Shingles... The Reincarnated Chicken Pox

Chicken pox is a very common childhood disease. In most children, after a couple of weeks of discomfort, fever and a skin rash with small itchy blisters, it disappears without trace in the forgotten chasm of early experiences.

However, the virus that causes it (the Varicella-Zoster virus) may remain hidden in the tissues of some people only to arise later to life, as a kind of unwanted Sleeping Beauty.

The virus usually hides in the sensory nerves close to the spinal cord. These are clusters of nerve cells which receive all kinds of sensations from the skin through connecting perception nerves. When the virus awakens, and by the way the awakening signal is not a kiss or a bell, it then travels along the sensory nerves to the region of skin that the particular nerves supply. There it grows and multiplies and causes a painful blistering rash, somewhat similar to that of chicken pox except that the lesions are deeper and more closely packed. The regional supply of skin by the various nerves accounts for the fact that distribution of the rash, usually on the face, chest or abdomen is over a fairly well defined, transverse strip of skin.

Shingles, or herpes zoster as it is medically named, should not be confused with the blistering rash of cold sores (herpes simplex) or with the ominous Herpes of the genitalia (herpes genitalis). It is a totally different condition.

Why certain people get the shingles, this viral infection of nerves, and others do not, is unknown. The virus is an equal opportunity agent--it affects all races and both sexes equally. However, elderly people and individuals with a less than effective immune defense system are more likely to develop shingles if they have experienced chicken pox in childhood. Trauma and sun exposure have also been reported to trigger the activation of the dormant virus.

A person must already have had chicken pox in the past in order to develop shingles and usually the disease does not re-occur, unless the person's immune system is depressed (e.g. by HIV, leukemia or cancer).

Contact with an individual affected with shingles does not cause another person's dormant virus to reactivate. In other words, a person with shingles cannot cause another to develop this condition. Similarly, contact of an adult with a child that has chicken pox will not precipitate shingles in the former.

However, the virus from a Shingles patient's lesions may cause chicken pox in someone who has not had it before. Because the virus is present in the fluid of the shingles' blisters, it may also contaminate pieces of clothing that become equally infectious. For this reason, covering of active shingles blisters is recommended, although isolation of patients is not necessary.

It is definitely advised that women who believe they may be pregnant avoid an individual with shingles because of possible harm to the developing fetus.

Symptoms:

The first sign is often an oversensitive skin, a tingling feeling on the skin, itchiness or a sharp, piercing pain. After several days, a rash appears beginning as a band or patch of raised dots on the side of the trunk or face. It then develops into small, fluid-filled blisters which eventually dry out and crust over within three to five days. When the rash is at its peak, symptoms may range from different degrees of itching to extreme and intense pain. The rash and pain usually disappear within

two to three weeks. Rarely, the pain or skin hypersensitivity may last for months or more, long after the rash has disappeared.

Complications:

Shingles is usually not dangerous to healthy individuals although it can cause a great deal of suffering during an attack. A high fever, difficulty eating or drinking, problems with hearing or balance, or persistence of symptoms should prompt a medical examination. It is strongly advised that anyone with shingles on their face, no matter how mild, should seek immediate medical attention because the virus may cause damage to the eye resulting in blindness. Complications are rare but may include partial facial paralysis (usually temporary), ear damage or encephalitis (inflammation of the brain).

Treatment:

Most cases of mild shingles resolve on their own without specific treatment, except for analgesics (pain killers). Two anti-viral medications (Vidarabine and Acyclovir) are of particular value in treating immuno-compromised patients affected by shingles. Such anti-viral drugs are especially effective when given early during the rash and are recommended even when shingles affects people with normal immune responses. Steroids, given early during the disease, also tend to reduce the severity of the discomfort and the likelihood of complications and nerve damage.

The only prevention strategy available in the prevention of shingles (herpes zoster) is to prevent chicken pox. A chicken pox vaccine is currently available and, hopefully, immunized individuals will be less likely to develop shingles in the future.