Melody M. Rodarte, D.O., is an internal medicine physician on staff at Banner Gateway Medical Center.
Question: What is shingles?
Answer: Shingles is characterized by a painful blister type rash that affects roughly one million Americans each year. Shingles is caused by the varicella-zoster virus (VZV) which also is the virus responsible for chicken pox. There is a 20 percent lifetime risk of developing shingles. After the infection with chicken pox the virus can reside in the nervous system quietly for years.
Herpes zoster, shingles, is a reactivation of the varicella-zoster virus which has been dormant in the nervous system. Any healthy adult is at risk but after age 50 our immune system decreases increasing the risk of the virus reactivating. Triggers for reactivation can include stress and an illness.
Painful blisters in a line or that “wrap around” one side of the torso is the characteristic rash for shingles. A tingling, heat sensation may proceed the eruption. Some have felt increased sensitivity or numbness to the area prior to the blisters appearing. The blisters may last a few days and then scab over. It may take three to four weeks for total healing of the rash and it is not uncommon to have a scar (darker skin where each blister occurred). The open blister phase is the contagious phase and precautions should be taken with pregnant women, newborns, immunocompromised persons and those who have not had chicken pox. You can not give someone shingles but you can give them chicken pox.
Complications of shingles can include continued pain which is termed post-herpetic neuralgia (PNH). About 10-15 percent of all patients develop PNH. Those at increased risk of PNH are the elderly. Ocular or ear involvement may occur if the face (trigeminal nerve) is involved and requires immediate treatment and surveillance. Superficial skin infections may also occur in the lesions. Prompt treatment can reduce the complications and duration. There are multiple treatment options using antiviral agents, pain medications and antidepressants which have calming effects on the irritated nerve.
In 2006, the FDA approved the shingles vaccine Zostavax. The vaccine is recommended for adults older than 60. The vaccine has shown to decrease the incidence of zoster by 51percent, decrease the severity by 61percent, and can decrease the risk of PNH by 67percent. Zostavax can be given to adults who have not had chicken pox or the chicken pox vaccine.
If you’ve had shingles, you can still get the vaccine but not during the infection. It is recommended for patients with some chronic disease states such as rheumatoid arthritis. Contraindications to the vaccine include acquired and primary immunodeficiency states, those receiving immunosuppressive treatments, pregnancy, allergy to vaccine components (neomycin and gelatin), some blood diseases (leukemia, lymphoma), and concurrent use of antiviral medications. The vaccine is a live-attenuated virus and thus a small percentage (less than 1 percent) may get a rash characteristic of shingles at the injection site. The most common side effects are local injection site reactions such as swelling, tenderness and redness. Zostavax should not be given with other live-attenuated vaccines.