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ShinglesIntroduction Shingles is an infection of a nerve and the area of skin that is supplied by it. It is caused by the herpes varicella-zoster virus which also causes chickenpox. Most people have chickenpox as a child, but after the illness has gone, the virus remains dormant (inactive) in the nervous system. The immune system keeps the virus in check, but later in life it can become reactivated, and cause shingles. About 1 in 5 people get shingles at some point in their life. Although it can occur at any age, it is most common in people aged over 50. Shingles usually affects the nerve supply on one Symptoms An episode of shingles usually lasts for 2-4 weeks. The two main symptoms are pain and a rash. The first sign of the condition is a tingling sensation in the affected area, followed by pain. The rash and pain may affect any part of the body. The nerves supplying the chest and abdomen are commonly affected. The upper face (including the eye), arms and leg can also be affected. The rash usually appears a few days after the pain begins. The pain and rash affect only one side of the body (left or right). Pain If you have shingles, you will experience a localised band of pain in the affected area. The pain caused by shingles can be a constant, dull or burning sensation, and its intensity can vary from mild to severe. Alternatively, or as well as this, you may have sharp, stabbing pains from time to time. The affected area of skin will usually be tender. Rash The rash usually follows 2-3 days after the start of the pain, occurs on one side of your body, and follows the line of the affected nerve. Initially, it appears as red blotches on the skin, before developing quickly into itchy blisters, similar in appearance to chickenpox. New blisters may appear for up to a week, but about three days after appearing, they turn yellowish, flatten, and dry out. Scabs form, after the blisters, which may leave some slight scarring. Other symptoms The symptoms of shingles are often mild and no medical treatment is required. However, if you have the symptoms of shingles, you should go to see your GP as soon as possible because early treatment will reduce the severity of your symptoms, as well as the risk of complications. If you have any of the following symptoms, you should seek medical treatment immediately: high fever, confusion, loss of memory, severe headache, and any symptoms that affect the eye area. You should also see you GP if you develop the symptoms of shingles and you are pregnant, or have a weakened immune system. Postherpetic neuralgia Some people who have shingles experience severe nerve pain (neuralgia). Postherpetic neuralgia occurs if the nerves are damaged, and it can last months or, in some cases, years after the initial symptoms have gone. See the complications section for further information about postherpetic neuralgia. Risks The blisters (vesicles) that develop as a result of shingles contain virus particles. The virus can be spread through direct contact with open blisters. A person who has shingles is contagious until the last blister has scabbed over. If you have not had chickenpox before (usually young children), you can catch it from someone with shingles. However, you cannot catch shingles from someone with shingles because the virus has to be reactivated, rather than passed on. If you have had chickenpox in the past, you are immune and cannot get it again. Pregnant women If you are pregnant and have not had chickenpox, you should avoid contact with someone who has shingles. If you are pregnant and get shingles, your risk of getting pneumonia is increased. There is also a slight risk that if your unborn child is exposed to the herpes varicella-zoster virus, your baby may be damaged or miscarried. However, this is less likely with shingles than chickenpox. Weak immune system If you have a weak immune system, it is best to avoid close contact with someone with shingles. If you have a shingles rash, you should avoid sharing towels, going swimming, or playing contact sports, in order to avoid passing the virus on to someone who has not had chickenpox. Complications There are a number of possible complications that can result from shingles. However, they are more likely to occur if you have a weakened immune system. Complications can include: an infected rash that becomes red and tender (a course of antibiotics may be required), white patches (a loss of pigment) in the area of the rash, scarring, though this is unusual, RamsayHunt syndrome, which causes earache, deafness, dizziness, and paralysis of the face, known as Bell's palsy. Pain usually improves with 48 hours, but hearing can become permanently damaged, ulceration and permanent scarring of the surface of the eye (cornea), and inflammation of some parts of the inner eye, such as the iris (the coloured part) and ciliary body (the ring of muscle behind the iris). This