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

READER’S “OTHER SYMPTOMS” PROBABLY NOT RELATED SHINGLES

Question: I'm a 47-year-old female who is being treated by my doctor for shingles on my face. The pain is acute, burning and itching with tingling down my nose. My niece has shingles, and I had been traveling with her on vacation.  Is it possible I could have caught shingles from her?  I've had an itchy and swollen eye for one night, but it got better the next day. That was the day after my niece had pinkeye. I’ve also had increased hair loss. Could either of these be related to the shingles?

Answer: Contact with shingles cannot cause shingles; they are not contagious. Shingles are caused by the reactivation of the chickenpox virus that has been dormant in a person’s system. This can happen for a number of reasons, including a weakened immune system and stress, but most of the time there is no apparent cause for the shingles outbreak. What happens is that this virus -- known as herpes zoster or varicella zoster -- goes into a kind of “hibernation” state and remains that way for a number of years. Then as you get older, the virus may start to stir and become active once again.

The pain you describe from the shingles sounds fairly typical. It’s also common for the person to notice a burning pain or tingling and itching in an area a few days before the rash appears. The rash starts out as a reddened area, then clear vesicles or blisters appear, usually in a tight cluster.

Shingles blisters have a unique pattern -- along the course of one or two nerves on just one side of the body. The nerves of the trunk and buttocks are most commonly involved, but it can occur on the face, too, as you know. Shingles usually resolves on its own, but you are wise to seek treatment. Early use of antiviral medications can limit the spread of the blisters, reduce complications and help the body heal more quickly.

While, as I said, contact with shingles does not cause shingles, they can cause chickenpox in an unimmunized person who has never had chickenpox. So, it appears that you and your niece have both had chickenpox in the past. It’s probably just a coincidence that you’ve come down with shingles at about the same time.

While shingles is more common in persons over 50, they can occur at any age. Most people make a full recovery without incident, but some people develop post-herpetic neuralgia (PHN) -- continued pain in the area of their shingles after the lesions have gone. Currently there is a vaccine for chickenpox that can also ultimately lead to a decrease in shingles.

A specific shingles vaccine is in final development stages. In clinical trials it markedly reduced the incidence of shingles and PHN among older adults. In April 2005, Merck, the vaccine’s developer, asked the Food and Drug Administration to approve it for general use. Merck estimates that in the United States the vaccine could annually prevent 250,000 cases of shingles and reduce the severity in another 250,000 cases.

As for your other symptoms, they are probably not related to shingles, as this disease seldom has symptoms other than the rash, pain and burning -- and sometimes fever and myalgia early on. I’m not aware of hair loss as a symptom. Shingles on the face can cause serious eye problems, but since you told me your eye specialist didn’t find a problem and your symptoms were so brief, I suspect you caught pinkeye from your niece. That is very contagious! If you have any return of your eye symptoms, please go see your eye specialist again.

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, or via e-mail to readerquestions@familymedicinenews.org. 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 diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.