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Identifying and Treating Shingles (Herpes)
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Identifying and Treating Shingles

John Kraft and Charles Lynde, MD, FRCPC

Shingles can affect anyone who has had chickenpox at some time. As most adults (over 99%) have had chickenpox at some point in their lives, almost everyone is potentially at risk of getting shingles. After contracting, and recovering from chickenpox, the virus goes into latency in the nerve roots of the spinal cord. The virus remains there, hidden away from the immune system. Shingles is the result of the virus coming out of latency due to a trigger such as old age, stress, or other weakening of the immune system. Varicella zoster virus is a member of the Herpes family of viruses, and is the cause of shingles. For more information, visit www.herpesguide.ca.

How the Virus Works

In shingles, the varicella zoster virus multiply when it becomes active at the root of a sensory nerve of the skin, and then migrates down the nerve, affecting the skin that the nerve touches. Initial symptoms of red blistering can be seen within 12 to 24 hours when the virus replicates in the skin. Over the first 3 to 5 days following the activation of the virus, the lesion will spread over the entire dermatome. During this time, the shingles is considered contagious, although it will only affect those who have never been exposed to chicken pox. For those people, they will develop chicken pox, but not shingles. Over time, the blisters will become pustules, dry out, and crust, usually within the first week. Within 2 to 4 weeks, the skin will recover from the crusty state. If the lesions become infected, the chances of scarring increase.

Shingles can cause considerable pain at all stages due to inflammation and destruction of the dorsal nerves. Generally, the pain subsides as the rashes disappear. The sensation is often described as a sharp burning, stabbing or throbbing pain. Enlarging of lymph nodes, fever, headache, nausea, vomiting, and general malaise are all considered to be symptoms of shingles.

Treating Shingles

Although shingles will naturally heal, various neurological (post-herpetic neuralgia), ocular (conjunctivitis, uveitis), dermatological (scarring, bacterial infection), or visceral (pancreatitis, pneumonitis) complications can occur following shingles. As such, shingles should be treated properly. Antiviral treatments can decrease the likelihood of developing post-herpetic neuralgia, which causes pain in the affected area for 3 months or more following the shingles. When the virus damages the nerves, it results in hyperalgesia or decreased pain thresholds, and allodynia or pain caused by normally innocuous stimulus.

Treatment Options

The main goal of treatment for shingles is symptom relief and preventing the occurrence of post-herpetic neuralgia, and other complications. Since the introduction of acyclovir, and antiviral that was developed approximately 20 years ago, this has been the mainstay of shingles treatment. Since then, new antivirals such as famciclovir (Famvir) and valacuclovir (Valtrex) have been introduced and has shown itself to be more effective than acyclovir. For more information on these antiviral treatments, please visit www.herpesguide.ca/herpes_treatment/available.html. These antivirals are most effective when used during the acute phase, within two to three days of the onset of shingles. As such, seeking treatment early is essential in minimizing the symptoms, duration of illness, and reducing the risk of later complications. Pain and itching can be mitigated by the use of acetaminophen, NSAIDS, and ACA as well as application of calamine lotion, ice, or cool baths. For those that have post-herpetic neuralgia, unconventional analgesics such as low-dose antidepressants or gabapentin may be used to relieve pain.

In all cases, early treatment with antivirals is critical in prompt and safe treatment of shingles. With quick treatment, the symptoms will be reduced and resolved quicker, and the risk of complications are greatly reduced.
 

Related:

chickenpox,   herpes,   shingles,   skincare,