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Shingles

June 6, 2016


Shingles

Shingles is a nasty illness associated with a specific rash, most commonly seen in the elderly.

The virus that causes shingles, herpes zoster, causes chickenpox to us when we are first exposed to it, normally in childhood. After the chickenpox clears the herpes zoster seeks refuge in a nerve ending where it lays dormant, often for decades.

Eventually the herpes zoster reactivates, and causes shingles. Shingles typically occurs in the over 60 year olds and is most common in the over 80 years old age group (50% will contract it in this group). Often it starts as a painful area of skin and later on a red rash develops. Blisters form on the area of redness, and typically they begin weeping before they dry up and crust. The crusts take about 2 weeks to clear. This 3-week illness causes a lot of disability, often it is associated with severe malaise and fatigue and also the rash is exquisitely painful.

The rash is very interesting as it follows a dermatome along the skin surface. A dermatome is the area supplied by an individual nerve and has a specific area that can be mapped out as shown on the diagram. Dermatomes do not cross the midline, so the shingles rash will either be on the left or the right, but not all the way across the body. Occasionally shingles will involve 2 nerve endings.

Typically, the shingles rash involves the face or trunk. Occular shingles (involving the eye) is particularly nasty and can cause blindness. Shingles on the face can lead to Ramsay Hunt syndrome, which causes hearing loss, loss of taste buds, and facial paralysis.

Chickenpox is a contagious disease and can cause chickenpox in those who do not have immunity. Shingles is also contagious, but it can only cause chickenpox in those who are not immune. It is impossible to catch shingles, only chickenpox. Chicken pox can be caught from someone with shingles only until all the sores have crusted over.

It is possible to have shingles more than once.

In 30% of cases shingles is followed by a painful episode called 'post herpetic neuralgia". This can last months or years, and it is pain in the nerve ending. Often it is not very responsive to simple painkillers.

If shingles is caught early, antiviral medication like aciclovir, may help minimise the illness, but once the rash is established there is little that can be done. The mainstay of treatment is pain relief, and often heavy duty prescription only medication is necessary. For post herpetic neuralgia early intervention with nerve pain drugs like amitriptyline may reduce the duration.

Prevention is possible, and there is a shingles vaccination licensed in New Zealand called ZOSTAVAX. It is licensed for use in the over 50s, but is most effective if given between 50 and 60 years. For those who have already had shingles their immune system will be good at preventing a recurrence for up to 4 years, so the best time to vaccinate is 4 years after the first episode.

ZOSTAVAX is not a funded vaccine unfortunately and is costly at $230. If you are over 50 years and would like to be vaccinated, please make an appointment with the nurse. We normally hold a small number of ZOSTAVAX in stock, but please check when you book your appointment. It is possible to receive a flu shot at the same time as shingles vaccination.