Shingles - Ask The Doctor
Question: I am a 75-year-old female who has developed a rash along the
right side of my mid back that extends underneath my arm and around to my chest.
This started about two days ago and is exquisitely painful. What can be done for
this problem?
Answer: These are symptoms of shingles or acute
herpes zoster, which can occur at any age, but the incidence in people older
than 60 years of age is much higher. This is caused by reactivation of the
varicella virus (chickenpox virus) and affects the nerves as they enter into the
spinal cord. This virus can lay dormant for many years and reactivate.
The rash usually occurs around the middle of the trunk, but can occur on the
face and on the lower portion of the back and extremities. It is important that
this syndrome be treated as soon as possible to prevent the onset of prolonged
pain, which can be present even after the rash heals. This can be present for
many months to years and is called postherpetic neuralgia.
Most studies have shown dramatic reduction of symptoms as well as prevention
of postherpetic neuralgia if onset of antiviral drugs is administered within 72
hours of onset of rash and pain. Shingles that affect the eyes should be
immediately treated by an opthalmologist or blindness can occur. There are side
affects from these medications and these should be discussed with your doctor
before starting treatment.
Is is possible that the development of shingles could be a clue to an
underlying immune deficiency or cancer and this should be discussed with your
physician. In addition to the antiviral medications, treatment with anti-inflammatories,
Tylenol and even narcotic medications for severe pain, can be helpful. Some anti
seizure drugs can be helpful as well as topical medications. Aggressive
treatment with epidural injections and nerve blocks with steroids can also be
very effective at decreasing symptoms.
Rarely this syndrome can occur without a rash and many times the pain
precedes the development of the rash. The above-mentioned signs and symptoms
should be addressed by your primary physician or a pain physician sooner rather
than later, to help decrease the chances of developing postherpetic neuralgia.
By Kevin M. Henry, MD
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