FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

MEDICATIONS CAN HELP READER AVOID SHINGLES COMPLICATIONS

Question: I have had very painful blisters on my right shoulder and the side of my neck. My doctor just informed me that I have shingles. Please explain what causes this and what I can do for the pain.

Shingles is a viral disease that is a bit more complicated than one might first guess. It is caused by the varicella-zoster virus (VZV) that is also responsible for another common illness. In fact, the first exposure to the virus produces chicken pox with its itching, irritated blisters and fever. Shingles is its second manifestation. So, to give you the proper background, I need to start by taking a moment to talk about this common childhood illness.

Ninety-three percent of us have chicken pox when we are children. Today, most children come down with chicken pox between the ages of 1 and 4 because of the high rate of exposure in day care. The VZV is spread by person-to-person transmission, particularly by infected respiratory secretions. Infected persons are most likely to spread this disease two days before the rash breaks out and for the first few days thereafter. Therefore, there is no practical way to distinguish a child with a mild cold from one who has the early stage of chicken pox. One sneeze while the children play together exposes all of his or her playmates to this disease. Ninety-eight percent of those living in the same household who haven't previously had an VZV infection will come down with chicken pox once someone brings the virus home to share. It is very contagious! Adults with an active case of shingles, not just children with chicken pox, can spread the virus in this manner.

When we have chicken pox, our defense system doesn't actually kill off the attacking varicella-zoster virus, it only holds it under control. As the chicken pox sores go away, the virus goes "into hiding" along the nerve pathways -- a state you can think of as hibernation. This sets the stage for a possible outbreak of shingles years later, perhaps at a time when your body's immune system becomes less active because of age, medicine or another illness.

When we have chicken pox, our defense system doesn't actually kill off the attacking varicella-zoster virus, it only holds it under control. As the chicken pox sores go away, the virus goes "into hiding" along the nerve pathways -- a state you can think of as hibernation. This sets the stage for a possible outbreak of shingles years later, perhaps at a time when your body's immune system becomes less active because of age, medicine or another illness.

While those with chicken pox usually require no treatment, those with shingles certainly do. One of several medicines should be started immediately at the outbreak of blisters. These drugs shorten the duration of shingles and reduce the likelihood of developing one of the most undesirable complications of it -- post-herpetic neuralgia. This condition is the persistence of shingles pain even long after the blisters have healed. You should promptly see your doctor about this treatment. On a brighter note, there is now an immunization for VZV. A single childhood shot provides immunity against chicken pox for at least 10 years. We aren't sure when a booster dose is needed because the vaccine has only been studied for about 10 years in this country. Widespread use of this childhood immunization will certainly reduce the incidence of chicken pox in children, and that is important because between 50 and 100 children in the U.S. die from this infection each year. The added benefit is that those who have the immunization do not have VZV in their body, and consequently, can't develop shingles when they get older.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.