The Sun (Malaysia)
Painful disease in all ways
> Shingles may affect patients not just physically but also emotionally and financially for a long period of time
YOU MIGHT or might not have heard about ‘sang seh’, the deadly ‘snake disease’ that the older Chinese folk speak of, that has nothing to do with snake or snake bite.
The medical term for the disease is herpes zoster, better known as shingles.
It starts off with a prickling pain either at the torso or facial region, and subsequently develops into a single stripe formation of rashes filled with small fluid-filled blisters that eventually snakes around the body. It can be unbearably painful even to the slightest touch.
The Chinese believe the rashes have the ability to attract each other through the blisters, and eventually the ‘head’ of the stripe will join with the ‘tail’ forming a circle. When that happens, the victim is in dire straits and may die. But that has been proven a myth.
The US Centre for Disease Control and Prevention (CDC) reports that one in three people will eventually develop shingles in their lifetime.
It is also reported that 95% of adults over 50 who have had chickenpox are at risk of contracting shingles due to their lowered immune system.
The scientific explanation for this is the reactivation of the varicella zoster virus that triggered the chickenpox – the virus never really goes away even after a person has recovered from chickenpox as it hides in the nerve cells of the body.
But this also means that those who have never had chickenpox before need not worry about getting shingles.
“For some people, [the virus] remains quiet for the rest of their lives, but for others, as they grow older and their immune system weakens, this chickenpox virus that’s been hiding reactivates as shingles,” said Hospital Sungai Buloh head and consultant physician for Infectious Disease Datuk Dr Christopher Lee.
Lee ( below) was speaking at a recent media forum organised by research-based pharmaceutical company MSD.
“It’s the same virus as chickenpox, just that it’s coming back again after your first episode, with the biggest risk factor being age,” Lee added.
While shingles are more likely to occur among older folk, it doesn’t necessarily mean the younger ones are not at risk.
“If you are young and have been taking steroids in the long term for some other disease, the chances of you getting shingles is higher,” said Lee.
“Shingles usually affects only one stripe of skin, but if your immune system is bad, for example, patients with AIDS or HIV, you can get many stripes of rashes.”
Surprisingly, Lee commented that the Chinese myth about the snake joining being fatal could have some basis of truth as it could be a sign of a serious underlying health issue.
“So with their low immune system, not only will the shingles kill you, the underlying problem also will.”
Shingles is physically painful, and in fact, the pain usually comes first before the rash.
Dr Mary Cardosa, the president of the Malaysian Association for the Study of Pain (MASP), described the pain as being different for different people, which can vary from just a discomfort or an itch, while for some, the itch is so severe that it feels like ants biting or bees stinging.
Shingles can also have an emotionally impact on the sufferer.
A recent MSD-sponsored study in Singapore reported that shingles usually occurs on the neck and chest (57% of the time) while about 20% had it over the mouth and eye – which carries an added risk of causing impaired vision.
Lee said if the rash occurred on the face, it can be disfiguring and cause scarring.
“So there are a lot of psychological issues [and] people can get depressed over it,” he added.
“There will be social withdrawals too and it’s not a good thing for older patients because we want them to be active.”
While shingles may completely heal after a week or two for some, 25% of the patients suffer from complications.
Lee said apart from germs entering the body from erupted blisters, patients may also suffer from post-herpetic neuralgia (PHN), a long-term chronic pain.
“Some patients with shingles will continue to have pain because the nerves are already damaged, and the pain can last up to one month and some up to a year,” said
PHN is expensive to treat, said Cardosa, because it occurs in the nerves.
Considering the complexity of nerves, Cardosa said not everybody responds well to nerve pain medications which can be costly.
There is no found cure for shingles yet.
But Lee said the risk of actually getting shingles can be significantly reduced via a zoster vaccination, which is a dosage 14 times higher than the chickenpox vaccine.
The recommended guideline is one dose per person who is at least 60 years and above.
“Prevention is possible now. There is a vaccine that reduces the risk up to 60%, so it’s something to consider,” said Lee.
“If you can, get vaccinated, [but] if you are not vaccinated and have symptoms of shingles, see a doctor immediately because it can shorten the risk of complications.”