Shingles.
A small nuisance to a major health problem.
A small nuisance to a major health problem.
Shingles is a blistering rash that affects a single area of the body and is caused by reactivation of the chickenpox virus. After causing chickenpox, the varicella virus lies dormant in the dorsal root ganglia at the back of the spinal cord. Re-activation of the virus occurs at one or two levels of the spinal cord and can occur many decades later. The virus spreads up the nervous system from that level in the spinal chord to the skin. The rash is therefore found on one or two segments of the skin, these segments being called dermatomes. The distribution of the rash is easiest to describe on the chest where the rash will go horizontally across the chest wall – at one level, and on one side.
The rash of acute shingles is often itchy. The pain of acute shingles may be described as burning, stabbing, or itchy. People often feel tired – called malaise – and may experience headaches.
Shingles can occur in all age groups. The condition is more common in females and in people who are immunosuppressed. Shingles are more common with increasing age.
Persistent pain, called postherpetic neuralgia (PHP), is the main issue with shingles.
The pain may be burning or tingling, and the skin may be very sensitive – or painful – to even light touch. There may be reduced sensation to touch or frank numbness.
What strikes doctors who see people with shingles is just how much it can knock people about.
These are risk factors for developing PHP:
How to identify Shingles?
The rash occurs in a segment of the body on either the left or right side but not both, and does not cross the midline.
The rash is made up of individual lesions that may number just a few to over a hundred. Just as with chickenpox, each lesion evolves through 4 stages: red spot, blister, pustule, and finally crusting. The rash starts to settle down after around 2 weeks and goes by around 3-4 weeks.
Skin HSV (cold sores) may appear similar to shingles. A viral swab will confirm which it is.
Is Shingles Contagious?
In a word – yes. But it’s not so straightforward …
The virus is found on the lesions, particularly in the early stages when there are blisters. Remember that shingles is reactivated from past chickenpox, so you can’t pass on shingles from shingles. But shingles can spread chickenpox.
The risk of spreading chickenpox from shingles is fairly low because:
Nevertheless, you should take precautions and be careful to wash your hands after touching the infected skin. Lesions that have completely crusted-over should not be contagious. Cover any non-crusted lesions with a light dressing. Take extra care around people who are immunocompromised.
Gallery of Shingles
Please click on the images for details.
Six Shingles Snippets:
Shingles small-print
Starting antiviral medication within 3 days will speed up the resolution of the rash. There has been debate about whether antiviral medication reduces the risk of developing PHP and probably it does not¹.
What treatment is available for postherpetic neuralgia?
The fact that PNP can cause real misery for people reflects in the myriad of treatment options that are available.
The following table summarises the main treatment options ².
The Shingles Vaccine
A shingles vaccine has been around for a number of years. The one-dose vaccine is licensed over the age of 50 years. National Australian guidelines recommend the vaccine in people over 60 years. In this age group, the vaccine is estimated to halve the rate of shingles, and to reduce the number of cases of PHP by 60%.
The live vaccine is relatively expensive and cost has so far been the major barrier to uptake.
Public funding for shingles vaccination of people age 70 to 79 years started in Australia from 1/11/2016.
You may have noticed that The Australian immunisation handbook (>500 pages of it) recommends the shingles vaccine in all adults over 60 years, but government funding is for adults 70 to 79. There will always be a difference between optimal recommendations and funded recommendations. Other publicly funded systems such as The UK’s NHS are also funding it for those age 70 to 79. This age group is the sweet-spot for the shingles vaccine – shingles is common and the vaccine is effective.
People age 60-69 may decide to fund the vaccine themselves. Current prices of ®Zostavax are a little over $200.
The vaccine “lasts” around 5 to 10 years. Mild injection site pain or redness occurs in half of people who have the vaccine.
Should someone with previous shingles be vaccinated?
Definitely – yes. Shingles can re-occur with some studies suggesting the risk and severity of shingles may be comparable to the risk in people without a history of shingles.
You can find more information from health direct Australia.
Oral or Topical | Prescription? Y/N | Effectiveness | Side Effects | Doses per day | Cost for 1 month * | Notes | |
---|---|---|---|---|---|---|---|
Paracetamol like ®Panadol | Oral | No Script | + | +/- | 4 times daily | $10-$20 | not that effective |
Anti-Inflammatory eg. Ibuprofen | Oral | No Script | + | + | 3 times daily | $10-$20 | small risk of Gastrointestinal side bleeding |
Opiate Pain killers (® Panadeine Forte) | Oral | Script | + | ++ | 4 times daily | under $20 – short term use only | Drowsiness, potential dependence |
Capsaicin Cream (®Zostrix HP) | Topical | No Script | ++ | ++ | 4 times daily | $25-$35 | Apply to healed, intact skin |
Lidocaine Patch (®Versatis) | Topical | Script | ++ | + | once daily | >$100 | Apply to healed, intact skin |
Amitriptyline (®Endep) | Oral | Script | +++ | +++ | once daily | $10-15 | Takes 4 to 8 weeks to work up to the right dose |
Pregabalin (®Lyrica) | Oral | Script | +++ | +++ | twice daily | $38 * | Dose also increased slowly |
Gabapentin (®Neurontin) | Oral | Script | +++ | +++ | 3 times daily | $10-$20 | Takes around 4 weeks to get to the right dose |
REFERENCES