Aftermath worse than shingles
Dear Dr. Donohue: Will you kindly write about shingles? My story started last December with pain. Two days later, I saw the doctor again, and he told me I had shingles. It had spread to my back. Now, the scabs are almost healed. Incidentally, the outbreak on my back was on both sides.
D.S. A million cases of shingles occur yearly in the United States, and most patients are past middle age.
The chickenpox virus causes shingles. Once that virus infects people — usually during childhood — it stays with them for life inside nerve cells.
When the immune system has a transient lapse in vigilance, the virus emerges from its nerve-cell home and travels down the nerve root to the skin, where it causes the typical shingles rash. The rash is just about always on one side. It comes in a band from the back and sweeps somewhat downward across the chest to the middle of the breastbone. It also can be on the face or the legs or arms.
It’s a rash of tiny blisters on a red base. New crops of blisters continue to form for a few days. The blisters merge and form a sore that becomes a scab. The rash phase of the illness ends in about two or three weeks. Pain can be severe.
As bad as shingles is, the aftermath is worse. It’s pain that lingers long after the rash has gone. That is postherpetic neuralgia, and it comes from the damage done to the nerve when the virus travelled down the nerve to the skin.
For shingles, the antiviral drugs acyclovir, famciclovir or valacyclovir are sometimes prescribed. Pain medicine is essential. For postherpetic neuralgia, Lyrica or neurontin often can control pain. Amitriptyline is also used, as is the lidocaine skin patch.