An Overview of Shingles

Shingles is a common, unpleasant condition characterized by localized rash and pain caused by the same virus that causes chickenpox. Shingles occurs in roughly 20% of the general population regardless of race, gender, or time of year.

It is more common with age: 50% of cases occur in people over 50 (Beydoun 1999), and up to 50% of those who live to be 80 will experience shingles. Its most feared consequence is postherpetic neuralgia (PHN)–chronic pain that persists after the outbreak of the rash has been put into remission.

This protocol will give suggestions to help stop a shingles outbreak in its tracks and minimize the risk of PHN, as well as explain other complications, the cause of shingles and its symptoms, conventional medical treatments, and helpful nutritional supplements.

Cause

Shingles is caused by a reactivation of the varicella zoster virus (VZV), also known as human herpes virus-3 (HHV-3). This virus is related to herpes simplex viruses types 1 and 2. It is a relatively fragile virus susceptible to disinfectants such as alcohol and hypochlorite. Initial infection with VZV results in chickenpox (varicella).

Despite recovery from this illness, the virus lies dormant in the sensory nerve roots of the spinal cord for years or decades until it becomes active again and is then classified as herpes zoster. The condition is then diagnosed as shingles. It is not known why the virus becomes active again, but age-associated immune dysfunction or any other compromise of immune function is highly suspect.

Thus, all people who have ever had chickenpox (nine of 10 adults) are at risk for developing shingles. Shingles arises from viruses that are already within the body and is not caught from someone else. Someone who has never had chickenpox has a low risk of contracting that illness from close contact with the shingles rash (vesicles containing virus). VZV infection typically occurs through inhalation of virus particles.

Chickenpox is highly contagious because in that disease virus is shed from the throat into the air that others breathe. Because this does not occur in shingles, it is not very contagious and normal hand-washing minimizes the risk. A second attack of shingles is very unusual and may signal an underlying immune disorder. Herpes simplex infection, which does recur, can also be misdiagnosed as shingles.

Symptoms

Shingles has two primary symptoms: rash and pain. More generalized symptoms include enlarged, tender lymph nodes draining the affected area and occasional mild malaise (fatigue).

Rash – The affected area is red with small vesicles or blisters. Unlike the “dew drop on a rose petal” appearance of chickenpox, several blisters per area are common in shingles. New lesions may occur for up to 1 week, after which the rash shows signs of healing. In severe cases, lesions may grow together, yielding a carpet of scabs and sometimes permanent scars. Overall, the rash usually lasts 2-5 weeks.

Pain – Pain in the area in which the rash will appear may precede the rash, known as prodromal pain, sometimes by a few days. The area often becomes flushed and unusually, sometimes unbearably, sensitive to pain. This is known as allodynia. The appearance of the rash often heralds a decrease in pain.

Shingles symptoms usually correspond to the skin area or dermatome supplied by the affected sensory nerve roots. The dermatome most commonly involved is the thoracic (trunk, palms, inner arms, legs, and feet), followed by the trigeminal (face). Cervical (back of head, neck, shoulders, outer arms, and backs of hands), lumbar (waist, front of legs, and tops of feet), and sacral (buttocks, backs of legs, and soles of feet) dermatomes may also be affected. About 16% of shingles sufferers have more widespread rash.

Complications

   Postherpetic Neuralgia (PHN)

Pain that persists more than 30 days after the appearance of the rash is the most feared consequence of herpes zoster. The burning or stabbing pain of PHN is attributed to virus-induced damage to the nerve roots.

General risk factors include anything that compromises the immune system such as age, illness, immune system disorders, certain cancers (especially those that affect the lymph or immune system), and medications that affect the immune system. More specifically, PHN has been linked to the following four factors:

• Age, which increases the likelihood and severity of PHN; people over 50 have about a 50% chance of having PHN.
• Prodromal (prerash) pain.
• Severe acute (with rash) pain.
• Failure to obtain adequate antiviral treatment within 3 days of the appearance of the rash.

   Secondary Infection

Shingles lesions usually dry quickly and heal well. However, secondary infection can occur, resulting in redness and swelling and often leading to scarring. Staphylococcus aureus is a common cause and may require consultation with a microbiologist because of problems with resistance.

   Paralysis of the Affected Area

Some degree of motor paralysis is not uncommon, but is not very evident on the trunk as opposed to the face or limbs. It occurs from extension of the disease to the motor regions of the spinal cord or brainstem. Weakness follows the rash by a few days or weeks. About 55% of those affected make a complete recovery; 30% of those remaining show significant improvement.

   Ramsay-Hunt Syndrome

This syndrome has a well-known association with shingles. Its symptoms are pain in the middle ear; blistering of the external ear canal, pinna, and throat; and loss of taste (reflecting the involvement of the nerve supply to the tongue). Complete recovery is usual, although it may take months; in some cases a residual deficit may remain.

   Meningoencephalitis

This very rare inflammation of the brain, despite the severity of symptoms such as coma, normally resolves completely.

   Recurrent or Disseminated Herpes Zoster

Shingles is 9 times more likely to develop in those infected with HIV. In the early stages of HIV infection, shingles symptoms are fairly typical (Wilkerson et al. 1987). In more advanced infection, herpes zoster may take the form of repeated episodes of severe, prolonged, and sometimes atypical (VZV retinitis) disease.

Shingles is also more common in immuno-compromised children and adults (including organ recipients and chemotherapy patients). In these patients it may be recurrent and may disseminate or spread cutaneously (on the skin) or viscerally (among the organs), with life-threatening consequences necessitating intravenous antiviral drugs.

There is hope, however.  Nature has provided some answers.  If you haven’t seen them yet, we invite you to look at our “3-Step Shingles Protocol” plan.