Shingles: An Explanation

Q:  My wife has been going through a very frustrating and, at times, very painful problem for over a month since first being diagnosed with shingles. She had a doctor's prescription covering the first week of shingles.

Since then, the skin eruptions under her right breast and around to her back have dried out, but the redness still appears. She has been treating the areas with zinc oxide, an ice pack and a lotion called Sarna, which has given her some relief from itching and other discomforts.

I know shingles is a virus that affects the nerves, but I'm surprised at how little information is readily available for help. Could you please explain this disease?

A:  Shingles, known medically as herpes zoster, is caused by the varicella-zoster virus, the same one that causes chickenpox in children. The virus remains dormant in the nerves for years, but gets reactivated in about 20% of the general population at some time later in life. About 70% of cases occur in people over the age of 50, and up to 50% of people who live to be 80 will experience shingles. All races and genders are affected equally by shingles that can occur at any season or time of the year.

A common location for shingles is the chest or back, and occasionally the face. The virus travels from the nerve root to the skin and causes painful blisters. These fluid-filled blisters actually contain the virus and can infect people who have never had chicken pox before if they come in direct contact with the lesion. Eventually the blisters crust and scab over in 7 to 14 days. At this point, the dry scabs no longer harbor the virus. For most people that's the end of it.

Unfortunately people over 60 have about a 50% chance of having continuing pain, even after the lesions heal. This complication is called "postherpetic neuralgia" and can last from a few months to a few decades. To prevent this chronic pain, it is important to treat with Acyclovir, an anti-viral drug, within the first 48-72 hours after the onset of shingles. I presume that this is the prescription your wife received from her doctor. After finishing a week of Acyclovir, there are a variety of creams available, such as Silvadene, Capsaicin, or Aspercreme, to relieve the discomfort.

For more information on this topic, see The Facts about Shingles.

"Dear Doctor" is a compilation of patient questions answered by doctors from the Medical College of Wisconsin.