(Updated at Jan 31 / 2023)
Who is at risk of developing shingles and how is it treated?
Shingles also known as zoster is an illness that is likely to develop in people older than 50 years of age or younger people with compromised immunity, for instance, those who suffer from autoimmune diseases and take medicines suppressing immunity, cancer patients, people with AIDS, after an organ transplant, and so on.
The disease is characterized by the unilateral stripe-forming rash accompanied by severe pain. It is a disease which symptoms can be present as long as several months but rash usually goes away within 2-3 weeks.
Short information about zoster
What causes shingles and how can it be acquired?
The disease is caused by the infection with the same virus as chickenpox or varicella. Thus, only those who have this virus in the body can develop zoster. People who hadn’t had chickenpox can develop it when contacting a person with shingles. But those who had chickenpox are likely to develop namely shingles.
The disease develops in about 30% of people who had chickenpox. The reason they have the disease is that the virus is never completely eliminated from the body. It can be dormant for many years and then “wake up” and cause shingles in predisposing conditions, for instance:
- Age older than 50 years (more likely at the age of 60-75);
- Use of medicines to suppress immunity;
- Cancer and its treatment;
- Long-term use of antibiotics or other medicines that indirectly lower immune system protection (cytostatics, glucocorticoids, etc.);
- After surgery for organ or bone marrow transplant.
How can you know if you have shingles?
When pain occurs it can be difficult to know if it is shingles if no rash occurred. However, in a couple of days, a characteristic rash develops and forms a stripe of inflamed bulbous tissue.
You can go to a doctor with only pain syndrome but then it would be needed to exclude other potential causes, for instance, if zoster affected your chest and resulted in heart-like-ache, your doctor will check your heart function for angina or other heart conditions. But if you go to a doctor when rash occurred, there is no need for additional tests as the clinical picture of zoster is quite obvious and a doctor can identify it just looking at the rash and hearing a patient’s complains about intense internal pain.
How is shingles treated?
Like other types of herpes, shingles can go away without any treatment. However, it causes such a significant physical and psychological discomfort that it is much preferable to start the treatment as soon as possible to diminish the duration of the presence of the symptoms, manage the pain, and prevent permanent nerve damage.
For this, the following groups of medicines are used:
- Antivirals. Antiviral medicines stop the replication of the virus which shortens the disease course and helps to ease the symptoms. However, they should be started to be taken not later than the third day of symptoms presence. The drugs of choice are Valacyclovir (Valtrex and generic) and Acyclovir. Valacyclovir is a slightly improved formulation that it taken fewer times a day than Acyclovir. Valacyclovir is taken by 1000 mg twice or thrice a day.
- Painkillers. Painkillers do not treat the disease but help lowering the pain. You can chose Ibuprofen, Ibuprofen, Naproxen, Ketorolac, or other OTC drugs but if the pain is as intense that these drugs do not help, you can ask our doctor for a prescription for oxycodone.
- Anticonvulsants. These medicines are primarily used for epilepsy but they can also be used for intense zoster nerve pain. They are prescription drugs including are gabapentin and pregabalin.
- Antidepressants. Some people suffer from the psychological effects of shingles so they can ask their doctors for antidepressants to cope with depressed mental health.
The complication of untreated shingles is postherpetic neuralgia. It is nerve damage that occurs when the virus is replicating uncontrollably and affects the nerves for an extended period of time. The condition is diagnosed when the pain is present even 90 days after the rash caused by zoster disappeared. It may last for many months and even years. There is no treatment but only measures for the management of symptoms such as topical ointments and patches based on capsaicin and lidocaine patches, and oral pills from painkiller group (prescription drugs such as tramadol, methadone, oxycodone, and morphine), tricyclic antidepressants, and anticonvulsants.
For the prevention of postherpetic neuralgia, it is important to start the treatment of zoster timely, and possibly use besides Valacyclovir also other medicines such as Amantadine that has virostatic properties (stops the replication of virus) and the ability to block peripheral NMDA receptors at the stage of pain impulse transmission.
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