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The Painful Truth about Herpes Zoster or Shingles

Herpes zoster, commonly known as shingles, is a viral disease characterized by
a painful, blistering rash on one side of the body usually forming a stripe or a line.
The word “zoster” comes from the Greek word meaning belt or girdle, which
describes the shape and location of the rash. The Latin word “cingulus”, from
which the word “shingles” comes, means girdle or zone.
Shingles occurs only in individuals who have been previously infected with the
varicella zoster virus, the chickenpox virus. After the chickenpox blisters heal,
the virus stays dormant in the nerve cells and then, for unknown reasons and
generally in midlife or later, the virus becomes active again resulting in shingles a
viral infection of the skin. The infection presents itself as a rash occurring on the
skin as a band above a nerve on one side of the body. It is most commonly seen
on the torso or lower back area although it can occur on the face and scalp.
Because almost every adult has had chickenpox, most people are at risk of
developing shingles. In fact about 20-30% of people develop shingles at some
point in their lifetime. Of note, is that the risk increases dramatically after age
fifty. For people eighty-five years and older, one out of two will have had
shingles. With the aging population we will see an increase in the incidence of
shingles in the coming decades.
What are the symptoms of shingles?

The first symptoms include headache, fever, and a general unwell feeling. Later,
burning pain, itching, prickling and or numbness of affected skin area occurs. A
rash usually follows in 1-2 days but may take up to 3 weeks to appear. People
have described their pain as burning or throbbing while others experience a
stabbing sharp pain. Pain may arise when the affected area is touched or it may
occur without any contact at all. The rash usually begins as red blisters which
become pustular, fill with blood and then crust over in 7 to 10 days. The crusts
eventually fall off and the skin heals, although there can be some scarring if the
blistering was extensive. In most cases the pain subsides within a month,
however in about a quarter of the cases, shingles can cause long-lasting nerve
pain and other serious complications. Shingle and can become a debilitating
o scarring o bacterial skin infections o weakness o muscle
but the most common complication is the pain called “post-herpetic neuralgia,”
which, by medical definition, is nerve pain persisting more than a month. About 5
% of people under age 60 with shingles develop this long lasting pain however
this increases to 20% for people aged 80 and over.
What is the treatment for shingles?

Shingles can be treated with antiviral drugs like acyclovir (Zovirax), valacyclovir
(Valtrex) and famciclovir (Famvir). These drugs may reduce the severity of pain
and the duration of the rash but it seems that they do not reduce the risk of long
lasting nerve pain.
It is important to start drug treatment within 72 hours of the appearance of the
rash for optimal effect. Pain relieving drugs like acetaminophen or anti-
inflammatory drugs like ibuprofen may be needed as the antiviral drugs have a
relatively modest effect on pain. It may be necessary to use stronger pain
relievers like codeine or tramadol for pain control.
Some anticonvulsant drugs have been useful in reducing the sharp burning pain
of post-herpetic neuralgia. These drugs include phenytoin (Dilantin),
carbamazepine (Tegretol) and gabapentin (Neurontin). Sometimes narcotics,
certain antidepressants and or capsaicin cream (Zostrix) are also used to help
control the pain.
What can be done to prevent shingles?

It makes sense to attempt to prevent the occurrence of shingles as the treatment
has significant limitations.
People with shingles may transmit the virus to people who have not had prior
varicella zoster virus infections, especially pregnant or immuno-compromised
It is very important for people who have shingles to cover the rash area and to
adhere to careful hand washing so there is no spread to others.
An individual is no longer considered infectious once the lesions crust over.
Recently a vaccine has become available in Canada for the prevention of shingles. “Zostavax” vaccine is approved for adults 60 years or over by the Canadian health authorities and recommended for adults over 60 years by an advisory committee to the Center for Disease Control (CDC) in Atlanta . This new vaccine contains a live, attenuated (not disease causing) strain of the varicella zoster virus and it reduces the risk of shingles infection by 51% and the burden of illness (symptoms and complications) by 61%. It has been shown to have good safety and tolerability profiles. If one does contract shingles, even though they have been vaccinated, the intensity and duration of nerve pain is significantly reduced. The vaccine cannot be used to treat an existing shingles infection or any ongoing post-herpetic pain caused by a shingles infection. If you have previously had chickenpox you may significantly reduce your risk of suffering from shingles by getting this vaccination. Your pharmacist can give you more information about shingles, its treatment and the vaccine however it is up to your doctor to decide if the vaccine is appropriate for you. Ruth Young B.Sc.Phm Family Practice Pharmacist Young’s Pharmacy & Homecare


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