SHINGLES - Full extract 

Shingles, or herpes zoster, is a painful skin condition characterised by a tingling, burning rash and blisters. It occurs most commonly on the chest wall but can affect any area of the body. Shingles nearly always affects just one side of the body. It is caused by the reactivation of a chickenpox virus acquired years before; the virus lies dormant in the system for years and then comes out along the course of a particular nerve. 

Shingles is a fairly common condition. About 10 to 20 per cent of people will get it at some stage of their lives, and the risk increases with age. It is more likely to occur in people whose immune system is suppressed. Shingles is often said to occur when people become run-down, and we do see it in people after an illness, surgery, and periods of great stress. 

The pain with shingles often starts three or four days before the rash appears. There may be generalised aches and a fever and the diagnosis may not be obvious. The telltale blistery rash appears and usually extends over several days. The blisters dry and scab over a few weeks. This may be followed by severe jabbing or burning pains called post-herpetic neuralgia, lasting in some cases for months or years. 

The treatment of shingles has altered dramatically in recent years because drugs such as Acyclovir…specific anti-viral medications that alter the course of the illness. These drugs greatly reduce the extent of the rash, degree of pain and blistering, and may also reduce the risk of post-herpetic neuralgia. To be effective they must be started within 72 hours of the rash breaking out and taken for seven days. The price of the tablets is about $400, but they can be available for the cost of an NHS script if specific prescribing criteria are satisfied.

Adequate analgesics are also required initially and old standard treatments such as cool packs and calamine lotion can give relief. If any secondary bacterial infection is present a course of antibiotics may be required. Although shingles can recur, in most cases it only strikes once. 

When shingles affects the eye there is a risk if permanent eye damage, and an eye specialist is usually consulted. 

Post-herpetic neuralgia is often difficult to treat. Certain medications may help to relieve pain. Topical capsicum cream, acupuncture, and nerve-stimulating machines may also be worth a try. Each person with shingles should have a general medical check-up; a standard blood test is also helpful to rule out any underlying health problems. It is not possible to catch shingles from someone else. However, for those at specific risk of contracting chickenpox, an immunoglobulin injection is available to help prevent cross-infection occurring. 

Health Tip:
* Unexplained pain for several days can be an early sign of shingles. Excellent medication is available, but it only helps if the condition is diagnosed early.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001