminophen; carbamazepine (Tegretol), an antiseizure medication; and amitriptyline , antidepressant medication. Also under study is Zostrix, a cream that contains capsaicin, a substance in hot peppers. When rubbed on the blisters, capsaicin produces a stinging sensation that appears to reduce the discomfort of shingles. Some doctors advocate injections of a corticosteroid medication, but this is a controversial treatment.
This has been shown to alleviate postherpetic neuralgia. Six sessions over a one or two month period are usual. Practitioners stress that prompt treatment contributes to the likelihood of success.
. Herbalists recommend applications of aloe vera gel, fresh leek juice, or compresses soaked in goldenseal, mugwort, or peppermint tea to soothe the shingles blisters.
This relaxation technique, perhaps combined with self hypnosis or biofeedback training, may be helpful in coping with the pain of shingles or postherpetic neuralgia.
Vitamin E supplements are said to reduce the likelihood of postherpetic pain. Some nutritionists also recommend high dose vitamin C to help heal the blisters.
Self care is directed to bolstering immunity by eating balanced, nutritious meals and getting adequate rest. If pain interrupts sleep at night, compensate by taking naps during the day. Discomfort from blisters can be reduced by applying cool wet compresses or soaking in a tepid bath containing a cup of colloidal oatmeal or a cup of baking soda. Another home remedy calls for mixing a crushed aspirin with a tablespoon of unscented skin lotion and applying it to the blisters. To reduce the likelihood of scarring, apply vitamin E oil or cream to the blisters as they begin to dry up. Lingering nerve pain may be controlled by TENS, or transcutaneous electrical nerve stimulation produced by a pocketsized device. After an accredited physical therapist provides instruction in its use, it is a convenient form of self treatment.
Other Causes of Herpetic Blisters
Herpes simplex can cause blisters similar to those of shingles, but they do not follow a nerve pattern.