For Shingles, It's Treatment ASAP

Q:  A friend of mine recently had shingles. She recognized the rash, visited her doctor and was cured in a short time with medication. She could recognize the rash because she has had friends with shingles, but I fear many people are missing out on shingles therapy because they don't see their doctors soon enough after symptoms start.

Could you alert your readers of the importance of seeing their physician within 48 hours of the first symptom of shingles?

A:  Shingles, or herpes zoster, is a reactivation of the virus that causes chicken pox. If you have had chicken pox, you have that virus lying dormant in the nerve cells of your body. In most people, the virus stays dormant and never bothers them again. But in others - usually older people or people with medical illness - the virus "wakes up" and causes a rash, similar to the chicken pox rash, but only on parts of the body.

Shingles causes numbness, itching or severe pain followed by clusters of blister-like lesions in a strip-like pattern on one side of the body. The involved area corresponds to the nerve that now has the active virus and occurs in the same location as the initial pain symptoms.

The biggest problem with shingles is the pain (referred to medically as post-herpetic neuralgia), which can persist for weeks, months, or even years after the rash heals. But when medications are started within two to three days of the rash, the medications probably limit the length of time of the pain to two months or less. Early start of medications can also modestly limit the duration of the rash - instead of about 10 days of rash, more like eight days.

The most successful therapies are either standard pain medications (such as ibuprofen or mild narcotics) or medications formulated for nerve pain, such as certain anti-depressants and anti-seizure medications (e.g., amitriptyline and gabapentin).

If you do get shingles, contact your health care provider as soon as possible to discuss treatment with antiviral medications. These medications are most effective if given as soon as possible after you notice the rash.

People with shingles are contagious to persons who have not had chickenpox. Therefore, people who have not had chickenpox can catch it if they have close contact with a person who has shingles. However, you cannot catch shingles itself from someone else. You get shingles from your own chickenpox virus, not from someone else.

The best way to prevent shingles is to prevent chickenpox with the chickenpox vaccine. Although it is possible for people who have been vaccinated against chickenpox to get shingles in later years, it is much less likely.

Children who are now vaccinated for chickenpox are reducing their risk for both chickenpox and shingles.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices internal medicine at the Froedtert & Medical College General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.