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Des Moines University
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Shingles
What is shingles and can it be prevented?
New vaccine could prevent lingering chickenpox virus from returning as a painful rash in adults
Every year, approximately one million Americans get shingles, a painful blistering skin rash caused by the same virus that causes chickenpox. This is the varicella zoster virus. It lies dormant in the body and can reactivate years, even decades, later as shingles.
"More than 90 percent of adults in the United States have had chickenpox, so these individuals are at risk for developing shingles at some point in their lives," explained Terriann Crisp, Ph.D., professor and chair of the physiology and pharmacology department at Des Moines University. Dr. Crisp's research focuses on studying the effects of aging on the development and treatment of chronic neuropathic (related to the nervous system) pain conditions.
A tingling, itching or painful sensation may be the first symptom of shingles, even before the painful rash appears. The rash begins as red bumps and turns to blisters that will eventually scab and fall off. The visible rash is usually gone within 10 days but the blisters can leave a permanent skin color change. The tingling pain sensation can last several months. Shingles can also cause pain or redness in the eyes or swollen eyelids. This can lead to glaucoma.
There is no way to predict who will get shingles. It occurs equally in both sexes and all races. It is known, however, that shingles occurs more often and is more severe in people older than 50 years old who may have a weaker immune system.
"As if shingles wasn't serious enough, approximately 20 percent of people who get shingles also experience a very severe and debilitating pain syndrome after the rash clears up," she said. "This condition is known as post-herpetic neuralgia."
Neuralgia is a term that refers to a painful disorder of the nerves. This particular pain syndrome can be difficult to treat and is often resistant to commonly used pain medications.
The good news is that a shingles vaccine known as Zostavax was developed by Merck and licensed by the Food and Drug Administration in 2006. In clinical trials, a single dose of Zostavax was administered to thousands of adults 60 years old or older, and was found to prevent shingles in more than half of the studied patients," Dr. Crisp explained.
Zostavax seems to be most effective for the 60-69-year-old population but also offers some protection for patients older than that. It should not be given to children or pregnant women and is not recommended for people with weakened immune systems or individuals on certain steroid medications. Patients being treated with chemotherapy and patients with a history of cancer in the lymph nodes or bone marrow should also not receive this vaccine. Any past allergic reactions to vaccines should, of course, be discussed with your physician before having this vaccine.
If you already have shingles, treating it will obviously be of utmost priority. The pain from shingles may range from mild to excruciating. Some patients with mild pain respond well to over-the-counter medicine such as ibuprofen or naproxen, but patients with more severe pain may require stronger medications with narcotic-like agents, according to Dr. Crisp. Capsaicin cream, a topical cream that causes a heat sensation, and nerve blocking agents like lidocaine have also been reported to help control pain in patients with post-herpetic neuralgia. An anticonvulsant drug, Neurontin, has also proven effective for alleviating the persistent pain from this virus.
"Most often, a treatment plan that combines more than one of these drugs is needed to treat the pain and improve the quality of life for patients with post-herpetic neuralgia," Dr. Crisp said. "If left untreated, this syndrome may persist for months to years after the shingles rash disappears."
To learn more about shingles, visit www.nlm.nih.gov/medlineplus/shingles or www.familydoctor.org. To learn about the vaccine, visit www.zostavax.com.
