Duration and Management of Shingles: A Look at Its Course and Remedies
In a bid to combat the potentially debilitating effects of shingles, the Centers for Disease Control and Prevention (CDC) recommends that adults aged 50 and above receive two doses of the Shingrex vaccination, with a gap of 2-6 months between each dose[1]. By doing so, individuals can significantly reduce their risk of developing shingles and the long-term complications that often accompany it.
Shingles, also known as herpes zoster, is a viral infection that affects approximately 1 in 3 adults in the United States[6]. While the rash is the most visible symptom, it is the less apparent long-term effects that can have a profound impact on a person's life. The most common complication of shingles is post-herpetic neuralgia (PHN), a condition characterized by persistent nerve pain in the area where the shingles rash occurred[1][2][4][5].
### Common Complications and Long-Term Effects of Shingles:
- **Post-herpetic Neuralgia (PHN):** PHN is the major and most frequent long-term complication. It involves chronic pain, which can be constant or intermittent and sometimes severe enough to impact quality of life[2][3][4]. Symptoms include allodynia, where even gentle stimuli like light touch or wind can trigger pain. PHN occurs in about 10 to 30 percent of people with shingles, with risks increasing with age[2][3][4].
- **Ocular Complications (Herpes Zoster Ophthalmicus):** When shingles affects the ophthalmic branch of the trigeminal nerve, it can cause eye complications such as conjunctivitis, keratitis, blepharitis, uveitis, episcleritis, scleritis, and retinal necrosis. These conditions can lead to long-term visual impairment or even blindness if not promptly and adequately treated[1][3]. PHN may also affect the eye area in these patients, causing prolonged facial and eye pain[1][3].
- **Secondary Bacterial Infection:** The shingles rash can become infected with bacteria, which may complicate recovery[1].
- **Motor Involvement:** Some cases involve motor weakness, especially in "motor herpes zoster," leading to temporary paralysis or muscle weakness in affected areas[1].
- **Neurological Complications:** Rarely, shingles can cause complications such as aseptic meningitis, encephalitis, cranial neuropathies, polyneuritis, or myelitis[1].
- **Facial Paralysis:** Partial facial paralysis may occur, usually temporary, particularly if the facial nerves are involved[1].
- **Psychological Impact:** Persistent pain from PHN can affect mental health, increasing risks of anxiety and depression[3].
- **Increased Risk of Cancer:** There is a slightly increased risk of developing cancer post-shingles, possibly due to immune suppression, though the exact mechanism is unclear and cancer mortality is not directly increased by the virus[1].
### Treatment and Management:
Treatment for shingles includes antiviral drugs, which ease symptoms, speed up recovery, and may prevent complications. A course of antiviral medications should start within 3 days of the shingles rash appearing[1]. Antiviral medications such as acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex) can reduce the duration and severity of shingles symptoms[1].
In addition to antiviral therapy, painkillers, antihistamines, anti-inflammatory drugs, corticosteroids, local anesthetics, and numbing products can help manage shingles pain and skin irritation[1]. For severe cases, antidepressant drugs like amitriptyline (Elavil) and duloxetine (Cymbalta) may be prescribed. Gabapentin (Neurontin) and pregabalin (Lyrica), anticonvulsant drugs, can also reduce nerve pain caused by shingles[1].
Self-care measures such as getting enough sleep and rest, using a wet compress on the affected skin, reducing stress, wearing loose-fitting clothing, taking an oatmeal bath, applying calamine lotion, and avoiding scratching the rash can help alleviate shingles symptoms[1].
As the rash starts to clear, a person may notice the rash blisters crack open and scab over. The blisters may also bleed[1]. It is crucial to avoid scratching the rash to prevent further complications.
### Prevention:
Vaccination is the most effective way to prevent shingles and its complications. The CDC recommends that adults aged 50 and above receive two doses of the Shingrex vaccination, with a gap of 2-6 months between each dose[1]. By doing so, individuals can significantly reduce their risk of developing shingles and the long-term complications that often accompany it.
It is important to note that shingles is contagious but only to those who have never had chickenpox or the vaccination for it. People with shingles should avoid close contact with such individuals until their rash completely heals[1].
References: [1] Centers for Disease Control and Prevention. (2021). Shingles.
- The Centers for Disease Control and Prevention (CDC) recommends two doses of the Shingrex vaccination for adults aged 50 and above, with a gap of 2-6 months, to reduce the risk of developing ulcerative shingles and its long-term complications.
- Shingles, or herpes zoster, affects approximately 1 in 3 adults in the United States and has various long-term effects beyond the visible rash.
- Post-herpetic neuralgia (PHN) is the major and most frequent long-term complication of shingles, involving chronic pain that can impact quality of life.
- Ocular complications, such conjunctivitis, keratitis, blepharitis, uveitis, episcleritis, scleritiss, retinal necrosis, can occur when shingles affects the ophthalmic branch of the trigeminal nerve, potentially leading to visual impairment or blindness.
- A secondary bacterial infection of the shingles rash can complicate recovery.
- Some cases of shingles involve motor weakness, leading to temporary paralysis or muscle weakness in affected areas.
- Rarely, shingles can cause neurological complications like aseptic meningitis, encephalitis, cranial neuropathies, polyneuritis, or myelitis.
- Partial facial paralysis may occur if the facial nerves are involved.
- Persistent pain from PHN can lead to psychological impact, increasing risks of anxiety and depression.
- There is a slightly increased risk of developing cancer post-shingles, possibly due to immune suppression.
- Treatment for shingles includes antiviral drugs, painkillers, antihistamines, anti-inflammatory drugs, corticosteroids, local anesthetics, numbing products, antidepressant drugs, and anticonvulsant drugs.
- Self-care measures such as getting enough sleep, using a wet compress, reducing stress, wearing loose-fitting clothing, taking an oatmeal bath, applying calamine lotion, and avoiding scratching the rash can help alleviate shingles symptoms.
- Vaccination is the most effective way to prevent shingles and its complications; it is contagious but only to those who have never had chickenpox or the vaccination for it.
