Shingles & PHN: Your Questions Answered

1. Who can get shingles?
   Everyone who has had chickenpox is at risk for shingles. It is most common among people over the age of 50, but can develop at any age. The risk of developing shingles is greater among individuals who have conditions or are undergoing medical treatments that weaken their immune systems. These include: HIV infection; chemotherapy or radiation therapy; corticosteroids; transplant operations and possibly stress. Typically, the older the person, the more severe and long lasting a shingles attack is likely to be. The VZV Research Foundation estimates that, in the United States alone, nearly one million people are afflicted with shingles yearly.
   
   
2. What causes the varicella-zoster virus to reactivate?
   
   Scientists do not know exactly what triggers a reemergence of the varicella-zoster virus (VZV). Research is underway to determine this. However, scientists do know that it more commonly occurs in people over age 50, and in those who have a weakened immune system brought on by aging or an illness such as cancer or HIV infection, and certain medical treatments such as chemotherapy, radiation and steroids. Some theorize that stress may also cause a shingles outbreak.
   
   
3. What are the signs and symptoms of shingles?
   The early signs of a shingles outbreak are so vague, they can easily be mistaken for another illness. They include burning or shooting pain, numbness, tingling or itching in an isolated region on one side of the body or face. Mild flu-like symptoms, such as headache, fever, chills and nausea may also be present. Lesions (the rash) appear on the skin from one to 14 days later, usually in a band on one side of the body, or clustered on one side of the face (where there previously was pain). In two to four days, these lesions become fluid-filled blisters. In two to four weeks, they slowly crust, scab and heal. Once the blisters heal, one may continue to have pain for a month or longer. The skin may also become discolored where the rash once was. It is important that you see your doctor if you suspect shingles; treatment works best if begun within 24-72 hours of the appearance of the rash.
   
   
4. Where do the rash and pain usually appear?
   The rash and pain of shingles usually occur on either the trunk, back, chest, head, face, lower part of the spine or neck.
   
   
5. Can shingles occur without a rash?
   Yes, but this is rare. It is called zoster sine herpete. The shingles rash may also go unnoticed. Shingles typically starts out without the rash. The patient may experience burning or shooting pain, numbness, tingling, itching, headache, fever, chills and nausea. While the rash almost always follows, it may be disregarded or mistaken for something else.
   
   
6. Can shingles be prevented?
   Currently, shingles itself cannot be prevented. However, the chickenpox vaccine, which was approved by the FDA in 1995, prevents chickenpox and, therefore, decreases the likelihood that a vaccinated individual will later develop shingles. A similar vaccine is being studied as a possible prevention for shingles in adults who have had chickenpox.
   
   
7. How can the immune system be strengthened to decrease the chances of developing shingles?
   Although shingles cannot be prevented at this time, common sense suggests that staying healthy, eating a nutritious diet, exercising regularly, resting adequately and controlling stress may help keep the immune system healthy. In turn, the chances of avoiding or recovering from shingles may be increased.
   
   
8. How is shingles treated?
   Antiviral drugs are prescribed to speed recovery from shingles. However, antivirals work best when taken 24-72 hours after the appearance of the rash. Oral antivirals include acyclovir, famciclovir and valaciclovir.
   
   
9. Can a person get shingles twice? If so, does it appear in the same place twice?
   Yes, a person can get shingles twice--it recurs in an estimated one to five percent of patients--and it can reappear many years after the initial episode of shingles. If shingles strikes a second time, it will usually not appear in the same location. Most people who seem to experience multiple episodes of shingles are probably having recurrent infection with a related herpes simplex virus and not true shingles.
   
   
10. Can a person who has never had chickenpox develop shingles?
    No. To get shingles, one must already have had a case of chickenpox and therefore harbor the varicella-zoster virus in the nervous system. However, the case of his or her chickenpox may have been very mild and unrecognized.
    
    
11. Is shingles contagious?
    Shingles cannot be caught from a shingles sufferer. Nor can a person catch shingles if exposed to someone with chickenpox. However, a person who has never had chickenpox can come down with chickenpox if he or she is exposed to the shingles rash. Although shingles is caused by a herpes virus, it is not the same virus that causes the common oral and genital herpes infections.
    
    
12. What is post-herpetic neuralgia (PHN)?
    Post-herpetic neuralgia (PHN) is the name given to the pain that persists for one to three months, or even years, after the shingles rash has healed. The risk of developing PHN is directly related to the patient's age when shingles appears. Patients whose shingles affects their forehead and eyes, a condition known as ophthalmic shingles, may also be at increased risk for PHN. The pain of PHN is the result of injury to the peripheral nerves. It may be sharp, piercing, throbbing or stabbing, and it may extend beyond the area of the original shingles eruption. The skin may be unusually sensitive to even the lightest touch (as from clothing), to the smallest breeze, and to changes in temperature (either hot or cold). The severity and duration of pain appears to increase with age.
    
    
13. How is PHN treated?
    PHN is treated by a variety of pain-relieving approaches: nonsteroidal anti-inflammatory drugs, narcotic analgesics and specific medications for nerve injury-related pain, including certain medications best known for also treating depression. In 1999, the FDA approved a lidocaine skin patch for PHN pain. The effectiveness of treatment for PHN varies widely among patients. If you develop PHN, you may wish to consult a physician who specializes in the treatment of pain; one option is the attending neurologist or anesthesiologist of a leading hospital in your area.
    
    
14. What other complications are associated with shingles?
    In addition to PHN, complications affecting vision and/or hearing are possible if shingles appears on the face. For instance, if shingles affects the eye (ophthalmic shingles), the cornea can become infected, resulting in temporary or permanent blindness. In patients with severely weakened immunity, the shingles virus can also spread to internal organs, infecting the lungs, central nervous system and brain. However debilitating it might be, shingles is rarely fatal, except in patients with severely weakened immunities.
    
    
15. What should I do if I suspect I have shingles?
    See a doctor immediately if you are experiencing any of the symptoms of shingles or if there is any unexplained rash or pain in any part of your body. Shingles treatment is most effective if administered by a doctor within 24 to 72 hours of the appearance of the rash. If a doctor cannot determine the cause of a shingles-like condition, the patient can suggest that it could be shingles. If there is a rash, the doctor can conduct a test to determine whether it is shingles.
    
    
16. How can a physician test for shingles?
    The test to determine whether a patient has shingles consists of the examination in the laboratory of cells recovered from a skin lesion.
    
    
17. If I suspect I have shingles, what type of physician should I see?
    You can consult a general practitioner, family physician, internist, dermatologist or neurologist.