Shingles - Herpes Zoster

Shingles or Herpes Zoster represents reactivation of the chickenpox virus. At least 99% of Americans silently carry this virus either from infection with natural chickenpox or from the live virus vaccine routinely administered to children. From the time of infection until we die, the virus lives within the dorsal root ganglia within the spinal cord. During the course of a lifetime, principally in those over age 60, something reactivates the virus and it travels through just one of the affected nerves and makes its way to the skin. An estimated 1 million cases occur each year with the lifetime risk of 20-30%. Even among senior citizens the likelihood of shingles averages only 10 in 1000 individuals each year. Several important points: you cannot “catch” shingles from anyone. Once you are infected with chickenpox or vaccinated as a child, immunity continues throughout life. Theoretically an unvaccinated child could develop chickenpox from direct contact with someone experiencing an acute attack of shingles. However unlike the diffuse eruption of chickenpox, viral contamination in shingles appears dramatically reduced. In the absence of immune deficiency a person will only develop a single attack of shingles during a lifetime. Shingles will not harm the fetus if the disease strikes a pregnant woman. Manifestations of shingles are basically limited to the skin served by the solitary affected nerve. This results in the band like blistery eruption extending in an interrupted pattern from the center of the back to the midline of the chest or abdomen. It affects only the nerve on the right or left side, not both. Blisters appear on a base of reddened skin resembling a cold sore or fever blister gone wild. Healing occurs with or without treatment in 2-3 weeks. Instead of the torso, shingles may involve the face, neck, arm, anogenital area or leg. Facial lesions may extend to the eye and lead to severe complications including blindness. Anogenital eruption leads to especial misery. While pain generally accompanies shingles and may indeed be present in anticipation of the outbreak, the most feared consequence continues to be post-herpetic neuralgia (PHN). By definition this severe pain lingers for more than 90 days after the skin eruption. Long after the virus disappears, the damage to the involved nerve persists. Often described as sharp, stabbing, pulsating, agonizing or throbbing, many liken it to being assaulted with a hot poker. Even the slightest breeze or the light touch of a shirt may precipitate a paroxysm of pain. PHN eventually fades but routinely only after a year or more in senior citizens. Alternatively many younger individuals never experience this degree of pain. Treatment for the shingles involves high does of acyclovir or valcyclovir within 72 hours of the eruption. Arguments continue regarding the optimal treatment for the PHN. Suffice it to say that none of our interventions work sufficiently well. The original shingles vaccine was a disappointment. At best Zostavax provided partial results and then only for a relatively short period of time. Shingrix the newer vaccine appears much more potent and offers long lasting protection against both shingles and PHN.