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February 29, 2012 at 8:22 PMComments: 10 Faves: 1

Shingles Fact and Fiction

By Jeffrey VanWingen M.D. More Blogs by This Author

Shingles is a real pain! Over the years I have seen many cases of shingles.  I have also heard a lot of things about shingles - some true and some not. This blog will explore some notions about shingles and determine which are myth and which are fact.  

Shingles Basics

Shingles, otherwise known as Herpes Zoster, is a skin manifestation of the dormant chicken pox virus.  Chicken pox, once an expected rite of childhood, causes a respiratory syndrome with a widespread rash.  The infection eventually resolves and the virus remains in the body, dormant in the roots of nerves at the level of the spine.  The virus finds a home in the cells of these nerves, alive and usually quite contained.  In the event of a weakened system, the virus can re-emerge in a single nerve root and travel along the nerve path to the skin. This "break-out" may be caused by caused by some stressor to the body such as illness, injury, cancer or may even be caused by emotional stress. Often, there is no predisposing factor. 

The symptoms of shingles may begin with fatigue. From there a very sensitive patch develops on the skin along the nerve pathway.  It is actually the skin that is sensitive and painful, often even to light touch or presence of clothing atop. Finally, the tell-tale red rash with blisters develops. Typically, symptoms resolve after a couple weeks.

That's the truth about shingles. Following are some common myths:

"Only old people get shingles." Fiction. Anyone who has the dormant chicken pox virus can get shingles.  Shingles is more common in the elderly, however.  About 50% of shingles cases are in people over the age of 60.

"If the band of shingles goes completely around you, you will die."  Fiction (though this is my favorite misconception, by the way). Shingles never crosses themidline of the body.  As stated earlier, the herpes zoster virus travels from a nerve root at the level of the spine to the skin.  Such nerve roots exist on both sides of the spine and cover a specific section of the body.  These sections are called dermatomes.  A map of specificdermatomes on the body looks like a tiger's stripes.  These stripes do not cross the middle of the body as the opposite side of the body is covered by the nerve on the other side of the spine.  Along these lines (no pun intended), shingles does not jump from dermatome todermatome.

"Like the chicken pox, once you get shingles, you will no longer get it again." Fiction. Shingles can recur along the same or different nerve tract.  It is not common, however.  While it is true that if you live to be 85, you will have a 50% chance of having an attack of shingles, this rate drops to 1% for more than one attack.  The bottom line is that a person can get more than one attack but it is much less common.

"Shingles can make you blind." Fact. It is not uncommon for shingles to emerge on a nerve of the face that supplies the skin around the eye and the eye itself.  The infection can spread to the eye and its nerve rarely leading to blindness if not addressed.  For this reason, it is important to see a doctor quickly if the eye area is involved and get treatment to prevent this complication.

"Shingles is contagious." Sort of Fact. A person with shingles does not give shingles to another person.  They can, however, give chicken pox to a person who has never had chicken pox (or the vaccination) or who has a weakened immune system (HIV, on chemotherapy).  A person with shingles is considered contagious until the rash is crusted over.  In general, however, transmission of chicken pox in this fashion is very uncommon. 

"A person who gets the shot for chicken pox cannot get the shingles." Fiction (in theory). The chicken pox vaccine is a live vaccine, so an immunized person still gets and deals with a sub-clinical infection. Not much information is out there, however, due to the fact that we have only been giving chicken pox vaccine for the last couple decades.  A small study did show lower rates of shingles in vaccinated children diagnosed with leukemia but no change in the severity.

"Shingles can be treated." Fact. While shingles cannot be cured with medication, antiviral drugs can be given to shorten the course and more importantly prevent the dreaded complication of postherpetic neuralgia.Postherpetic neuralgia is the lingering syndrome of pain that continues long after the rash is gone. It is important to note that the treatment is only effective if given within the first 72 hours of the onset of symptoms. Herein lies the problem. It is quite common for people to wait and come in to see me only after the rash becomes unbearable because they have no idea what is going on. Thus, education leading to awareness and recognition is the best medicine in successful treatment.

