Shingles can be a very painful condition where the patient can suffer from pain even touching the skin where the herpes zoster virus has attacked. I have a elderly patient who had nerve pain lasting up to 2 years before the pain finally becomes bearable. Each time it attacks he has to come to the clinic for an analgesic injection to relieve the pain. I also gave some tranquilizer tablets to calm his nerves down because there is also a psychological effect.
Shingles or Herpes zoster is a condition where a crop of blisters caused by the varicella zoster virus form a band across one side of the chest, abdomen or face.
The same virus that causes chicken pox causes shingles. The chickenpox virus remains in a dormant state in certain nerve cells of the body from months to many years, and then reactivates, causing shingles.
This infection is due to a temporary decrease in the body's resistance, allowing the virus to start multiplying and to move along nerve fibres towards the skin.
About 1 in 10 people who had chickenpox as children will develop shingles as adults.
The disease occurs
1.more often in older people (over 50 years old) because the immune response is believed to be weaker in older people.
2.Trauma or possibly stress may also contribute to an attack of shingles.
3.Weakened Immune system people like those with cancer, eg. Leukaemia, lymphoma, undergoing chemotherapy or radiation therapy for cancer, patients with organ transplants and taking drugs to ward off transplant rejection and patients with diseases that lowers the immune system eg. AIDS.
The first symptom is a burning pain or tingling and extreme sensitivity in one area of the skin.
This may be present for one to three days before a red rash occurs.
A group of blisters then forms on a red base which looks like chicken pox lesions.
The blisters generally last for two to three weeks, during which time they accumulate pus and then crust over and begin to disappear.
The pain may last longer for a month or longer.
A slight discoloration or scarring of the skin is also possible.
The pain is usually severe enough for the doctor to prescribe painkillers.
A long-lasting painful complication of shingles called post-herpetic neuralgia occurs in some older patients.
This may last long after the shingles have healed.
For these people the slightest touch or contact with clothing can be unbearable.
Shingles generally affect only one side of the body.
Most commonly, blisters will appear on the chest or abdomen, including the buttocks and genitalia, and even the face.
If the blisters involve the eye region, permanent eye damage can result. Your doctor will refer you immediately to an eye specialist when such a complication develops.
Post-herpetic neuralgia, a condition in which either constant or episodic pain persists for a long time after the skin has healed.
About 50% of affected patients are over the age of 60 years.
The chronic pain is believed to be due the damage to nerve endings.
People who suffer this long-term pain may experience psychological suffering such as depression, insomnia and weight loss.
Infection of the blisters by bacteria can also cause delayed healing of the skin.
Antibiotic treatment is needed.
If the shingles affects the forehead, sometimes inflammation of ophthalmic nerve of the eye may occur.
It may cause severe pain in the eye and cause blindness.
Damage to the cornea may also occur.
If the shingles affect the the ear, it may cause pain, tinnitus (buzzing sound in the ear), dizziness, loss of hearing or an increased risk of spread to the brain.
In patients with weakened immune systems, there may be high fever and spread of the disease all over the body.
Shingles is much less contagious than chicken pox.
People with shingles can spread the virus if blisters are broken to someone who has never had chicken pox or who is already ill.
The people who are at risk include babies and those who already are ill such as cancer patients.
Shingles can result in scarring if the blisters are infected or if the patients have used toxic home remedies on the blisters.
Some Chinese physicians believe that a snake in the skin causes the disease and the head of the snake must be burned with chemicals in order to stop the snake from growing.
In most cases Shingles clears on its own in a few weeks and seldom recurs.
Treatment consists of painkillers, as well as cool compresses to help dry the blisters.
Antibiotics are given if there is bacterial infection
The antiviral drug, acyclovir, may be given especially for patients with eye involvement or who are very ill. It is useful only if it is started early in the disease.
The earlier it is taken after the disease begins the better the effect. The drug might prevent post-herpetic neuralgia.
Post-herpetic neuralgia can be treated with painkillers and high doses of tranquilizers at night.
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