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- - Shingles is caused by reactivation of the varicella virus that has lain dormant in the dorsal root ganglion.
- - The varicella zoster virus is believed to enter the sensory nerve endings in the skin during a chickenpox infection, travelling up the nerves to the ganglia.
- - Painful blisters develop following the underlying route of the nerves that are inflamed by the virus.
- - Every year about 200,000 people in the UK have an attack of shingles.
- - It mainly affects adults: 60 per cent of people who have shingles are over 50 and five per cent are under 15.
- - It more frequently affects people with weakened immune defences and is, therefore, more common in older people or those with chronic conditions such as leukaemia or AIDS.
- - Most people only have shingles once. However, people with impaired immune systems, may have repeated episodes.
- - The pain and rash of shingles is characteristically unilateral.
- - Past history of chickenpox.
- - May start after a period of debility.
- - Some blisters may weep fluid.
SIGNS AND SYMPTOMS
- - Painful blisters form in the area supplied by one nerve root. This usually affects only one side of the body.
- - The initial symptom is usually a tingling sensation in the affected area.
- - Pain and discomfort, which can be severe, begins about five days before the rash emerges.
- - Red papules develop into blisters, which crust over and heal within three to four weeks.
- - Malaise and fever are common and this, coupled with pain, makes shingles a debilitating condition.
- - Analgesic such as ibuprofen or co-codamol to control pain.
- - Oral antiviral agents help if taken in the first 72 hours.
- - Advise patient to:
- - Keep rash dry;
- - Rest, especially while malaise is a problem;
- - Stay away from newborn infants, pregnant women and anyone who is frail or unwell;
- - See his or her doctor if the rash becomes worse;
- - See his or her doctor if the pain is not controlled with simple analgesics.
- - Secondary infection can cause tissue damage and result in scarring.
- - Post-herpetic neuralgia, where pain persists beyond the normal two-to-three week period, lasting for months and sometimes years is a distressing complication that is more common with increasing age.
- - Damage to the inner ear can result in deafness and vertigo.
- - Involvement of the eye can cause ulceration and permanent scarring of the cornea.
- - A patient with shingles can transmit chicken pox to a susceptible individual but a patient with chickenpox cannot transmit shingles.
- - Creams and lotions are not recommended for treatment of the skin rash as there is a risk of spreading skin bacteria into the blistered area.
- - Prompt referral to a doctor is important for patients with:
Pain that is not managed with simple analgesia;
Anyone over 75;
If the face or eyes are affected.
- - Immediate treatment with antiviral drugs can reduce the severity and duration of an attack.
Ankrett, V., Williams, I. (1999)Quick Reference Atlas to Dermatology. Tunbridge Wells: MSL.
Johnson, G. et al (2000)The Minor Illness Manual. Oxford: Radcliffe Medical Press.
Youngson, R. (2002)The Royal Society of Medicine Health Encyclopaedia. London: Bloomsbury Publishing.
Information for patients is available from StudentHealth: www.studenthealth.co.uk
National Institute of Neurological Disorders and Stroke: www.ninds.nih.gov/health_and_medical disorders/shingles doc.htm
British Association of Dermatologists: www.bad.org.uk/patients/patient_s