Definition

     Often found in people with a past history of Chicken Pox, this disease occurs when the Chicken Pox virus reactivates in a nerve root.  Any person who has had Chicken Pox previously may get an outbreak, but those with AIDS, or who are immunocompromised (such as on cancer chemotherapy or those with Hodgkin's Disease) are more predisposed.  Symptoms usually last for 3-6 weeks (shorter with treatment).

Cause

     The disease is caused by varicella, the same virus that causes chickenpox. Anyone who has had chicken pox has the potential to develop shingles later in life.

Symptoms

• Blistering along a nerve root distribution that stems from the spinal cord. It is common to see a band of blisters (that may be continuous or have eruptions) on one side of the body or the other.  Initially, they may be painless or have only mild itching.  Later, the areas often become severely painful.  Immunocompromised individuals may have outbreaks in multiple areas.

Screening and Diagnostics

• In most cases, Shingles are easily identified by the physician.

Treatment

• Most patients without an underlying medical illness will recover without treatment, but they will recover quicker and with less pain if properly treated.

• Calamine lotion may help with itching

• Acyclovir, Famciclovir, and Valaciclovir for 7 days are an effective treatment. All of these will shorten the course of Shingles, and help prevent postherpetic neuralgia.

• Narcotic Pain medication is often necessary

• Ophthalmology referral if the disease is involved with the eyes in any way.

• Corticosteroids may be helpful in some patients, especially those with severe pain.

• Foscarnet may be used if Acyclovir fails in immunocompromised patients

• Postherpetic Neuralgia:

1. Capsaicin ointment

2. Amitriptyline

3. Doxepin

4. Nerve Blocks

Complications

• Eye involvement can be quite severe, causing blistering, swelling, and redness of the eye. It may also impair the patient's vision.

• Sacral may cause bowel or bladder problems

• Postherpetic neuralgia occurs when persistent pain causes the nerves to be affected after the Shingles are gone, resulting in chronic, ongoing pain.

Prevention

• The Chicken Pox vaccine, which is now routinely given to young children, should prevent Shingles.  Once someone already has had Chicken Pox, it cannot be prevented.