Health Zone: Dr Miriam Stoppard's Health Focus Shingles - Lurking for a chance.
IN the UK, one person in 350 suffers a shingles attack. It's painful, sometimes disabling and mainly strikes people aged over 50. The worst part of shingles is the nerve pain that may persist when the attack has subsided. And shingles is caused by the same virus as childhood chickenpox: one in four people who had chickenpox will get shingles.
SHINGLES is caused by the herpes zoster virus which also causes chickenpox. The only people who can develop shingles are those who have had chickenpox.
After a bout of chickenpox (usually in childhood), the virus becomes inactive and migrates to the nerve cells, often close to the spine, where it waits, dormant.
In some people, it never re-activates, but in others it does - often for no apparent reason.
However, if you think back, you sometimes realise a significant event occurred shortly before the onset of your shingles.
It may have been another illness, an injury (sometimes to the part where the rash later appears) or a stressful event of some kind.
Stress causes the release of cortisol - a hormone which can undermine the immune system and liberate the virus.
No one can predict who will get shingles but it does seem to come at a time of weakened immunity.
Even a cold or flu may give shingles the opportunity to strike. When the virus is reactivated, it spreads along the nerves.
So herpes zoster often affects a strip of skin which follows the line of the thoracic nerves that run round the body parallel to the ribs.
Less commonly, it affects a strip on one side of the neck and arm, or on one side of the trunk.
Sometimes, herpes zoster involves one side of the upper half of the face, affecting the eye. Here shingles is known as herpes zoster ophthalmicus and can be very serious.
What is shingles like?
THE first sign is usually excessive sensitivity in the skin affected over the inflamed nerve.
This is followed by pain which is sometimes severe and, until the rash appears, may be mistaken for pleurisy or appendicitis.
After about five days, the rash appears starting with small, slightly-raised red spots that quickly turn to tense blisters, teeming with virus.
Within three days the blisters have turned yellowish and soon dry, flatten and crust over. During the next two weeks or so these crusts drop off, sometimes leaving small pitted scars, just like chickenpox.
Post herpetic neuralgia THEmost serious feature of herpes zoster is pain following an attack, a condition known as postherpetic pain. The pain is a a consequence of damage to the nerves, causing strong nerve impulses which pass upwards to the brain.
The pain, which affects about one third of suffers, may be severe and last for months or even years.
It's quite a task to find a successful remedy because, the older the patient, the more pronounced the rash and the more likely the pain will be severe and persistent.
Ophthalmic herpes zoster
HERPES zoster of the eye complicates shingles on the upper part of the face but it may be confined to the eyelids and forehead and need not affect the eye itself.
But, if it does, it may cause a corneal ulcer or uveitis, both of which are potentially serious and need specialist treatment. Anyone with ophthalmic herpes must see an ophthalmologist promptly.
Can you catch it?
IT'S highly unlikely anyone will catch shingles from someone who has it. However, it is possible for someone with shingles to pass on chickenpox to someone who has never had it.
The virus is most contagious when in its rash form. Once the crusts have formed, it becomes much weaker and the risk of infecting others is low.
Unlike German measles, which can cause deformities in unborn children, the shingles and chickenpox virus does not.
How will a doctor treat it?
TREATMENT is a three-pronged attack:
1 Antiviral drugs
2 Steroid drugs
3 Topical creams and sprays
Immediate treatment with antiviral drugs like aciclovir can significantly reduce the severity and length of an attack.
These drugs have to be given very early in the course of the attack, before the rash appears, when they may help stave off the painful after effects of shingles.
Steroids can be useful in ophthalmic herpes to protect the eye and prevent facial neuralgia later.
Topical sprays can be used to cool and dry the skin and prevent secondary infection.
Hope for the future
THE outlook for shingles could be changed completely by a new vaccine similar to one that has been developed against chickenpox in America.
The aim is to suppress the virus in those people who've had chickenpox, so it can't become active again and cause shingles.
The vaccine works by reintroducing the immune system to the virus, so that it will be primed and ready to suppress any future uprising.
While shingles isn't life-threatening, it can be debilitating, particular for the elderly, and it's increasingly affecting young people.
Offering the jab to anyone with shingles, and to people aged 65-plus at the same time as they get the flu vaccine, pain and stress could be greatly relieved.
Elderly adults are most vulnerable. They're 12 times more likely to be hospitalised with shingles than children.
Nearly 40,000 people a year develop lasting pain and around 44 die from complications. So the vaccine, available in the next year or so, could prevent suffering and death.
Shingles in pregnancy
A PREGNANT woman should stay away from anyone where there's the risk of contact with chickenpox or shingles.
It's possible for susceptible people to pick up chickenpox from a person with shingles, but it's very uncommon for shingles to develop as a result of exposure to chickenpox, even in a pregnant woman.
Shingles is not infectious unless you touch the spots. On this basis, the risks to mother and baby are quite small.
Should a woman be exposed to the infection, some doctors recommend the use of protective immune globulin which could prevent or reduce the severity of infection.
If a woman does develop a severe case of shingles, treatment with aciclovir can be used without danger to the baby.
Something else to consider is that, while the virus can pass through the placenta, the disease is usually prevented from being too serious by protective antibodies from the mother which attack the virus.
Shingles Support Society, 41 North Road, London N7 9DP, enclose an SAE, website: www.herpes.org.uk.
IN PAIN: One third of sufferers have nerve damage
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|Publication:||The Mirror (London, England)|
|Date:||Mar 14, 2002|
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