Shingles: Causes, treatment and prevention
Shingles (also known as “herpes zoster”) does not only happen to the elderly, young people who suffered are also on an uptrend.
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Risk factors for shingles
If you have been infected with chickenpox, you may develop shingles. Age, daily stress, chronic diseases such as diabetes, long term use of immunosuppressant (such as oral steroids) are major risk factors, and the virus in the nerves may be reactivated again.
Shingles are caused by the reactivation of varicella-zoster virus (VZV) inside patients. Patients will experience itchiness or soreness over the skin of a certain part of the body at first, but then a rash will appear, followed by numbness, tingling, burning, and even throbbing sensation of electric shock. These are common sensations experienced by patients with shingles. Yet, patients may mistake the symptoms for other diseases when feeling the pain. For example, if a patient experiences chest pain, s/he may think it is heart disease instead of shingles.
The virus travels along the affected nerve to the area of the skin served by those nerves, then cause a distinctive, stripe-like rash. The rash developed into blisters and spread along the affected area. The blisters may last for 1 to 14 days, which may accompany by pustules or blood. The blisters usually dry up, form scabs and then fall off within two to three weeks.
First step if you suspect having shingles:
If you suspect having shingles, please seek professional help as soon as possible. "The Golden 72 hours" (the first 72 hours of developing symptoms) is an important form of treatment. When blisters appear, visit a doctor as early as possible for diagnosis. If the patient can take antiviral drugs within the first 72 hours, it can shorten the blister period, relieve pain, reduce the chance of recurrence and transmission, and reduce the complication of nerve pain (neuralgia).
Long term effects of shingles
The rash from shingles comes with blisters. Theatrically, most of the blisters on the skin are self-healed. However, if handled incorrectly, e.g. blisters are pierced through and infected, the inflamed wound will worsen the symptoms. However, the self-healed scenario only applies to the skin. The nerves may not heal on their own and may cause complication of long-term nerve pain (neuralgia).
Some patients may experience serious complications after recovery, including post-shingle nerve pain (also known as “Postherpetic Neuralgia”). The pain may last for months or years. Even if touching the skin softly, the patient may occasionally feel enormous pain. Also, pigmentation may appear on the affected area, causing the skin to darkened, which may take several months to dissipate. In severe cases, scars may be left.
After recovery, shingles may recur
Although there is no accurate figure for the recurrence rate, according to different studies, about 6% of patients have a chance of recurrence after the first time. Women are more likely to relapse, with unknown cause, among the cases. Cancer patients, individuals who take high-dose steroids and those who have immune system diseases also have a higher chance of relapse after recovery. Patients who suffer from long-term stress and lack of sleep, which weaken the immune system, also have a higher chance of relapse.
Shingles blisters are contagious
The fluid inside the blister on the skin is contagious. Therefore, we advise patients with shingles to avoid contact with individuals who have not had chickenpox. For example, patients in the period when the rash is blistering, shall avoid contact with grandchildren who have not had chickenpox. The virus in the blisters will be transmitted through contact, causing the other person to have chickenpox. The contagious period ends when the blisters become scabs.
Effective shingles prevention
There is no guaranteed disease prevention, yet vaccination can effectively prevent shingles. Most vaccines in the market have a protection rate of more than 50%. For individuals over aged 60, the protection rate is higher than 60%. Both men and women are suitable for vaccination. Even if patients develop shingles after vaccination, the duration is effectively shortened, chances for nerve pain (neuralgia) and degree of pain are reduced. Currently, there are two types of shingles vaccine available in Hong Kong.
Myth 1: Rash is the first symptom of Shingles
- Truth: No. In the early stage, the skin may look normal despite that patients may experience itch and pain, burning and tingling sensations, and the affected area becomes hypersensitive which is painful when being touched softly.
Myth 2: It always develop on your torso
- Truth: No. Shingles could be developed at any part of the body where the nerves locate, including the waist, hands, feet and even the face. If shingles develop on the face, they may affect the cornea or ears, causing blindness or deafness.
Myth 3: Rash develops across the body will cause death
- Truth: No. Shingles are generally concentrated on the left or right side and do not cross the middle line of the body. Because the blisters of shingles, which were caused by the same virus that cause chickenpox at a young age, remains dormant in the nerves. As we aged or when our immune system is weakened, the viruses may be reactivated and develop along the nerves.
Myth 4: Chickenpox was incompletely manifested during childhood then develop into shingles
- Truth: No. If you have had chickenpox during childhood, you may develop shingles. Even if children get chickenpox vaccination, the chance of getting chickenpox still exist. Vaccination only helps to reduce the disease severity and complications. Once you had the virus inside your body (chickenpox during children), the chance of getting shingles exists.
Myth 5: Chickenpox and shingles are the same thing
- Truth: No. Both are caused by the same virus, but shingles and chickenpox are not the same illness. Chickenpox brings on hundreds of itchy blisters that heal in 5 to 7 days, usually in children. However, shingles rash can last about a month which brings a higher degree of discomfort and complication.
Myth 6: Shingles is harmful to pregnant women and unborn babies
- Truth: No. Pregnant women can develop shingles if they have previously had chickenpox. However, it's usually mild and there is no risk to the mother or baby. However, if you're pregnant and suspected of developing shingles, please consult a doctor immediately.