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Shingles and Its Remedies

Nearly one out of three people in the United States will develop shingles, with half of the estimated one million cases each year occurring in men and women age 60 and older[1].

What's Singles


Shingles, also known as herpes zoster, is a reactivation of the chickenpox virus (or varicella zoster virus; VZV) in anyone who was previously infected with chickenpox. 


According to the Centers for Disease Control and Prevention (CDC), studies show that more than 99% of Americans age 40 and older have had chickenpox, even if they don't remember getting it.   The reason behind this is: chickenpox is so contagious that few nonimmunized people escape this common disease when they are exposed to someone else with the disease.


Whereas chickenpox is generally a disease of childhood, herpes zoster (or shingles) and post-herpetic neuralgia (a complication of shingles; HPN) become more common with increasing age. 


"It takes up latency in the nervous system and your normal immunity will hold it in check.  As we get older, or in certain people who are immuno-suppressed, by illness or medication, that virus is just ready to jump back out and cause the second illness," explains Dr. Anne Louise Oaklander[2]. Sometimes high temperature differences in weather can play a role too.  For example, there are higher eruption rate of Shingles during the changing seasons from autumn to winter , said Dr.  Yi-Chen Ho[8].


Factors that decrease immune function include[3]:
  • Human immunodeficiency virus infection
  • Chemotherapy
  • Malignancies 
  • Chronic corticosteroid use
Once shingles erupts in your system, it is not just in the nerves.  It appears to also affect vascular tissue, and other studies have also said it may be in the gastrointestinal tract as well.  In a Mayo Clinic Proceedings video interview, Dr. Yawn said :[13]

"We're starting to think that zoster, or shingles, may not be just a neurological disease, but it may be a systemic disease." 



Symptoms[10,14]


Reactivation of latent VZV from dorsal root ganglia is responsible for the classic dermatomal rash and pain that occur with shingles

Burning pain including itching and tingling typically precedes the rash by several days and can persist for several months after the rash resolves.  If you experience a band of inexplicable pain, itch or unusual sensation, Dr. Oaklander suggests contacting your doctor immediately.

The painful or burning rash usually starts on one side of the face or body.  The rash forms blisters that typically scab over in 7 - 10 days and clears up within 2- 4 weeks.

Most commonly, the rash occurs in a single stripe around either the left or the right side of the body.  In other cases, the rash occurs on one side of the face.  In rare cases (usually among people with weakened immune systems), the rash may be more widespread and looks similar to a chicken pox rash.

Other Complications

Singles can lead to other complications (some are common and others are rare):
  • Common Condition
    • postherpetic neuralgia (or PHN)
      • The most common complication of a shingles eruption
      • Pain may persist well after resolution of the rash and can be highly debilitating
      • Occurs in half or more of untreated people age 60 and older
  • Short-term risk for stroke
    • In a retrospective case-control study, those age 50 and up who had an acute episode of herpes zoster virus were at a significantly increased risk of stroke over the next 3 months compared with controls, Barbara Yawn, MD reported.[13]
  • Rare Conditions
    • Encephalitis
    • Stroke
    • Spinal cord damage
    • Vision and/or hearing loss
    • Death
Remedies

Always consult with your doctor for any of the remedies below:
  • Singles vaccine[9]
    • Approved by the FDA in 2006
    • Reduces the likelihood of getting shingles by 50 - 70%.  Also reduces the severity of shingles-related complications
      • Based on [13], Dr Yawn and colleagues concluded that shingles does appear to carry an increased risk of stroke in patients 50 and up within the first 3 months of their illness, and that vaccination may help diminish this risk.
    • A single dose of zoster vaccine is recommended for adults aged 60 years and older regardless of whether they report a prior episode of herpes zoster. 
      • Although the vaccine is licensed by the Food and Drug Administration (FDA) for use among and can be administered to persons aged 50 years and older, ACIP (Advisory Committee on Immunization Practices) recommends that vaccination begins at age 60 years.
    • Persons aged 60 years and older with chronic medical conditions may be vaccinated unless their condition constitutes a contraindication, such as pregnancy or severe immunodeficiency.
  • Antiviral medications
    • Help shorten the length and severity of the illness
    • Most effective when started within 72 hours after the onset of the rash
  • Topical analgesics[4]
    • Includes capsaicin or menthol creams, and lidocaine patches, as well as antiseizure and opioid medication
      • Capsaicin reduces the amount of substance P, a chemical that carries pain messages to the brain, in your body. When there is less substance P, the pain messages no longer reach the brain, and you feel relief. 
      • Capsaicin cream (0.025 - 0.075% capsaicin) may be applied directly to the affected area up to 4 times a day. Pain may slightly increase at first, but then may get better over the next few days. Capsaicin should be applied regularly several times a day. It usually takes 3 - 7 days before you notice substantial pain relief.
      • Don' t apply capsaicin cream to cracked skin or open wounds.
      • However, research is mixed with the effectiveness of the capsaicin cream.  It may be that it works for some people and not others.
  • Tricyclic antidepressants (or anticonvulsants)
    • Have been shown to relieve pain in up to 2/3 of those suffering from PHN and shorten the duration of the chronic condition by half.
    • Often given in low dosages, may help to control neuropathic pain
  • Corticosteroid 
    • The addition of an orally administered corticosteroid can provide modest benefits in reducing the pain
  • Try tai chi
    • A UCLA study[7] found that practicing tai chi chih can significantly boosts the immune systems of older adults against the virus that leads to the painful, blistery rash known as shingles.
      • Tai chi chih is a nonmartial form of tai chi and comprises a standardized series of 20 movements. It combines meditation, relaxation and components of aerobic exercise and is easy to learn.

Shingles itself can develop only from a reactivation of the VZV in a person who has previously had chickenpox[5].  In other words, shingles itself is never transmitted from one person to another either in the air or through direct exposure to the blisters.


However, people can catch chickenpox from direct exposure to a shingles rash if they have not been immunized by vaccination or a previous bout of chickenpox. In such cases, transmission happens during the active phase when blisters have erupted but not formed dry crusts. 

It can take up to a month to fully recover from shingles. However, for those who develop PHN, they may never shake the devastating, and often life-changing symptoms.  Finally, shingles can recur in about 1 to 5 percent of patients.

References

  1. Shaking the Shingles (Costco Connection)
  2. Anne Louise Oaklander, MD, PhD, associate professor of neurology at Massachusetts General Hospital in Boston.
  3. Stankus SJ, Dlugopolski M, Packer D. Management of herpes zoster (shingles) and postherpetic neuralgia. [Review]. Am Fam Physician. 2000;61(8):2437-44, 2447-2448.
  4. Cayenne (www.umm.edu)
  5. Shingles and chickenpox (Varicella-zoster virus) - Risk Factors
  6. Health Benefits of Chill Peppers
  7. Practicing Tai Chi Boosts Immune System in Older Adults, UCLA Study Shows
  8. 帶狀疱疹痛難耐 有藥可解
  9. Recommended Vaccinations Indicated for Adults Based on Medical and Other Indications
  10. Conditions with Similar Symptoms as: Varicella-Zoster Virus
  11. Shingles (Second Opinion TV; must watch)
  12. Yang-Style Tai Chi Chuan 24 Forms (Travel to Health)
  13. Stroke Rounds: Shingles Tied to Short-Term Risk for Stroke
  14. Shingles (Mayo Clinic)

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