Shingles diagnosis and treatment
What is shingles?
Shingles is a disease that occurs as a result of infection by exactly the same pathogen, a virus, which causes chickenpox (varicella). It develops only in those who had varicella. It is so because even when chickenpox is cured, the virus still remains in the body in an inactive form that can be activated in the occurrence of risk factors. And then, it causes shingles instead of repeated varicella. Statistically, around 30% of people who had chickenpox also eventually develop shingles.
Short information about shingles
The disease develops in 12 to 15 per 100,000 people aged 60-75 years. It generally does not reoccur but in rare cases, a repeated flare-up can happen. It had been observed in 2% of people with normal immunity and 10% of people with compromised immunity (i.e. using medicines to suppress immunity, patients with HIV, and AIDS).
Shingles is also dangerous for children unvaccinated for chickenpox as they can get infected after being exposed to the virus contacting an adult with shingles.
How can you get infected with shingles?
The disease is most likely to be transferred to another individual if they touch the rash. But the virus in active form can also be transferred via the droplets of the saliva of the ill person that comes into the air when a person speaks, coughs, sneezes, etc.
If you have had varicella before, your virus won’t become active after you contacted a patient ill with shingles. But those who hadn’t had chickenpox can obtain it after contact with an individual with shingles.
What are the signs of the disease?
Shingles symptoms include two main manifestations:
- Strip of rash, in most cases, on one side of the body (face, chest, or back in the most cases);
- Intense pain in the affected area.
The pain can precede rash for several days which makes it difficult to identify the disease at once. However, when a rash occurs, the disease is easily diagnosed.
How are shingles diagnosed?
In the presence of a strip of rash and intense pain, there is no need for additional tests as the symptoms are quite characteristic of this disease and a doctor can easily identify it.
However, considering that sometimes the disease develops for several days without the occurrence of rash but only pain is present, it is important to exclude other conditions, for instance, angina.
If the rash is present but it doesn’t form a clear pattern, tests should be made to ensure that it is not caused by insect bites or herpes simplex.
Who can develop shingles?
First of all, it only develops in those who had varicella. These individuals can start suffering from the disease in the presence of risk factors that are all basically related to the lowering of the immune protection of the body:
- Age older than 50 years;
- Period of pregnancy;
- Use of drugs that suppress immunity;
- Long-term use of antibiotics, glucocorticosteroids;
- Being for a long time in cold;
- Cancer treatment;
- After organ or bone marrow transplant.
Although the disease can fade away over time, it is crucial to treat it as soon as possible because the intense pain and itching significantly worsen the quality of life of a patient. The symptoms can persist for three to four weeks or even several months without appropriate therapy. The illness can also provoke complications such as postherpetic neuralgia that is the chronic inflammation and pain in the affected nerve.
Therapy with medicines is crucial for people with a high risk of complications i.e. with immunodeficiency, and people aged over 50 years.
In general, the therapy can be performed at home unless there is a risk of eye nerve damage, brain, or the suspected infection by the virus of other organs (relevant for immunocompromised people).
- The first measure that must be taken is the use of antiviral agents such as Valacyclovir or Acyclovir. These medicines can significantly shorten the duration of the disease and alleviate the symptoms if they are started to be taken not later than three days after the onset of the first signs. Valacyclovir is basically the improved version of acyclovir as it has the same effect but can be taken fewer times a day for the same effect as if acyclovir is taken several times a day.
- Besides the antiviral agents, painkiller medicines can be also used to help to manage pain. The non-prescription drugs suitable for the herpetic main management are Dexketoprofen, Ibuprofen, Naproxen, Ketorolac, and Ketoprofen. Keep in mind that these drugs are not advised to be taken for more than 5 days in a row as then can significantly damage the stomach and even cause stomach ulcer bleeding. In severe pain that is not relieved by the first-line over-the-counter painkillers, prescription medicines such as oxycodone.
- The prophylaxis of postherpetic neuralgia is made by Amantadine sulfate. The medication has a mild antiviral, painkiller, and anti-inflammatory effects.
- Sometimes for pain relief, anti-seizure medicines are also used. The possible choices are gabapentin and pregabalin.
- To lower the negative effect of the disease on mental health, a doctor can also prescribe antidepressants.
There is also a way to prevent shingles – get the chickenpox vaccine. Usually, it is made in childhood and prevents kids from developing chickenpox and eventually shingles.