Shingles-Fighting Strategies

Shingles Overview

If you’re 60 or older and had chickenpox as a child, chances are you might experience shingles during your lifetime. About 1 in 3 will develop shingles, according to the Centers for Disease Control (CDC), resulting in an estimated 1 million cases annually (1).

Shingles, also known as herpes zoster, is a painful skin rash caused by the varicella zoster virus, the same virus that causes chickenpox. After a person recovers from chickenpox, the virus lies dormant in the body and can reappear years later.

Shingles most often starts as a rash on one side of the face or body. The rash starts as blisters that scab after 3 to 5 days. Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. Other symptoms of shingles can include fever, headache, chills, and upset stomach. The rash usually clears within 2 to 4 weeks.

Who Can Get Shingles?

The risk of getting shingles increases as a person gets older, usually due to an age-related decline in immune function, specifically the loss of zoster-specific cellular immune response. The virus lies dormant in nerve ganglia until something, often severe stress or another illness triggers its reactivation. People who have medical conditions that keep the immune system from working properly, like cancer, leukemia, lymphoma, and HIV virus, or people who receive immunosuppressive drugs, are also at greater risk to get shingles.

Treatment, Complications & Spread

Anti-viral drugs such as acyclovir (Zovirax) or famciclovir (Famvir) taken orally and applied as a topical cream, can often shorten the duration of the skin lesions and may lessen the pain and discomfort if started within a few days of the onset.

Shingles can occur on the face or trunk of the body, though it most commonly occurs on the chest, abdomen, or the eyes (called ophthalmic zoster) – areas that are supplied by the trigeminal nerve and thoracic ganglia (nerve cells). One complication of shingles is eye involvement which occurs in 10-25% of zoster episodes, and can result in prolonged pain and loss of vision. Another complication that can happen in up to 20% of those with shingles is debilitating nerve pain that can last months or even years. Called postherpetic neuralgia (PHN), it is often managed with corticosteroids, analgesics and antidepressants. Also helpful in relieving PHN pain is capsaicin cream, which contains the active component of hot red peppers (2).

While shingles can’t be passed from one person to another, the virus can be spread from someone with active shingles to a person who has never had chickenpox through direct contact with the rash. The person exposed would develop chickenpox, not shingles. A person with shingles can spread the disease when the rash is in the blister-phase, but is no longer contagious once the rash has developed crusts.

Prevention is Possible!

In 2008, an advisory committee of the CDC recommended the recently developed zoster vaccine for everyone aged 60 and over (who have no contra-indications) (3). Even though a 2nd episode of shingles is uncommon, the vaccine is also recommended for those who have already had shingles as well as those with certain medical conditions.

Studies report that the vaccine can cut the risk for shingles in half, and greatly reduce the severity of symptoms in those who do get it. The vaccine is not for those who are pregnant or have a weakened immune system from cancer or AIDs, for example, or are allergic to any of the vaccine’s ingredients. To find out more, visit www.cdc.gov/vaccines and ask your doctor.

Along with vaccination, controlling stress and supporting the immune system through nutrition and exercise are good strategies to pursue. Make sure you get adequate levels of vitamins C, D, E, beta-carotene and zinc needed for proper immune function. Finally, some studies suggest multi-nutrient supplementation can enhance immune function in the elderly.

References

1. CDC framework for shingles prevention and control (www.cdc.gov).
2. Opstelten W, et al. Clinical Review: Treatment of herpes zoster. Can Fam Physician 54:373-7, 2008.
3. MMWR Recommendations and Reports: Prevention of herpes zoster, June 2008 / 57:1-30.