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Shingles

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(Herpes Zoster; Post-herpetic Neuralgia)

 

Causes

Shingles is caused by the varicella zoster virus. This is the same virus that causes chickenpox . Shingles occurs in people who have had chickenpox. After causing the first chickenpox infection, the virus is not totally eliminated from the body. Some of the remaining virus settles in nerve roots near the spinal cord. When reactivated, the virus travels along nerve paths to the skin where it causes pain and a rash.
Shingles Blisters
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Risk Factors

Factors that may increase the risk of shingles include:
Shingles can occur in those with no known risk factor.
Shingles is not usually transmitted from one person to another. But, a person who has never had chickenpox and never received the varicella vaccine is likely to get chickenpox if contact occurs with a person who has shingles. Covering shingles sores with a bandage reduces the risk of transmitting shingles to others.
 

Treatment

Shingles cannot be cured. Treatment focuses on:
  • Easing symptoms
  • Speeding recovery
  • Preventing PHN

Home Remedies and Over-the-Counter Products

Your doctor may recommend that you use these treatments to reduce discomfort:
  • Calamine lotion
  • Wet compresses
  • Frequent oatmeal baths
  • Over-the-counter pain relievers such as acetaminophen, ibuprofen, naproxen, and capsaicin cream
If you are not getting any relief from the over-the-counter products, your doctor may prescribe medicine. For example, your doctor may prescribe a short course of oral steroid medicine such as prednisone.

Antiviral Medication

Certain antiviral medicines may control shingles. Examples include:
  • Acyclovir
  • Famciclovir
  • Valacyclovir
Antiviral therapy may shorten a shingles episode. But you must start it within 48-72 hours after symptoms first develop.

Treatment for Post-herpetic Neuralgia

If you develop PHN, your doctor may recommend:
  • Tricyclic antidepressants
  • Selective serotonin reuptake inhibitor (SSRIs)
  • Gabapentin, an anti-seizure medicine
  • Prescription pain medicine such as long-acting opiates or pregabalin
  • Capsaicin cream
  • Lidoderm patch
  • Nerve blocks
  • Transcutaneous electrical nerve stimulation—a device that generates low-level pulses of electrical current on the skin's surface

Treatment for Shingles of the Eye

If you develop shingles on your face, contact your doctor right away. You may be prescribed medications, such as steroids to treat this condition. Without treatment, permanent eye damage can result, including glaucoma, scarring, and blindness.
 

RESOURCES

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov

VZV Research Foundation
http://www.vzvfoundation.org

 

CANADIAN RESOURCES

Canadian Family Physician
http://www.cfpc.ca/

Public Health Agency of Canada
http://www.phac-aspc.gc.ca/

 

References


Ocular shingles. Wills Eye Institute website. Available at: http://www.willseye.org/health-library/ocular-shingles . Updated October 5, 2011. Accessed June 6, 2013.


Shingles. Family Doctor.org website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/shingles.html . Updated January 2011. Accessed September 7, 2012.


Shingles: diagnosis, treatment, and outcome. American Academy of Dermatology website. Available at: http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/q---t/shingles/diagnosis-treatment . Accessed June 6, 2013.


Shingles (herpes zoster). Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/shingles/about/overview.html . Updated January 10, 2011. Accessed September 7, 2012.


1/14/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Tseng HF, Smith N, Harpaz R, Bialek SR, Sy LS, Jacobsen SJ. Herpes zoster vaccine in older adults and the risk of subsequent herpes zoster disease. JAMA . 2011;305(2):160-166.


6/9/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Forbes H, Bhaskaran K, et al. Quantification of risk factors for herpes zoster: population based case-control study. BMJ 2014;348.

 

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