Friday 28 November 2014

How to identify the symptoms of Shingles

Varicella Zoster or Shingles effects one in five of us and kicks us when we're down.

Dr Ciara Kelly

Published 18/08/2014 | 02:30

Blisters caused by herpes zoster in the hand and arm of a child.
Blisters caused by herpes zoster in the hand and arm of a child.

Shingles, really is the virus that keeps on giving. Three quarters of us have had the chicken pox and most of us barely remember it - not me, I got it at 16 and was covered with huge blisters like a thousand golden fish eyes, I put a tea towel over my head, went to bed for three weeks, but I digress.

With chicken pox being so common most of us are vulnerable to developing shingles - the reactivation of the varicella zoster or chicken pox virus - and one in five of us will get it. I see a huge amount of it in practice.

Shingles is an unfortunate illness, in that it kicks you when you're down. So when you're stressed, tired, sick, exhausted or vulnerable in some way, that's when shingles strikes. Feeling run down and rubbish? Boom! You get the shingles.

Shingles is an infection of a nerve and there are three main aspects to the disease. Firstly the prodrome - the run in to the illness, before the rash appears. In this stage you may feel fluey or as if you're coming down with something. It can be bad, or may be barely noticeable.

In the second phase, the rash appears. This is often the first thing you become aware of. The rash is always unilateral - on one side of the body only - and it occurs in a dermatome. Which means it appears to run along a line, on the skin. It consists of small clusters of blisters, that look quite like chicken pox blisters and they sting, burn and itch. They can occur anywhere on the body but usually are on the torso or head and tend to be described by patients as sore, rather than painful. And there can be any amount, from a couple of blisters, to a large thick band of them, running around from your back, to your front.

The rash can be managed in the same way as chicken pox, with symptomatic relief from bread soda baths, topical treatments, antihistamines and pain killers. And unless it's very extensive, it's mostly manageable - although we do occasionally see dramatically painful, florid occurrences.

The third stage, however, can be the worst part. After the rash has gone and you think you're on the mend - post-herpetic neuralgia develops. This is the sometimes intractable nerve pain that develops after shingles - particularly in those over 50 - along the line of the rash. And it can remain long after the rash has disappeared. This pain comes between people and their sleep. It's a deep, burning ache that can be severe and it responds poorly to pain killers. It often needs medication that specifically acts on the irritated nerves themselves.

This post shingles pain is why we use anti-viral therapy. And why it's important you seek medical advice if you suspect you have shingles. Use of anti-viral treatments reduces the risk of post-herpetic neuralgia and can save you possibly years of subsequent pain after a bout of it.

The other important thing to remember about shingles is that it's a virus, so you are infectious to others - you can give them the chicken pox! So it's a good idea to keep away from non-immune, pregnant women and immuno-suppressed patients, such as those on chemo, while you have it.

Some countries give the varicella vaccine to prevent the spread or contraction of chicken pox and shingles. But we don't routinely vaccinate here, so most of us have had the chicken pox and therefore have potential to develop shingles. Because it can be nasty and has that capacity for complications, it's important to get medical advice, should the "belt of roses from hell" appear.

Twitter: @ciarakellydoc

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