WHAT IS HERPES ZOSTER (SHINGLES)?
Stanley M. Bierman MD, F.A.C.P. (C2004)
WHAT IS HERPES ZOSTER (SHINGLES)?
Herpes zoster is an infection caused by the varicella zoster virus, the same virus that causes chickenpox in children. The disease is usually heralded by complaints of localized skin hypersensitivity, following which patients develop unilateral blistering lesions along the distribution of a nerve trunk. Untreated, patient may develop post herpetic neuralgia, a painful condition due to damage of the nerve trunks lasting months to years.
HOW IS SHINGLES TREATED?
Prompt therapeutic intervention early in the course of disease is often effective in foreshortening the duration of infection, speed the healing of the skin blisters, and help minimize or abort the painful post herpetic neuralgia sequealae. There are two potent and effective antiviral therapies available from doctors such as FamVir and Valtrex which drugs have minimal adverse side effects. The drugs are administered for a seven to ten day period in combination with appropriate analgetics to relieve the pain that frequently accompanies the disorder. Patients may use Tylenol, Aspirin or Aleve every four to six hours for pain relief but if these over-the-counter agents are insufficient to dull the pain, the doctor may administer a prescription for Darvocet N 100mgm to be taken every four to six hours. For individuals with severe nighttime pain, Amytryptaline (Elavil) 25mgm is an effective pain killer.
Topical treatment for the infection is as follows:
- Apply Listerine mouth wash on a Qtip to the blistered areas three times daily for purpose of cleaning the crusts from the sores.
- Apply Silvadene cream (a prescription will be written for you) with a tongue blade to the involved areas. Silvadene will leave a silver-black discoloration but dramatically relieve the pain and burning.
- Once the blisters have dried (usually 7 days) you may apply Zostrix cream (an over-the-counter agent) to the painful sites as a means of reducing skin pain.
It is important that you limit your physical activities and avoid strenuous exercise and allow your body to rest. Many patients complain of body fatigue following infection but this is an anticipated phenomena (post viral "poop") The use of systemic cortisone in the management of shingles remains controversial, and is usually reserved for circumstances in which there us an extreme degree of swelling and inflammation accompanying the shingles. Thrice weekly intralesional injections of dilute triamcinolone (4mgm/cc) mixed with xylocaine along the distribution of the shingles is often an effective means of pain relief. The treatment is given three times weekly.
- For individuals who fail to obtain relief from the above, a prescription for EMLA (lidocaine) cream will be provided to relieve the burning sensation.
Because shingles is an infectious disease to friends and family members (particularly those who have never had chickenpox as a child), you should observe the following:
- Towels, linens and clothes should be handled with care and washed separately from other family members. Add several ounces of Lysol disinfectant to the wash water.
- Q-tips, dressings and gauze that have touched the lesions should be discarded in a separate brown paper bag and placed in the trash.
- Sleep in separate bed from your spouse for the period of time that the lesions are blistering.
- Keep away from children and elderly individuals who have low immunity.
- Avoid having friends give you a friendly "get well" kiss.
Finally, it is important that you visit your primary care doctor for a complete physical examination and have blood studies performed to investigate your immune status.
- Recent studies indicate that the zoster virus can be spread through airborne secretions and detected on items in the patient's room.