That irritating itch!

That irritating itch!

Nothing can be more frustrating than having a rash that will not go away and constantly itches. As the rash spreads like a belt around your waist, you start to panic. Is it fatal?

Most of us have had chickenpox (varicella) when we were young but some may get it only when they are adults. It’s a virus which causes itchy blisters to form all over the body. Although not a serious health problem in healthy children, this illness is contagious and the patient needs to stay at home.

The majority of those who have gone through chickenpox will tell you that they’re so glad when it’s over as the itch can be unbearable and you can scratch until liquid or even blood oozes out. However, what they don’t know is that although the rash may have subsided, the virus remains in the body, waiting to come out again; this time in the form of shingles.

Consultant Dermatologist at Pantai Hospital Cheras, Dr Irene Lee shares her expertise on this medical condition. She confirms that there’s no known circumstance / condition that predisposes the virus to stay in the body.

What is shingles?

Shingles (herpes zoster) is a band of painful rash that runs along the skin like a belt. It is caused by the varicella-zoster virus which infects a nerve or a certain area of the skin. For some, the pain is mild but for many the pain can be quite severe. The word ‘shingles’ comes from the Latin word which means ‘belt’. This is because shingles normally cover an area of the midsection in the rough shape of a belt or band.

If you notice any pink or red blotches of rash on one side of your body, it’s advisable to consult a doctor because it could be shingles.

Symptoms of shingles

You know you’re going to have shingles if you have tingling, itching, burning or pain in a certain area of your skin that won’t go away after five days. The virus normally affects only one nerve on one side of the body. The symptoms will occur in the area of the skin that the nerve supplies. However, there may be a crossover, that is, two or three nerves next to each other will be affected. The areas of the body commonly affected are the chest, abdomen and even the upper face, including the eye.

After a few days of itching, the blisters will appear, which may give you a burning sensation or deep pain. The symptoms normally last for two to four weeks. However, for some, normally people above 50 years of age, the pain may persist even after the rash has gone. It may even go on for months or years, despite total resolution of the skin condition.

This chronic pain known as postherpetic neuralgia is caused by damaged nerves in and beneath the skin. It can precede the rash, have the same onset with the rash or happen during the recovery phase of shingles. The pain can be so severe that it can cause weight loss, insomnia and even depression. Prompt treatment of shingles can help reduce the chances of developing post-herpetic neuralgia as it can help reduce the timeframe of the shingles infection.

Lee says shingles rarely persist for more than two to three weeks. However, in patients with severe retardation of their immune system, for instance AIDS, this disease can persist for a much longer duration. On top of that, patients with complications secondary to shingles such as a secondary bacterial infection or shingles that affect other parts of the body may take longer to recover.

During the initial stage, shingles is not contagious. The affected area is usually tender. Avoid scratching as this can cause open sores which are susceptible to bacterial infection. Severe cases of infection can lead to scarring. To prevent scars, keep the rash area clean and covered. The fluid-filled blisters will normally dry up, become scabs and then slowly fade away. There may be scars after the blisters are gone.

Generally a person will not get shingles twice but some people can have recurring shingles on the same spot.

What causes shingles?

“Everyone with a history of chicken pox has the possibility of reactivation of the varicella zoster virus that has remained dormant in the body,” Lee says. “Any condition that is associated with lower immunity predisposes one to reactivation of this virus causing shingles. These include stress, acute illness, illnesses associated with lower immunity (i.e. cancer, HIV infection), medication that suppresses immunity (i.e. corticosteroids, immunosuppressants such as azathioprine, cyclosporine, etc), radiation and physical trauma.”

However, Lee says that medical professionals postulate that shingles mainly affects people who are 50 years of age and above because of their lower immunity as well as higher prevalence of other concurrent medical illnesses and concurrent medications that have an effect on their overall immunity.

Shingles is normally not contagious. However, the blisters which have erupted will ooze liquid. Before the blisters dry up to form scabs, a person who has not had chickenpox before can catch chickenpox if they come in contact with the person having shingles. Once all the blisters have completely formed a crust, the risk of spreading the virus is lower. One piece of good news is that you cannot get shingles from someone who’s having shingles.

“Most studies did not show a gender predilection. However, there is one study that showed a higher prevalence in women compared to men. Those who have dark skins are reported to have a lower risk compared to those with fair skins,” says Lee.

Complications from shingles

Normally there are no complications with shingles, however:

  • The nerve affected by shingles may be a motor nerve (nerves that control muscles) and this may weaken the muscles supplied by the nerve.
  • Some people may have a fever for a few days.
  • In rare cases, the virus may infect the brain or the spinal cord, thereby affecting the whole body.
  • People with shingles who have a poor immune system may develop rare or serious complications. These include people with HIV/AIDS, cancer patients on chemotherapy, etc.
  • The virus may attack the ear and cause hearing or balance problems.
  • For shingles of the eye, the rash may cover the area around the eye as well as the forehead and nose. The front of the eye may swell and in severe cases, this can lead to inflammation of the whole eye which may cause vision loss. It can also affect the nerve that controls facial sensation and movement in the face. Other symptoms include headaches, chills and a stomach upset.

Treatments

Treatments aim to ease the pain and discomfort as well as to prevent complications from developing. Treatments include:

  • Over-the-counter medications: Pain relievers such as paracetamol or oxycodone and anti-itch creams or lotions such as calamine.
  • To reduce inflammation of the eye or ear, doctors will prescribe anti-inflammation medication such as corticosteroids.
  • Your doctor may also prescribe antiviral medications that will stop the virus from multiplying.

Can shingles be prevented?

There has been a vaccine against shingles (varicella-zoster virus) in the US since 1996 but it’s more to protect children against chickenpox. Studies have shown that this vaccine is effective in reducing the risk of shingles in older people, and has very few side-effects.  However, it’s not known to be a compulsory vaccine in most countries.

A shingles vaccination called Zostavax is also currently available. It reduces the risk of shingles by half and reduces the risk of post-herpetic neuralgia (nerve pain associated with shingles) by 2/3. This vaccination is approved by the FDA for people aged 50 and above. Benefits for patients below 50 are unproven. In 2013, the UK carried out a shingles vaccination programme for people between the ages of 70 and 79.

A healthy lifestyle and stress management can reduce the occurrence of shingles. So live healthy if you want to reduce your chances of developing this nasty itch.

Is this Shingles?

  • Small blisters that appear only on the lips or around the mouth are not shingles but may be caused by a herpes simplex virus. It could be cold sores, otherwise known as fever blisters.
  • You may have itchy blisters after gardening or spending time on outdoor activities such as hiking. These blisters can be a reaction to plants or things you normally don’t come in contact with.

It’s always advisable to consult a doctor for any medical condition.

Steps to ease shingles pain

If you have shingles, ease your pain with these simple steps.

  • Wear loose-fitting cotton clothes as this may help reduce the irritation of the affected skin area.
  • Ease the pain by cooling the affected area with ice cubes wrapped in a plastic bag or a cool bath.
  • Cover a raw and blistered rash with a non-adherent dressing which may reduce pain caused by friction contact with your clothes.
  • Apply cream or lotion to stop the itch.

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