"Shingles can be prevented." Fact (as of the past few years). A vaccine is now available to prevent shingles.  It is approved for people over the age of 60 but this may be changed to 50 in the near future.  It is effective but, as with many things novel and new, it is expensive.  Many insurance carriers do cover the vaccine but out-of-pocket costs approach $300.  Some small, but interesting studies looked at fruit consumption and vitamin use and have found statistically significant benefits to consuming three servings of fruit each day and/or taking a multivitamin (1)

In Summary...

In summary, shingles is a painful rash that travels along a nerve tract originating in the spine.  It originates from past chicken pox infection that has resided dormant in the nerve cells at the level of the spine.  The infection keeps to a specific nerve tract called a dermatome and does not deviate from this tract.  Shingles can be treated within a window of about three days.  It can also be prevented with a vaccine.  The best thing you can do to arm yourself if you decide against vaccination or are too young to receive it is to gain knowledge about recognition and identification of shingles so that treatment can be rendered.

Source: 

http://ije.oxfordjournals.org/content/35/2/307.full

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10 Comments

  • i had a bout of shingles in 2003 at the young age of 22. it was summer and i had been having great fun with friends boating at the lake. i had never done any water sports in my life other than an occasional round of tubing behind a boat, i finally tried out WAKE BOARDING one day. next thing i know.. i had SHINGLES! but im not sure if the 2 are linked because it is unknown if i had suffered from a water sport injury.
    located on my back right in my left shoulder blade joint at first i didnt know i had it. wearing my bikini.. a friend pointed out the rash worried i had some kind of contagious disease. i didnt know what it was but i knew it wasnt scabies. my sister looked in her home medical book and symptoms suggested shingles. i called kaiser for appointment but wouldnt be seen by a doctor for 4 more days. it must have been the first day i had it because i wasnt in any pain so i went about my day.
    id never really heard of shingles.. other than the one's on my roof LOL, until several weeks before this while watching the David Letterman Show. it was during this time that David letterman himself had it on his face affecting his eye and kept being mentioned by the Guest Superstars he had hosting his show for several months (one being craig kilbourne.. who started his own show once letterman returned)
    but the next day when i woke up.. i was in PAIN. it hurt to lift my arm and i was vomiting continuously about every 15 minutes. so i went to the ER and wasnt even seen until midnight after spending more than 10 hours throwing up every 15-20 minutes. i was put on an IV.. and man..THOSE ICE CHIPS TASTED SO GOOD. i still havent tasted ice that good yet! lol
    i mentioned wake boarding to the doctor.. but it was kaiser emergency room.. that just about explains that. so i dont know if my bout was triggered because of an injury.

    BUT IT DOESNT END THERE! ..it took almost 6 weeks to fully recover. and after i did and the rash and blisters and scabs were gone.. i still felt pain where the rash was. like a sharp knife in my shoulder blade and someone is pushing on it realy hard and is s l o w l y twisting it back and forth back and forth. i wasnt told or given any information about shingles from the doctor/hospital.. and somethiing wasnt right that i was still feeling pain. so i GOOGLED IT! ..and found there was a complication of shingles called PHN. so i educated myself.. ordered publications from the research/disease centers which helped a lot. but the thing was that EVERYTHING THAT I READ.. THE STATISTICS AND FACTS.. NOT 1 APPLIED TO ME OR MY CASE OF SHINGLES. i wasnt old, not HIV positive, no chemo therapy or organ transplant, i wasnt stressed, no compromised immune system from any illness.. and sounded like i was lucky enough to be the small % of people to suffer from the shingles complication PHN!
    now i found all of that kind of well.. .AMAZING! i spent some time trying to find surveys to participate in and other ways to share my factual findings with researchers and wanted to be sort of a singles advocate whos goal would be to educate the public about shigles and encouraging schools and hospitals and health websites to talk more about shingles to bring it into the "spotlight" and provide better education, publications and resources for the public/to the public and seeing to it that hospitals and doctors are doing their jobs and also helping do their part to research by having/providing necessary materials available to doctors and patients conveniently in patient rooms which could consist of proposing that better procedures and guidelines be made.

    with lack of any kind of support.. i gave up before i even knew where to start. today i am a chronic pain sufferer caused by the shingles complication called PHN.

    THANK YOU FOR READING MY SHINGLES STORY

  • Wow! Thanks for sharing,Trace! That's just crazy - I'm 25 and I would never suspect I could get shingles. You should really make this into a blog all it's own!

  • The US CDC says that 20% of shingles involve multiple dermatones, which can cross the midline. Mine did.

