By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

SHINGLES OFTEN RESOLVE ON THEIR OWN, BUT SEEKING TREATMENT WISE

Question: My mother, who just turned 60, called to tell me that her doctor old her that the strange rash on her back was shingles. Mom said it was like chickenpox, but she had those as a child. Can I catch this from her? How did she catch it? Will it spread or get worse?

Answer: The condition your mother has, shingles, is due to the same varicella-zoster virus (VZV) that causes chickenpox and several other illnesses. Your mother’s first exposure to the virus produced the chickenpox she had as a child. Typically, the symptoms of chickenpox are a body-wide rash with itching, irritated blisters and fever. Well over 90 percent of adults have had this common childhood illness, which usually clears up within a few days without any complications.

Shingles is a reactivation of the VZV germ and is fairly common in people over 50. What happens is that the virus goes into a kind of “hibernation” state and remains that way for a number of years. Then, as you get older, the VZV may start to stir and become active once again.

In most cases doctors and scientists don’t really know why this virus reactivates in a particular person at a specific time. However, we do know that reactivation sometimes happens when the person is under a lot of stress or when his or her immune system has become weakened due to cancer or cancer treatment, transplant surgery or HIV infection.

The presentation of shingles is quite classic, and the disease is easily diagnosed during an exam by an experienced practitioner. The person usually first notices a burning pain, or tingling and itching in an area with no visible rash. This precedes the rash by a few days. The rash starts out as a reddened area, then clear vesicles, or blisters appear, usually in a tight cluster.

Shingles blisters are quite distinct in that they follow the course of one or two nerves on just one side of the body. The nerves of the trunk, as in your mother’s case, and buttocks are most commonly involved. Fever and general malaise are common. Shingles usually resolves on its own, but your mother is wise to seek treatment. This is because early intervention with antiviral medications can limit the spread of the blisters, reduce complications and help the body heal more quickly.

The most common complication of shingles, is pain after the rash has disappeared –- a condition called “postherpetic neuralgia.” The use of antiviral agents is particularly effective at preventing this complication if started during the earliest stage when the patient is experiencing the burning sensation and pain, but the blisters have not yet appeared.

Shingles can also lead to meningitis and encephalitis, but these complications are very rare. Also, uncommon but very serious, is a herpes zoster infection in the nerve around the eye. This is an emergency situation and prompt treatment is required to prevent possible blindness.

To answer your questions, no you cannot catch shingles from your mother, but you could get chickenpox if you have never had it. Your mom should stay away people who have a compromised immune system and take her medication faithfully.
Currently, studies are underway to develop a shingles vaccine, but that’s not likely for a while.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at http://www.FamilyMedicineNews.org.