Shingles

Generally, shingles heals well and problems are few. However, on occasion, the blisters from the disease can develop an acute bacterial infection, causing cellulitis, a bacterial skin condition. If this occurs, the area will become reddened, warm, firm, and tender. You might notice red streaks forming around the wound. If you notice any of these symptoms, contact your health care professional. Antibiotics can be used to treat these complications and hopefully avoid scarring associated with the infection.

A more worrisome complication occurs when shingles affects the face of a patient, specifically the forehead and nose. In this situation, it is possible, although not likely, that shingles can affect the eye (known as herpes zoster ophthalmicus), leading to loss of vision. If you have shingles on your forehead or nose, your eyes should be evaluated by a healthcare professional.

A rare complication of shingles is known as Ramsay Hunt syndrome. In this case, the cranial nerves (cranial nerves V, IX, and X) are involved. Symptoms may include peripheral facial nerve weakness and deafness. The typical rash is often observed around the ear and ear canal.

There are several effective treatments for shingles, which is an adult expression of the varicella zoster or chickenpox virus. Medicine for treatment of viral disease (antivirals) can reduce the severity and duration of the rash if started early (within 72 hours of the appearance of the rash). They include:

• acyclovir (Zovirax),
• valacyclovir (Valtrex), or
• famciclovir (Famvir).

In addition to antiviral medications, pain medications may be needed to control symptoms of the condition. Both nonsteroidal anti-inflammatory medications and any narcotic pain-control drug may be used for pain management in shingles.

The affected area should be kept clean. Bathing is permitted when you have the condition, and the area can be cleansed with soap and water. Cool compresses and anti-itching lotions, such as calamine lotion, may also provide relief. An aluminum acetate solution (Burow's or Domeboro solution, available at your pharmacy) can be used to help dry up the blisters and oozing.

The most common complication of shingles is postherpetic neuralgia. This occurs when the nerve pain associated with shingles persists beyond one month, even after the rash is gone. It is a result of irritation of the nerves of sensation by the virus. The pain can be severe and debilitating. Postherpetic neuralgia occurs primarily in people over the age of 50 and affects 10%-15% of people with shingles. There is evidence that treating shingles with antiviral agents can reduce the duration and occurrence of postherpetic neuralgia.

The pain of postherpetic neuralgia can be reduced with medical treatment. Tricyclic antidepressant medications (amitriptyline [Elavil] and others), as well as antiseizure medications (gabapentin [Neurontin], carbamazepine [Tegretol], and pregabalin [Lyrica]), have all been used to relieve the pain associated with postherpetic neuralgia. In 2012, the FDA approved the use of gabapentin enacarbil (Horizant), previously used for the management of restless legs syndrome, for the treatment of postherpetic neuralgia. Capsaicin cream (Zostrix), a derivative of hot chili peppers, can be used topically on the area after all the blisters have healed, to reduce the pain. Lidocaine pain patches (Lidoderm) applied directly to the skin can also be helpful in relieving nerve pains by numbing the nerves with local lidocaine anesthetic. These pain-relief options should be discussed with your health care professional.

Currently, there are two shingles vaccines called Zostavax and Shingrix. Recommendations from the Centers for Disease Control and Prevention (CDC) are that healthy adults 50 or older should get Shingrix, which is given as two injections separated by 2-6 months. Even adults who previously received Zostavax should now receive Shingrix in addition. A chickenpox vaccine is also available. According to information from the CDC, children should get their first dose of the varicella immunization at 12 to 15 months, and the second dose at 4 to 6 years of age. The shots will prevent chickenpox, though they will still be at risk for shingles, potential postherpetic neuralgia, and related conditions later in life.