  • I had a shingle break out at the age of ten, however, at the age of nine I had suffered an injured spleen. I understand now the correlation there.
    I had an episode that landed me into emergency earlier this year (2014), and now that this year is nearly over, I still have pain that feels similar to flames on the underside of my skin. I have very little rash symptoms with this last episode. The childhood one was a full out half torso wrap of painful blistering rash. As I have begun to educate myself with various reading, I begin to recognize that throughout my life since the childhood onset, I have had bouts of shingles in mild forms. Of course, by the time I saw a medical practitioner about rashes, it was too late. Never during those times had anyone mentioned the word 'shingles'.
    What worries me now (I am 47) is the tingling sensations I get in my face now and again. I have been told that I have some disc damage in the neck, as well as a pinched nerve, and am scheduled for an MRI in Feb 2015.
    It seems that shingles is more common and yet still mysterious. I never considered nor was informed about PHN, and maybe that is something I need to look at in my self education to living with this blasted pain and discomfort that so few understand. Thank you for sharing your story Trace. Thank you very much.

  • I got shingles exactly two years ago. The breakout occurred on my right eye - mainly eyelid, eyebrow and forehead. I was considered to be a very young looking, attractive 63 year old. I looked absolutely horrendous for weeks. Though the rash looked horrible, I never missed a day of work with sunglasses and bangs! When I hear everyone talk so much about pain, I cannot relate. Mine was more unsightly and annoying than painful and after a visit to Urgent Care, two rounds of antivirals, several visits to my ophthalmologist, bottles of eye drops and loss of my eyelashes my appearance slowly got back to normal. And, I began antivirals even BEFORE the rash appeared! BUT, I suffer every day (mostly at night) with the most awful itching, burning and eye watering! I keep waiting for the after affects to go away but I've resigned myself to the fact that this will go on for the rest of my life. When I see TV commercials urging people to get the vaccine, I so wish they would also mention the horrible consequences that no one can see long after the blisters are gone.

  • I'm 45 and got shingles next to my left eye brow. 2 Shingles in fact. I thought they were bug bites, because they were slightly puffy, with a center "bite" that scabbed over. I didn't think much of it until my parents suggested I get it checked. We treated it with antiviral meds just in case. Good thing, because they now come back on occasion. They are so small now, they look like freckles. It's crazy. But I feel them come on immediately, almost like a slight bee sting. They itch for a day or two and then I have no other symptoms. I'm sharing this because I haven't found a case similar to mine and I was curious if anyone out there has a like story? Thanks!

  • I had my first bout of shingles while under severe stress. This was on chest to left shoulder. About ten years later another outbreak was on my head, right side of forehead, to eyebrow, this caused a postponement of a required surgery (so again stress related). I am currently experiencing a patch on my chest, up close to neck, it traverses the midline, but symptoms are right, it also responds to the meds. I have itching, crawling feelings on many parts of my body and regularly want to scratch all the way to the bone... When things get too much of a worry I want to rip my scalp off and odd spots get really hot. itchy, crawly. What name do you give this ongoing torture? will the vaccine help to alleviate any of this?

  • Shingles DOES go across the midline, please change this factrnWould you like one of my own pictures for proof?

  • My husband was just diagnosed with shingles and he had the shingles vaccination. so you can still get shingle if you got vaccinated. Thank you for the information.

  • Shingles, also known as zoster or herpes zoster, is a viral infection caused by the varicella-zoster virus, the same virus that causes chickenpox.rnAnyone who's had chickenpox can get shingles. After you've been infected with chickenpox, the varicella-zoster virus lies inactive in your body — mostly in spinal or cranial nerves — usually for many decades. If the virus reactivates, it can travel along nerve pathways to your skin and cause a rash to erupt. Shingles isn’t life-threatening, but it can be exceedingly painful. Tingling and numbness in the area where the rash will develop are other common symptoms of shingles, and you may even experience the pain but not the rash.rnBecause the pain of shingles originates in the nerves, it has a different quality than any other pain you might have experienced before. rnAccording to EverydayHealth, despite treatment, an estimated 5 to 20 percent of shingles patients will continue to experience pain for weeks or even years after the blisters heal. Those who are still feeling pain 90 or more days after the onset of the rash have a condition that’s called postherpetic neuralgia.

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