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SHINGLES

One of the most common and most painful skin conditions I see is “shingles” (also known as “herpes zoster”).  In fact, as a dermatologist, the only time that I ever need to prescribe strong pain medication is for a patient with a bad case of shingles.

  Medical Dermatology for Shingles
What exactly are the “shingles”?
Shingles are caused by the same virus that causes chicken pox:  varicella zoster virus. Most people experience chicken pox as a child, it lasts a few weeks and then it is gone. But it is never really “gone”.  The immune system wins the war against the varicella zoster virus and the chicken pox clear up, but the virus continues to live inside your body forever; it just goes into hiding.

Shingles occur years later, often when you are run-down or “stressed out” (or sometimes for no reason at all).  The chicken pox virus emerges from its hiding place (somewhere in your central nervous system) and travels down a single nerve to erupt in a single line or band on your skin. It is this linear pattern that gives shingles its distinctive look and its name:  The word “shingles” is a corruption of the Latin cingulum meaning a belt or girdle. Unlike a belt, however, the rash is only on half of your body and does not cross the mid-line.  That is because it only affects the skin that is supplied by the nerve that it travels along.

You cannot “catch” the shingles (but it is contagious!):
Shingles are caused by a virus and when you have it you ARE contagious. However, you are only contagious to people who have never had chicken pox, AND you will not give those people “shingles”, they will catch chicken pox from you.  Shingles is always caused by your own varicella zoster virus that has been living inside you since you had the chicken pox. 

When a person has the chicken pox, they are contagious through respiratory droplets. In other words, they can cough or sneeze on you and give you the chicken pox.  The shingles, on the other hand, are only contagious through direct contact to the rash or the virus shed from the rash.  Hand-washing is important to prevent transmission.  You are contagious until the entire rash has “crusted over”.  Until that time you should avoid other people and rest at home. Especially important is to avoid pregnant women or people who are immunocompromised (from AIDS or cancer etc…). A case of the shingles for these people can be devastating, even deadly.

Can you get shingles if you have received the chicken pox vaccine?
Yes.  Surprisingly there are cases of shingles in people who were vaccinated against the chicken pox and therefore never had chicken pox.  The reason is that the chicken pox vaccine is a live attenuated vaccine.  That means that the vaccine is made up of a live virus that has just been modified so that it gives you immunity but not the symptoms of the disease.  When people get shingles after the chicken pox vaccine, it is the vaccine virus that is causing the shingles!

The “aftermath”: Post-herpetic neuralgia:
The problem with shingles is that you don’t just suffer while you have it, many people continue to be uncomfortable for weeks or months after the rash is gone.  This is called “post-herpetic neuralgia”.  The nerve that the virus traveled along remains irritated from all of the inflammation that the infection caused.  The symptoms can range from a nagging tingle that lasts a few weeks, to outright pain that lasts for months and requires treatment from a neurologist.  There are effective new medicines for post-herpetic neuralgia, but the most effective treatment is to prevent the problem in the first place.  Get vaccinated!

  shingles vaccine
The “shingles” vaccine:
Recently a shingles vaccine has become available (as opposed to the chicken pox vaccine).  It is called Zostavax and it is very effective at preventing the shingles. It is recommended for people over the age of 60, because the older you are the more likely you are to get shingles and the worse it usually is.  However, at this time, many insurance companies do not cover the vaccine.  But take it from someone who treats a lot of patients with this disease (and who has no conflict of interest), you do not want shingles:  get vaccinated, especially if you are over 60 years old.  We do not carry the Zostavax vaccine in our office – but we will order it if a patient has difficulty getting vaccinated because their primary care doctor does not offer it.