Early Diagnosis And Treatment Are Critical For Successful Management Of Shingles

by Darline Turner Lee, Physician Assistant, ACSM Exercise Specialist

Article Last Reviewed: Sept. 9, 2006

I awoke one Saturday morning with a dull ache in my right shoulder and back. I tried to remember a causative activity, but with family coming into town, I had been on a cleaning and shopping frenzy. I applied some Aspercreme and continued with my day. By nightfall, the slightest movement caused excruciating pain and I couldn’t lift my one-year-old daughter. I applied ice, then heat and took ibuprofen without relief. The following morning, my skin was red and tender to the touch. Monday morning, two days later, I had a blistering linear rash from the lower tip of my shoulder blade, around my ribs, to just below my armpit. I had shingles.

Shingles is caused by the varicella-zoster virus, the same virus that causes chicken pox. After the initial chicken pox infection, the virus settles along nerves throughout the body and stays dormant for years. For unknown reasons, the virus reactivates later, causing shingles in about ten percent of adults who have been infected. Though more than fifty percent of shingles cases occur in adults over age fifty, and the risk of shingles increases with age, it can actually occur at anytime after the initial varicella outbreak. Research from the National Institute of Neurological Disorders and Stroke (NINDS) shows that shingles occurs in a weakened immune system, for example, following an illness, during stress, in those over the age of fifty and in immune compromised people. While most people who develop shingles will become immune to the virus and not get shingles again, The US Food and Drug Administration (USFDA) estimates that approximately four percent of people will have shingles more than once.

Shingles is not contagious and only manifests in people who have had chicken pox. A person who has never had chicken pox, and is exposed to someone with active shingles, can develop chicken pox. It is uncertain if taking the varicella vaccine series prevents future development of shingles. Officials at the USFDA are closely monitoring new cases of shingles to see if there is a decline in outbreaks consistent with the decline in chicken pox outbreaks since approving and implementing the use of the vaccine in 1995.

Shingles, like it’s cousin Herpes Simplex, cannot be cured but it can be effectively managed, especially if diagnosed within the first forty-eight to seventy-two hours of an outbreak according to The National Institute of Allergy and Infectious Diseases (NIAID). Antiviral medications relieve much of the pain, shorten the duration of the rash, and shorten the duration of the viral infection. Once I noted the blisters on my torso, I called my doctor and was seen that afternoon and started on antiviral medication.

Early diagnosis and treatment is critical when shingles is on the face. Shingles can cause facial paralysis, severe ear pain, hearing loss and vertigo. These symptoms are usually temporary, but can become permanent if shingles is not aggressively treated. If shingles occurs around the eye, immediate treatment by an ophthalmologist is necessary to avoid damage to ocular nerves leading to decreased or total loss of vision in that eye.

Antiviral medications reduce the risk of developing post herpetic neuralgia, the ongoing pain along the affected nerve that can persist for years after the infection has resolved. More common in the elderly, post herpetic neuralgia is extremely uncomfortable and causes difficulty moving and performing routine activities. One’s lifestyle is significantly impaired and associated depression is common. Early treatment and effective pain management prevent depression, loss of mobility and independence, and loss of quality of life.

If you suspect you have shingles, seek medical attention immediately. Prompt treatment relieves the symptoms and reduces the risk of infection, scarring, nerve damage, sensory loss, and post herpetic neuralgia.