Shingles: more than just a rash

Some 95% of U.S. adults had chickenpox when they were children. Chickenpox, scientifically called varicella, is usually an annoying but not dangerous illness in children.

What makes the illness treacherous is that the causative varicella-zoster virus can go into a dormant phase, hiding out mostly in nerve roots near the spinal cord. When our immune system is weakened by stress, illness, medications or simply aging, the virus can spread out from the nerve root along the nerve.

This recurrence of virus along the course of a nerve is shingles.

The clinical course of shingles is usually very stereotyped. With a patient who is a good observer, I can usually diagnose it over the phone.

Stage one is an itching or burning pain localized to a band around one area of the body with nothing visible. To many, it feels as if they burned themselves when they did not.

The next phase sees them break out with blisters in the same area. It can be on any part of the body, head to toe, but is virtually always only on one side, right or left.

The blisters scab over and eventually dry up, but this may take weeks. Particularly in older people, the pain may linger for months or years after the rash has gone. This is called post-herpetic neuralgia and is very distressing.

If the involved nerve is one of the nerves of the face, the eye may be affected, and this can be a sight-threatening issue.

To fight back, we have treatment and prevention.

Two anti-viral drugs, acyclovir and famciclovir, are useful in shortening the course of the illness and in preventing post-herpetic neuralgia. To be effective, they should be given early, ideally within a day of the rash appearing. If you break out with what may be shingles on Friday, do not wait until Monday to seek help.

Vaccines are available that reduce the likelihood of getting shingles. The older one, Zostavax, is about 65% effective and the newer one, Shingrix, is over 90% effective. While Zostavax is easy to get: one shot, minimal side-effects, the more effective Shingrix requires two shots and is more likely to give you a day or two of flu-like symptoms.

There have been recent studies suggesting that vaccination reduces the risk of dementia, possibly by preventing the re-emergence of the varicella-zoster virus dormant in the brain.

Since most children are now vaccinated against chickenpox – the vaccine came out in 1995 – we can hope that shingles will follow polio and smallpox into “mostly of historical interest.”

In the meantime, most older adults should get the shingles vaccine. If getting Shingrix, don’t schedule your shot the day or two before an important event.


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