condition is known as uveitis, and in rare cases, encephalitis can develop which causes a high fever and confusion. Postherpetic neuralgia Postherpetic neuralgia is the most common complication of shingles. It is prolonged and, in many cases, severe nerve pain (neuralgia) that persists after the rash and any other symptoms have gone. It mainly affects people who are aged over 50, with 25% of those aged 60, or over, having pain that lasts for more than a month. Usually, the pain will ease gradually, but it can last for many months or, in some cases, even years. Treatment There is no cure for shingles, but the symptoms can be controlled, particularly if they are treated at an early stage, before the blisters appear. You may find that wearing loose fitting clothing helps to reduce the irritation that is caused by the rash. Also, using ice cubes (wrapped in a flannel or plastic bag) will cool the affected area, and using wet dressings may also help to reduce the pain. Antiviral medications Antiviral medicines (such as aciclovir, famciclovir, and valaciclovir), are usually taken in tablet form, and are effective if taken during the early stages of shingles. They do not kill the herpes varicella-zoster virus, but prevent it from multiplying. They also help to control the rash, minimise nerve damage, and reduce the risk of prolonged pain and complications. Adults with shingles may be prescribed a course of antiviral medicine if the rash is diagnosed within 72 hours. In many people, an episode of shingles is mild, and will disappear in due course without complications. However, antiviral medicines help to prevent the small number of people who would have gone on to develop into a more serious condition. Generally, the older you are, the more likely you are to develop worse symptoms and complications, and it is more likely that you will benefit from antiviral medicines. People with shingles often visit their doctor when they have had their rash for more than 72 hours. At this stage, an antiviral medicine is unlikely to be effective and will not usually be recommended. Most people will have mild symptoms, particularly if they are under 50 years of age. However, in certain situations, when the rash is more than 72 hours old, your doctor may advise that you take an antiviral medicine. For example if: shingles affects your eye or inner ear your GP may refer you to a specialist if your eye or ear is affected, you have a poor immune system, the rash is severe, or you are elderly. As children rarely have severe shingles or develop complications, antiviral medication is not usually prescribed for them. Painkillers To ease the pain caused by shingles, regular pain relieving medicines are often recommended. A non-steroidal anti-inflammatory drug (NSAID), containing an analgesic (painkiller) may be prescribed by your GP, as long as it does not interact with any other medication that you are taking. Lower strength NSAIDs, such as ibuprofen, paracetamol, or aspirin, are also available from your local pharmacy. However, when taking these medicines, you should always follow the instructions on the box, and children under 16 years of age should not take aspirin. Antidepressants and anticonvulsants If you have severe pain, as a result of shingles, or if you develop postherpetic neuralgia, an antidepressant or anticonvulsant medicine may be prescribed. In the case of shingles, these medicines are used to treat pain, rather than depression or seizures. Tricyclic antidepressants, such as amitryptiline and imipramine, can be effective in easing the severe pain that is often experienced during postherpetic neuralgia. Anticonvulsants, such as carbamazepine and gabapentin, can often help to reduce the pain symptoms of shingles. If you are prescribed an antidepressant or anticonvulsant, you should ensure that you take the medicine regularly, as it may take two weeks, or more, for the medicine to become effective. Alternative treatments If shingles causes long-lasting pain (post herpetic neuralgia), your GP may recommend trying alternative treatments, and may refer you to a pain specialist. The essential oils of Bergamot, Eucalyptus and Tea Tree can be helpful for easing the pain and also for drying out the blisters. Use a combination of them for the best effect. It is interesting to note that Bergamot is probably one of the finest antidepressant oils in the whole repertoire and people who develop shingles are often tense, anxious and depressed. The attack itself causes further depression and so this oil can be of immense value. Try using a small paintbrush to apply the oil and use a combination of half Bergamot and half Tea Tree on the blisters. If a larger area of the skin is affected then have a baht using these oils. Where the pain persists after the blisters have gone try using Chamomile Roman and Lavender essential oils with Bergamot, Eucalyptus and Tea Tree. |
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