Shingles

Many people think that if they had chicken pox as a child, they’re immune to shingles. They’re not. Between one-third and one-half of those who had chicken pox will develop this “grown-up” version of the disease, with some studies indicating women are more at risk.

What is shingles?

When people get chicken pox, scientists believe the varicella zoster virus particles in the blisters leach into the nervous system. The virus remains dormant until triggered, when it multiplies and travels along the nerves to the skin and erupts into blisters.

Shingles is characterised by a rash, followed by fluid-filled blisters. Unlike chicken pox, the shingles rash is generally on one side of the body. The most common region is outwards from the spine around the waist, though it can appear anywhere and on multiple parts of the body at once. Sometimes burning, tingling, numbness or itchiness precedes the blisters by days or weeks.

Symptoms and complications

Along with the rash, blisters and pain, shingles can produce a wide range of symptoms that usually disappear in three to five weeks:

• light sensitivity
• flulike symptoms: abdominal pain, diarrhoea, chills, fever, swollen glands or joint pain
• headache, confusion and drowsiness
• Postherpetic neuralgia

The hallmark of shingles is pain ranging from mild tingling or tenderness to intense, throbbing fiery pain. For 20 per cent of people, the pain becomes chronic. Called postherpetic neuralgia, it often affects the forehead or chest, leading to difficulty eating, sleeping, performing regular activities and depression.

For some, the pain lasts for weeks or months. For others, it lasts forever. Those at risk of postherpetic neuralgia are primarily those over age 60; it may also be more common in women.

Optic nerve
Optic (eye) nerve involvement (herpes zoster ophthalmicus) affects 10 to 25 per cent of shingles sufferers and can result in drooping eyelid, loss of eye motion, corneal ulcers and vision problems.

Ramsay Hunt syndrome
Less common is Ramsay Hunt syndrome (herpes zoster oticus) when the nerve close to the inner ear is affected. This syndrome features a painful rash on the eardrum, ear canal, earlobe, tongue and palate. The swelling of the nerve causes hearing loss, vertigo and weakness or paralysis of the affected side of the face.

The worst case
At its worst, shingles can lead to permanent pain, blindness, deafness, secondary bacterial skin infections, brain (encephalitis) or blood (sepsis) infections and neuromuscular diseases.

Precautions and prevention

While shingles itself isn’t contagious, the underlying chicken pox virus is to anyone who hasn’t been vaccinated for chicken pox or has had the virus. Sufferers should stay away from young children and pregnant women, especially if blisters are still in the weepy stage.

Shingles vaccine
Although it’s not the preferred preventive measure for everyone, a shingles vaccine is available in Australia. In the three-year Shingles Prevention Study, American researchers followed 38,000 adults aged 60 and over who received the vaccine. They discovered that the vaccine

• reduced the likelihood of getting shingles by 51 per cent
• reduced duration and intensity of shingles; those who developed shingles were also 65 to 70 per cent less likely to experience postherpetic neuralgia
• was most effective in people aged 60 to 69, with effectiveness declining with age

On the negative side, the vaccine

• is so new researchers aren’t sure how long the protection lasts; current research indicates at least six years
• should not be given to people with compromised immunity and women who are or might be pregnant
• is expensive and not subsidised in Australia
• has storage and reconstitution requirements that limit availability and distribution

While there is some disagreement about the recurrence of shingles, a recent study in the Journal of Infectious Diseases put the risk at about 24 in 10,000. So people who have had shingles may not need to be vaccinated.

Who is at risk?

Researchers haven’t identified the precise mechanism that causes the virus to reactivate. However, they believe physical and emotional stressors weaken the immune system and contribute to the onset of the disease.

Risk factors

• having chicken pox under one year of age
• being 50 or over
• immune-suppressant drugs following organ transplant
• hemotherapy or radiation therapy
• recent surgery or injury
• serious illness or disease, such as cancer, or chronic diseases that suppress the immune system, such as diabetes, lupus, HIV and AIDS
• poor nutrition
• stress
• being a woman (some studies have indicated women are more likely to develop shingles)

What you can do

Since weakened immunity plays a role in activating the virus, boosting the immune system is a first line of defence. Eating properly and decreasing stressors—both physical and emotional—are important. Tai chi, a traditional Chinese form of exercise, may help.

Tai chi
In a study supported by the US National Institute on Aging and the National Center for Complementary and Alternative Medicine in the US, a group of seniors participated in a 16-week tai chi program, combining aerobic activity, relaxation and meditation, before getting vaccinated. The tai chi group was then compared to a control group that only received health information before vaccination.

Seniors taking tai chi doubled their rate of immunity during the study and had an approximately 40 per cent greater increase in immunity to the shingles virus after being vaccinated.

Natural pain management

Consider natural ways to relieve pain, either in conjunction with or in place of conventional medication.

Note: always check with a health care practitioner before using supplements or herbs, as they can interact with other medications.

Vitamins
Vitamin E (1200 to 1600 mg per day) or vitamin B injections may reduce symptoms of postherpetic neuralgia, according to some small studies.

Proteolytic enzymes
Papain (from papaya) and bromelain (from pineapple) may reduce pain as much as standard antiviral drugs, with fewer side effects.

Traditional herbs

• cayenne
• German camomile
• licorice

Acupuncture
Some studies show that acupuncture helps relieve nerve pain.

Traditional homeopathic remedies

• Arsenicum album
• Mezereum
• Ranunculus bulbosus
• Rhus toxicodendron
• Apis mellifica

Relaxation therapies

• meditation
• breathing exercises
• progressive muscle relaxation
• biofeedback