Hurricanes Gustav and Ike, along with present economic issues, have caused many a great deal of stress. I have seen an increased number of patients with shingles in the past month. Shingles, also known as Herpes Zoster, is caused by the same virus that causes chicken pox. Once the rash of chicken pox resolves, the virus remains in a dormant “sleeping” state in certain nerve cells and then reactivates, causing shingles. What prompts the virus to “awaken” and cause problems is usually related to some type of stress. The stress may be mental, emotional or physical.
Shingles may occur anywhere on the body, even in the eye. The first symptom of shingles 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. There also may be a little fever or headache. The rash soon turns into groups of blisters that look a lot like chicken pox. Great care must be taken if the blisters involve the eye region because permanent eye damage can result.
The blisters generally last for two to three weeks. During that time pus may collect in the blisters. The blisters will then crust over and begin to disappear. Severe pain can linger for months or years as a condition called post-herpetic neuralgia. This problem is of most concern to me because it is avoidable for most patients by early, aggressive treatment.
The shingles virus is contagious. Shingles can be passed on to others who have not had chicken pox, but they will develop chicken pox, not shingles. Shingles may be passed on to people who suffer certain illnesses and those who have weakened immune systems.
Anti-viral drugs taken by mouth should be prescribed for all cases of shingles. Severe shingles requires early, more aggressive treatment with systemic steroids and sometimes nerve block injections. Combination treatments are often needed for the more painful shingles. I often use tricyclic antidepressants like amitriptyline ( Elavil) and anticonvulsants like gabapentin (Neurontin) at adjusted dosages. Most of these medications should be started early, at low doses, then increased quickly to achieve maximum benefit. Medicines taken within 1 to 3 days of the onset of shingles work best and may stop the progression of shingles completely.
Zostavax, the shingles vaccine made by Merck and licensed by the FDA in May of 2006, will reduce the risk of shingles in adults 60 and over. Zostavax is given as a single dose by injection. In clinical trials, the vaccine prevented shingles in about half of people 60 years of age and older.
The problem I see most in my office is that patients wait too long to seek treatment, because they do not recognize the pain and rash as shingles until later in its course. Remember, shingles treatment works best when begun immediately. Please get help quickly.
Dr. John Jones is an Associate Professor of Dermatology and Dermatologic Surgery at LSU Medical Center in New Orleans, a board certified dermatologist, and has offices in Thibodaux and Raceland.
John J. Jones, Jr. M.D.
