Shingles Fact and Fiction
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, 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, 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.