Shingles is a condition characterized by a painful, blistering skin rash. This rash can affect any part of the body. The medical name for shingles is Herpes Zoster. It is the caused by the same virus that causes chicken pox. People who have had chicken pox are potentially at risk for developing shingles later in their life. Patients who have never had chicken pox can get this from individuals who have an active attack of shingles, as the rash is contagious. Shingles can appear anywhere on the body but tend to follow the distribution of the nerves, as this is where the virus lives. Although severe in any part of the body, facial involvement around the eye presents an even greater problem. If shingles involves the upper face, the eye can be affected, potentially leading to eye complications including infection and corneal ulceration. The treatment of an acute attack of shingles involves giving a patient one of the specific antiviral agents such as Zovirax (acyclovir), Famvir (famcilovir) or Valtrex (valacyclovir) along with Prednisone to shorten the duration of the attack and to lessen potential for development of postherpetic neuralgia. Postherpetic neuralgia develops in about 20% of patients who have had shingles. Shingles is much more common in individuals over the age of 50. Approximately 1 million people in the United States get shingles every year.
The FDA has recently approved a shingles vaccine, Zostavax, to aid in the prevention of this condition. This is an injectable medication that requires only one treatment. The Center for Disease Control has recommended that all eligible patients over the age of 60 be immunized. The requirements for receiving the vaccine are as follows: you are in good health and must not have any condition that would lower your immune system function. Conditions that lower your immune system include diabetes, cancer, chemotherapy or steroid therapy, active tuberculosis, excessive alcohol consumption or acute illnesses such as pneumonia. The best available treatment to prevent shingles is this vaccine.
Postherpetic neuralgia (PHN) is an extremely painful condition that follows after having an attack of shingles. Although the rash and blisters clear, affected patients are left with a searing, burning painful sensation on the skin, in the area of the rash. This is a form of peripheral neuropathy. Their skin can be so sensitive that even clothing or bed sheets brushing up against the skin can trigger severe pain. Unfortunately, narcotic pain killers do not help in reducing this pain. Alternate treatment with nonnarcotic medications is necessary. Commonly used medications for treatment of PHN include the anticonvulsants such as Tegretol, Lyrica, Neurontin, Trileptal and Topamax. Other agents that are helpful are the tricyclic compounds such as amitriptyline, imipramine and nortryptiline. A novel approach to treatment involves using Lidoderm patches. These are lidocaine embedded patches that control the pain without having to take an oral medication. These can be used in combination with oral medications to better control the pain of PHN. Most patients will have clearing of their PHN within 1-6 months. Rarely it can persist for a longer period of time. For patients who have received the shingles vaccine, who subsequently develop shingles, the incidence of developing PHN is significantly reduced and the severity of the symptoms are generally less. Please contact Sarasota Neurology for more information.