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“НАШЕ ЖИТТЯ”, ТРАВЕНЬ 2014 WWW.UNWLA.ORG 33 SHINGLES/HERPES ZOSTER Ihor Magun, MD, FACP Herpes Zoster, also referred to as shin- gles, has been in the headlines over the past sev- eral years. This sporadic disease occurs due to a reactivation of the human herpes virus (original- ly manifested in childhood or young adulthood as chickenpox). The virus remains dormant for years, and although it can reappear at any time, the incidence is highest among individuals in the sixth decade of life and beyond. For unknown reasons, it is more often seen in the springtime and autumn. The first visible bodily symptom of shin- gles is a rash which first presents as a red area and evolves into grouped vesicles (blisters) resembling dew drops on a red rose petal. The vesicles can become pustular in three to four days and then begin to resolve by crusting in seven to ten days. The rash follows a distinctive pattern—unilateral distribution over what is referred to as a “derma- tome,” or an area of skin supplied by a spinal nerve. Laboratory testing is not necessary to con- firm this diagnosis because the characteristic ap- pearance is sufficiently distinctive. One major de- fining feature is that the rash never crosses the midline of the body remaining only on either the body’s right or left side. The rash can occur in any body distribution from head to toe. If shingles symptoms consisted of only the rash, the reactivation would not be that un- comfortable. However, the pain that frequently accompanies the rash can be severe, and despite complete resolution of the rash, pain can persist for weeks, months, and in rare cases for years. This persistent type of pain is referred to as post herpetic neuralgia (PHN). Is the virus contagious? The fluid present in the actual blisters contains live virus and pos- es a risk of infection to those who come in con- tact with it. Patients with shingles can transmit an infection to individuals who did not have chickenpox and thus cause chickenpox in those individuals. Patients with shingles cannot give shingles to anyone who has already had chicken- pox. Once all the affected lesions are crusted, there is no live virus present, and the person is no longer contagious. Infected patients should stay away from immunocompromised individu- als and pregnant women. Any visible sign of shingles should prompt an immediate consultation with your physician. Initiation of antiviral agents within seventy-two hours of rash eruption will reduce the symptoms, hasten the resolution, and mini- mize or reduce the pain. Pain management de- pends upon the severity of the discomfort, loca- tion, and extent of involvement. Frequently, over-the-counter pain medications are very help- ful, but more potent agents are often pre- scribed—especially for PHN which may require local analgesic agents, pain medications, and pain desensitizers. Even antidepressant medica- tions may be beneficial for pain management. Cases of severe pain can be challenging to con- trol, and some pain medications may have signif- icant side effects. Steroids in the form of creams or tablets have no affect on shingles, and infec- tion with bacteria is occasionally seen and needs to be addressed either with local wound care or antibiotics, or possibly with both. In presentations where there is eye in- volvement (accompanied by redness at the tip of the nose) consultation with an ophthalmologist is mandatory. This condition is a very serious in- fection which may rapidly lead to permanent eye damage. Currently, the Center for Disease Control (CDC) recommends that the shingles vaccine be given after age sixty with no maximum age limit and regardless if the patient recalls having con- tracted chickenpox or not. The CDC does not have a recommendation for patients in their fif- ties, but the vaccine is approved for this age group. However, most insurance companies will only cover the high cost of this live vaccine for ages sixty and above. If anyone does have an epi- sode of shingles regardless of age, the vaccine is no longer necessary. The take-home message for seniors is then simple: get vaccinated! You will prevent many possible complications, and as the saying goes, an ounce of prevention is worth a pound of cure!
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