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Chicken pox isn't just for kids.

Those of us who had chicken pox in childhood were doubtless told that we need not worry about getting it again in adulthood. Unfortunately, that information is rather misleading.

Although the typical chicken pox rash rarely occurs among persons who previously had the disease, the virus that causes it - herpes zoster - is responsible for another form of the disease that occurs much later in life - shingles. This painful affliction affects about one in 20 persons who had chicken pox during childhood.

It seems that the body doesn't always completely rid itself of the virus during a chicken pox attack. Instead, some of the virus may remain, making itself at home in the nervous system, usually in one of the sensory nerves near the spinal cord or within the brain itself.

The virus usually remains dormant for years-until some untoward event occurs that reactivates it. This may result from suppression of the immune system (as in the case of AIDS), cancer of the lymphatic system (such as Hodgkin's disease), or lymphatic leukemia.

In many cases, however, it is something as simple as physical trauma to the skin from an injury or from excessive sunlight. Even emotional stress may reactivate the virus.

Both "zoster" and "shingles" (the first word comes from Greece, the second from Scandinavia) mean "a belt." The Norwegians call the disease "Belt of Roses from Hell" - an apt and vivid description of the painful eruptions that often occur.

Whatever the precipitating factor, the awakened virus tends to migrate along the nerve until it reaches the skin - accounting for the peculiar distribution of the painful blisters that characterizes the disease. Because only a single nerve bundle is affected, the lesions are usually on one side of the body, typically the face or the trunk.

The pain, however, usually appears from one to three weeks before the eruption of the blisters, and may be accompanied by fever and chills.

Because the virus may travel along nerve paths to the eyes, ears, or the brain, where severe damage may occur, it is important for the patient to consult a doctor as early as possible.

Acyclovir, an antiviral drug, keeps the disease from spreading and eases the pain. Aspirin, acetominophen, or stronger pain relievers are also helpful. Cold or warm compresses, according to one's preference, can be applied to the blisters several times a day, for 30 minutes to an hour at a time.

The blisters should not, however, be scratched or bandaged, for they are easily infected with bacteria - and until they dry up and the crusts fall off, they can be a source of infection to others.

Because the disease results from reactivation of a virus already in the patient's nervous system, one cannot catch shingles from a person with shingles. However, a person who has not previously had chicken pox can get it from contact with a shingles patient.

Conversely, a case of chicken pox within a family has been known to produce both chicken pox in an exposed sibling and shingles in an exposed parent. In the latter instance, infection with the fresh virus seems to have reactivated the dormant virus.

Unfortunately, the pain of shingles may persist long after the skin lesions have disappeared - for months and even for years. Many different drugs and other forms of therapy have been used to treat post-herpetic pain, none of which seems to work for everyone.

If you or someone you know continues to suffer from the pain of shingles, you may wish to write to the International Pain Foundation, 909 NE 43rd Street, Suite 306, Seattle, Washington 98105 for information on the proper management of chronic pain.
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Publication:Medical Update
Date:May 1, 1992
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