What is shingles?
Shingles is a painful rash that is caused by reactivation of varicella-zoster virus infection. Varicella-zoster primary infection is known as chickenpox, recognizable by many vesicular lesions that appear in different states of development on the face, trunk, and extremities. As the primary infection resolves, the virus remains latent in the sensory nerves. Shingles refers to reactivation of the varicella-zoster virus to produce a painful eruption of vesicles, usually on one side along a particular nerve distribution known as a dermatome. Herpes zoster, as shingles is known, can occur at any age, although it occurs with greatest frequency in adults who are over the age of 60.
What happens if you have shingles?
Shingles begins with a painful vesicular rash that spreads in a particular pattern along the affected nerve. The nerve is inflamed and nerve pain may continue for weeks, long after the vesicles have crusted over. The pain is most likely the result of viral replication, inflammation, and production of inflammatory chemicals called cytokines that can cause nerve destruction and increased sensitivity of pain receptors. Shingles are painful and unsightly, so if you have developed shingles, you will be glad to know your dermatologist can assist you with treatment.
Is treatment available?
Absolutely! Treatment has multiple goals, including reduction of the severity and duration of pain associated with the neuritis and promotion of more rapid healing of skin lesions. Appropriate treatment can prevent formation of new lesions and decrease the amount of “viral shedding” to reduce the risk of transmission to others. Treatment may play a role in prevention of post-herpetic neuralgia (chronic nerve pain that can result from herpes zoster), but this is still controversial.
Antivirals: start early
Treatment is two-pronged: control of the virus and relief of pain. Antiviral medications, which include acyclovir, famciclovir, and valacyclovir, have all shown clinical benefit and safety in patients with an intact immune system. The benefits of antiviral therapy are more widely studied in older patients, but since the risk of therapy is low and early treatment can reduce symptoms and shorten the course of the disease, patients who present within 72 hours of developing symptoms are also good candidates for antiviral therapy. The key to success is early antiviral treatment.
Antiviral therapy can reduce the pain associated with shingles, but frequently an analgesic should be prescribed. For mild pain, use of acetaminophen and a nonsteroidal anti-inflammatory drug (NSAID) can be helpful alone or in combination with a weak opioid analgesic like tramadol. Some patients experience severe pain that may disturb sleep. For those patients, we recommend a stronger opioid analgesic medication. Other therapies have not demonstrated consistent results. These medications include gabapentin, tricyclic antidepressants, and glucocorticoids.
Herpes Zoster Vaccine
The herpes zoster vaccine is recommended for individuals who are 60 years of age or older. It appears to be moderately effective in reduction of the incidence of shingles and post-herpetic neuralgia. Most experts recommend a zoster vaccine whether or not the person has a history of herpes zoster in the past.
If you have a painful rash, there could be a number of causes. Call us today for your appointment at one of our convenient locations in Glendale, Beverly Hills, or Encino. Shingles is surprisingly common and can be treated to reduce your discomfort and pain. If you have a painful rash, call today for diagnosis and treatment with one of our experienced dermatologists.