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Shingles more painful in elderly

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Shingles is a painful, and somewhat mysterious, skin disease that affects people who have had chicken pox. It may occur spontaneously or may be induced by stress, fever, radiation therapy, tissue damage or immunosupression.

Dr. Oanh Lauring, chief of dermatology at Mercy Medical Center, says doctors do not know the specific mechanism that triggers reactivation.

What is shingles?

A reactivation of chicken pox later in life. Another name is herpes zoster, which confuses people because they think it is related to the herpes virus that is sexually transmitted or causes mouth sores, but it isn't. Once a person has had chicken pox, they have the varicella virus for life. The virus lives in a nerve root on one side of the spinal cord, and when you get shingles, you develop symptoms of skin tingling, pain or itching that is quickly followed by an eruption of painful grouped blisters that occur along a strip of skin to which the affected spinal nerve provides sensation. The most common areas affected are the shoulder and chest.

Who is likely to get it?

People with a history of chicken pox have a 20 percent lifetime chance of developing zoster. The severity and incidence increases significantly with age. Also, people whose immune system is compromised.

What are its causes?

Nobody knows. It occurs in times of stress, whether it's emotional stress or stress from an illness.

How common is shingles?

Before childhood vaccination for the virus became routine, 90 percent of children in the United States got chicken pox before the age of 10. Varicella zoster develops in approximately 20 percent of healthy adults and 50 percent of immunocompromised persons (those on chronic steroids, transplant patients on immunosuppressants, HIV patients, cancer patients and people older than age 50).

What are the symptoms?

Usually, a person gets soreness, a tingling, itching or numbness of the skin, followed by painful blisters that run unilaterally along a horizontal band of skin that extends from the front to the back but does not cross the midline. It can feel like nerve pain or muscular pain. When the rash occurs on the left chest, people may mistake it for heart attack pain. It differs from a herpes eruption in that lesions of herpes are clustered in a single spot rather than running along a band of skin.

What is the treatment?

We give patients acyclovir, famvir and valacycovir. They are FDA-approved anti-viral drugs that decrease the shedding of the virus, shorten the life span of the infection. They can decrease pain if they are taken within 72 hours of the onset of the first blister. Usually, patients receive the medicine for seven to 10 days.

What complications can arise without treatment?

If you don't treat shingles, it will go away in children and young adults with intact immune systems. However, the pain, rash and complications become more severe with increasing age and immune compromise. Complications include chronic debilitating nerve pain that can last months to years, secondary bacteria infection, scarring, hepatitis and motor paralysis. Also, if you are immunocompromised, shingles can be life-threatening. Another potential complication is if you get shingles involving the eye, you can develop scarring and blindness.

Is it contagious?

People with zoster can infect another with varicella (chicken pox) via direct contact with the blister fluid. A person who has shingles should not be around anyone who is pregnant, infants, people who've never had chicken pox or immunocompromised individuals.

How does it spread?

Zoster usually spreads by skin-to-skin contact, but it can also be airborne.

Can a person who has been vaccinated for chicken pox but never had the disease get shingles?

Yes, but those who had the chicken pox vaccination in childhood are less likely to develop zoster than those who were naturally infected.

How long does shingles last?

If you get early treatment, just a few weeks. You may not have any residual pain. But for some older people, the pain can last the rest of their lives. It is a kind of pain that doesn't respond well to traditional treatments.

Can shingles be prevented?

There is a shingles vaccine that can potentially boost the immune system later in life, when we are at more risk for shingles due to a waning immune system. The zoster or shingles vaccine can therefore decrease the risk for contracting shingles later in life.

Copyright © 2014, The Baltimore Sun
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