Herpes Zoster Infection / Shingles

Herpes Zoster Infection / Shingles 

Herpes Zoster or Shingles is a viral infection caused by the Varicella-Zoster virus (the same virus which causes Chicken Pox).  Shingles is the reactivation of this virus many years after the initial Chicken Pox infection which many of us would have has as children.

Who is at risk of getting Shingles

• People over the age of 50 years account for 30% of all Shingles cases
• People with poor immunity (cancer survivors, patients with HIV or patients with organ transplant on long term treatment with steroids or immunosuppression medications)
• Patients with leukaemia or lymphoma

Symptoms and Signs

Shingles usually affect only one side of the body, usually the face, chest and abdomen. The symptoms include;

• Pain or burning / tingling sensation with increased sensitivity
• Red rash (with blisters) which begins 2-3 days after the pain
• Itchiness at and around the skin rashes
• Mild flu like symptoms such as fever, tiredness or headache

Management

Antiviral Medication

Oral antiviral medication such as Acyclovir, Famciclovir or Valaciclovir should be started as soon as possible (ideally within 72 hours) to reduce the duration and severity of the Shingles infection. This oral medication can also reduce the risk of Post-Herpetic Neuralgia which is a debilitating complication of Shingles.  Topical antiviral medication is also useful where there are active blisters on the skin

Pain Relief Medication

Pain medication such as Paracetamol, NSAIDS or Cox-2 inhibitors may be taken to provide pain relief during the acute phase.  Post-Herpetic Neuralgia can be relieved using Phenytoin, Carbamazepine or Gabapentin as well as anti-depression medication such as Amitriptyline or Nortriptyline. 

Self Care & Prevention of Spread

Patients with shingles can spread the Varicella-Zoster virus to those who have NOT had chickenpox before or who have reduced immunity such as people on cancer treatment, newborn babies or pregnant mothers.  Patients should avoid direct contact with people while still having the rash or blisters in the early stage of the shingles.

• APPLY moisturiser over the rashes to reduce the amount of itchiness
• COVER the blisters with a dry soft cloth or bandage
• AVOID scratching the blisters or rashes to prevent scarring or infection

Complications of Shingles

• Post-Herpetic Neuralgia (around x% get long-term pain along the nerves of the affected area.  This complication can be reduced if anti-viral treatment is started early or if the patient has had Shingles vaccination
• Scarring or discolouration of the skin.  This complication is more common if the patient scratches the skin or bursts the blisters during the acute phase)
• Iritis or corneal ulcer if the eye is affected.  The eye is at risk when the shingles affects the forehead and eyelid.

Prevention

Shingles vaccine is recommended for people over the age of 50 years (regardless whether they have had shingles or not when they were younger) as well as people with reduced immune system (such as cancer survivors).  The vaccine is usually given in 2 doses between 2-4 months apart. 

Speak to your Pharmacist or Doctor if you are at risk of getting Shingles

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