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What is Shingles?

DEFINITION

Definition

Shingles is the common term for herpes zoster, a very painful disease that prefers to target seniors, or people who are 50 years of age and above. Shingles or herpes zoster generally lasts between two and six weeks. People may get shingles only once, but it is also possible to have the disease two or more times.

Other Terms for Shingles

In Filipino, shingles is called kulebra or kulebrang ahas. Among the Chinese population, it is known as "snake disease" or "flying snake". Many medical doctors have termed the condition the "scourge of the elderly".

CAUSES

Causes

Shingles is caused by a reactivation of the Varicella-Zoster Virus (VZV). This VZV is the same agent that causes varicella or chickenpox. After the initial episode of chickenpox, the VZV lies dormant in the spinal nerves. It may re-emerge later in life as shingles.

SYMPTOMS

Symptoms

Shingles usually starts out as a pain, an itch or a tingling sensation over one area on one side of the body. After 1 to 5 days, a rash will emerge. Though it occupies a relatively small area of the body, it often appears as a band in inconvenient places like the face or the torso. This rash is usually accompanied by pain, which can sometimes be so severe and excruciating that some patients have reported it to be even worse than labor or post-surgical pain.

The skin reddens, blisters, and becomes more painful over the next few days. The small bumps turn into extremely sensitive fluid-filled blisters. The blisters will typically scab over in 7 to 10 days then clear up within two to four weeks. Fever, chills, headaches, and an upset stomach can also be accompanying symptoms.

WHEN SHOULD YOU SEE A DOCTOR?

It is important to see a doctor when symptoms of shingles first appear to prevent more severe complications. Medical attention is most needed in the following situations:

  • Pain or rash near the eye
  • Widespread and painful rash
  • When affected individual is 70 years and older
  • Patient has weakened immunity due to medications or chronic illness

Warning signs may start appearing a few days before the painful rash develops. They may not look very serious, but they can help a doctor diagnose the disease at its early stages. Be sure to watch out for these symptoms of shingles to get immediate treatment:

  • Fatigue
  • Aching Muscles
  • Headaches
  • Nausea
  • Fever
  • General feeling of being unwell

SHINGLES PAIN

Shingles Pain

The most common symptom of shingles, acute pain, is almost always experienced by patients suffering from the disease. A 2004 US study reported that 96% of herpes zoster patients experienced acute pain, with 45% of these patients reporting that they experienced the pain every day.

The pain has been described as excruciatingly severe, even worse than childbirth pain. Depending on the location of the nerve involved, it can be mistaken for pain caused by other serious conditions such as angina or heart attack, appendicitis, or sciatica.

For some people, shingles pain may persist for months or even years even after the rashes have disappeared. Called post-herpetic neuralgia (PHN), this chronic pain can leave patients feeling miserable. Patients with PHN experience allodynia, a type of pain caused by non-painful stimuli, such as a very light touch, or breeze on the affected skin.

COMPLICATIONS

Complications

As if the attack of shingles is not bad enough, the possibility of complications can be even worse. The most common of these is called post-herpetic neuralgia (PHN). The condition can endure for extended periods of time, even after the rashes have disappeared. The possibility of PHN exponentially increases with the age of the person: the older one is at the time of the shingles episode, the greater the chances of having PHN.

Other complications depend on where the rashes or blisters appeared.

Shingles emerging around the eyes and forehead, called ophthalmic shingles or herpes ophthalmicus, can result in chronic in-turning of the eyelashes and blindness.

Shingles blisters around the ear can lead to hearing loss, or a rare disease called Ramsay Hunt syndrome, which is associated with the paralysis of facial muscles.

Additional complications include scarring, skin infections, pneumonia, encephalitis, or rarely, even death.

POST HERPETIC NEURALGIA

Post Herpetic Neuralgia

Postherpetic neuralgia (PHN) constitutes the most common serious complication and cause of zoster-associated morbidity. The frequency and severity of PHN increase with age, and may complicate 25 to 50% of zoster cases among patients over 50 years of age.

PHN has been variably described as a tender, burning, throbbing, stabbing, shooting and/or sharp pain that can persist for months or even years and can also lead to emotional distress. Allodynia, another pain-related complication of shingles, is a type of pain that is caused by a non-painful stimulus (mapatungan lang ng tshirt, masakit na). Allodynia  is typically described as distressing and debilitating, and is present in at least 90% of patients with PHN. The duration of PHN may persist even longer than 90 days after the onset of the rash.

BURDEN OF ILLNESS

Burden of illness

Before the body finally overcomes the disease, the patient is under extreme distress. The slightest pressure on the affected area can cause so much agony. Common activities such as sitting, sleeping, or even changing clothes, can aggravate the pain of shingles, making it almost impossible for the patient to perform these actions. In one study, 42% of those surveyed described shingles pain as ‘horrible’ and ‘excruciating’. In fact, the severity of shingles pain can exceed musculoskeletal pain, osteoarthritis, chronic cancer pain, and childbirth.

The disease drastically reduces a person's quality of life. Shingles pain affects the person's activities of daily living and creates difficulties for him/her to work, socialize, or generally enjoy life. Some people never return to normal activities, and become depressed and reclusive, especially if they develop long term pain and disability.

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