Shingles is an outbreak of a rash or blisters on the skin that may be associated with severe pain. The pain is generally on one side of the body or face.
It is caused by the varicella-zoster virus, the same virus that causes chickenpox. After an attack of chickenpox, the virus lies dormant in the nerve tissue and then, as we get older, it is possible for the virus to reappear in the form of shingles. Shingles is estimated to affect 20% of people in their lifetimes.
The incidence of postherpetic neuralgia is almost negligible before age 50, but at least 50% of patients older than 60 years and almost 75% beyond age 70 become affected following an attack of shingles. Luckily, there is also a marked natural tendency for postherpetic neuralgia to improve over time without treatment. Some estimates suggest that only 2%-3% of patients have pain that lasts for more than 1 year.
Who is at risk for developing shingles?
Although it is most common in people over age 50, anyone who has had chickenpox is at risk for developing shingles. Shingles is also more common in people with weakened immune systems from HIV infection, chemotherapy or radiation treatment, transplant operations and stress. Chicken pox vaccination given to children reduces the incidence and severity of both chicken pox and shingles later in life.
What are the symptoms?
Early signs of shingles include burning or shooting pain and tingling or itching generally located on one side of the body or face. The rash or blisters are present anywhere from one to 14 days.
Are there any possible complications?
Prognosis is good unless the infection spreads to the brain. Eventually, most patients recover completely. If shingles appears on the face, it can lead to complications in hearing and vision. For instance, if shingles affects the eye, the cornea can become infected and lead to temporary or permanent blindness. Another complication of the virus is postherpetic neuralgia, a condition in which the pain from shingles persists for months – sometimes years – after the shingles rash has healed. Bacterial infection of the affected area is another possible side effect.
Conditions that suggest Shingles (Herpes Zoster)
Risk factors for Shingles (Herpes Zoster)
Chicken pox in childhood
Anyone who has had chickenpox is at risk of developing shingles.
Counter Indicators
Not having chicken pox in childhood
Weakened Immune System
Shingles is also more common in people with weakened immune systems from HIV infection, chemotherapy or radiation treatment, transplant operations and stress.
Shingles (Herpes Zoster) suggests the following may be present
Recommendations for Shingles (Herpes Zoster)
Cayenne Pepper (Capsicum frutescens)
Capsaicin used topically may benefit sufferers of postherpetic neuralgia. Capsaicin cream is also called capsicum cream. It is available in drug stores, health food stores, and online. A typical dosage is 0.025% capsaicin cream applied two to four times a day. The benefit may take several weeks to develop.
Conventional Drugs / Information
In a double-blind, randomized, crossover study, 58 patients with postherpetic neuralgia received 6-week courses of amitriptyline, 12.5 to 150 mg/d; lorazepam, 0.5 to 6 mg/d; or lactose placebo. Doses were titrated to the maximum level tolerated. Patients rated pain in a diary, using lists of verbal descriptors. Forty-seven percent of patients reported moderate or greater relief with amitriptyline, 16% with placebo, and 15% with lorazepam. Mean amitriptyline dose was 65 mg/d. Greater relief was associated with higher amitriptyline doses, up to the maxiumum dose of 150 mg/d, and with higher serum tricyclic levels. Lorazepam did not relieve pain and was associated with severe depressive reactions in four patients. [NEUROLOGY 1988;38:1427]
Based on evidence from randomized trials, tricyclic anti-depressants appear to be the only agents of proven benefit for established postherpetic neuralgia.
Ozone / Oxidative Therapy
At the Center of Medical and Surgical Research in Havana, 15 adult patients suffering from herpes zoster were treated with injections of ozone/oxygen for a period of 15 days. All patients were completely symptom-free after the treatment and follow-up examinations a year later showed no relapse.
One analysis of the behavior of Herpes Zoster was carried out with topical ozonized oil therapy and intramuscular application of ozone (0.8mg per day) to patients suffering from this disease. Comforting results and relief of the local symptomatology were obtained just after a few hours from the beginning of the topical use of the ozonized oil, with regression of the cutaneous lesions after 5 days. The pain stopped after 24 hours from the beginning of the therapy, without secondary effects. [J.Delgado, F.Wong, M.Gòmez y S.Menèndez Centro De Investigaciones Mèdico Quirurgicas, Centro Nacional De Investigaciones Cientificas]
Calming / Stretching Exercises
Tai chi chih, the Westernized version of the 2,000-year-old Chinese martial art characterized by slow movement and meditation, significantly boosts the immune systems of older adults against the virus that leads to the painful, blistery rash known as shingles, according to a new UCLA study.
The 25-week study, which involved a group of 112 adults ranging in age from 59 to 86, showed that practicing tai chi chih alone boosted immunity to a level comparable to having received the standard vaccine against the shingles-causing varicella zoster virus. When tai chi chih was combined with the vaccine, immunity reached a level normally seen in middle age. The report appears in the April issue of the Journal of the American Geriatrics Society, currently online.
The results, said lead author Michael Irwin, the Norman Cousins Professor of Psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA, confirm a positive, virus-specific immune response to a behavioral intervention. The findings demonstrate that tai chi chih can produce a clinically relevant boost in shingles immunity and add to the benefit of the shingles vaccine in older adults.
“These are exciting findings, because the positive results of this study also have implications for other infectious diseases, like influenza and pneumonia,” said Irwin, who is also director of the UCLA Cousins Center for Psychoneuroimmunology. “Since older adults often show blunted protective responses to vaccines, this study suggests that tai chi is an approach that might complement and augment the efficacy of other vaccines, such as influenza.”
The study divided individuals into two groups. Half took tai chi chih classes three times a week for 16 weeks, while the other half attended health education classes – including advice on stress management, diet and sleep habits – for the same amount of time and did not practice tai chi chih. After 16 weeks, both groups received a dose of the shingles vaccine Varivax. At the end of the 25-week period, the tai chi chih group achieved a level of immunity two times greater than the health education group. The tai chi chih group also showed significant improvements in physical functioning, vitality, mental health and reduction of bodily pain
The research follows the success of an earlier pilot study that showed a positive immune response from tai chi chih but did not assess its effects when combined with the vaccine.
The varicella zoster virus is the cause of chickenpox in kids. Children who get chickenpox generally recover, but the virus lives on in the body, remaining dormant. As we age, Irwin said, our weakening immune systems may allow the virus to reemerge as shingles. Approximately one-third of adults over 60 will acquire the infection at some point.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
Glossary
Shingles
A severe infection caused by the Varicella-Zoster virus (VZV), affecting mainly adults. It causes painful skin blisters that follow the underlying route of brain or spinal nerves infected by the virus. Also know as herpes zoster.
Virus
Any of a vast group of minute structures composed of a protein coat and a core of DNA and/or RNA that reproduces in the cells of the infected host. Capable of infecting all animals and plants, causing devastating disease in immunocompromised individuals. Viruses are not affected by antibiotics, and are completely dependent upon the cells of the infected host for the ability to reproduce.
Neuralgia
Pain of severe throbbing or stabbing nature along a nerve.
HIV
Abbreviation for human immunodeficiency virus, a retrovirus associated with onset of advanced immunodeficiency syndrome (AIDS).
Chemotherapy
A treatment of disease by any chemicals. Used most often to refer to the chemical treatments used to combat cancer cells.
Chicken Pox
An acute, highly infectious illness, principally of young children, caused by the chicken pox-herpes zoster virus and marked by fever and successive eruptions of clear blisters over the body. Chicken pox may enter latency in the deep nerve ganglia and reactivate years later in the form of herpes zoster.
Cornea
Transparent structure forming the anterior part of the eye.