Rash, Pain and Itching

Shingles (herpes zoster) is a viral disease caused by the same virus that is responsible for chicken pox. It usually strikes people in their 60s who had chicken pox as children. The virus causes pain in the area of the inflamed nerves, followed by a red rash with small fluid-filled blisters. The pain caused by inflammation of the nerves can continue long after the rash has cleared. The antiviral drug acyclovir can speed the healing of the rash and reduce inflammation of the nerve endings if treatment is started early.

The blisters that appear along with a red rash in shingles can be painful and itchy.

Shingles Is a Viral Disease

Shingles is a painful inflammation caused by the same virus that is responsible for chicken pox. The virus, known as varicella-zoster, can remain inactive in the nervous system of chicken pox victims for decades and then, for unknown reasons, it can become active. Persons who develop shingles often cannot recall being exposed to a person with chicken pox when the symptoms of shingles appear. Shingles rarely appears more than once during a lifetime.

Factors: Shingles usually occurs in persons past age 60 who had chicken pox as children. The virus infects the nervous system and afterward stays inactive for years. The virus, after reactivation, causes pain in the area of the inflamed nerves, usually in the face and areas of the body adjacent to the spinal cord and its nervous system. The seriousness of shingles depends on the age of the patient and the state of the immune system. In children, cases of shingles are usually mild and the rash develops without pain. In patients over age 50, up to one half will have severe pain that lasts for more than one month. Patients with a poorly functioning immune system, such as those with AIDS or lymphoma, may have a more severe case, take a longer time to heal and they may develop more serious complications from the infection.

Symptoms: Typically, the beginning of shingles is marked by pain, tingling or itching in a single area about 48-72 hours before a rash develops. The red rash is quickly followed by the formation of vesicles, or small sacs filled with fluid, that look like chicken pox vesicles but are confined to a smaller area. The vesicles form for 3-5 days, then usually dry up and the scabs fall off within two weeks. In some cases, though, the skin may not return to its normal appearance for a month. Usually the rash appears on one side of the body, on the arms or legs or on the trunk. Unusual patterns of infection include shingles on the eyelids or across the nose, a sign that an eye infection could develop or has already developed. In these cases, an ophthalmologist should be consulted immediately to start early treatment because severe eye pain may occur and there is danger of glaucoma or blindness. Vesicles can also appear in the mouth, on the tongue or in the ear canal. These infections can leave a patient with facial weakness, loss of taste, hearing loss, dizziness and changes in sensation in the affected area. Weakness may develop in the extremities up to two weeks after the rash appears. Unfortunately, for one fourth to one half of patients, pain may remain after the rash is gone, a condition called post-herpetic neuralgia. Constant and severe pain or on-and-off stabbing pain are symptoms. Changes in temperature may also worsen pain.

Treatment: The goal of treatment is to stop the spread of the virus within the nervous system. Acyclovir is an antiviral drug that heals and prevents nerve inflammation if given early in the disease. In most patients it is given orally 5 times a day for 7-10 days. Soaking the affected area with aluminum acetate solution (Burow's solution) for the first day or two soothes and cleanses the rash. Analgesics such as acetaminophen or ibuprofen can reduce the pain during a shingles outbreak or from post-herpetic neuralgia. For chronic neuralgia, drugs such as amitriptyline and fluphenazine have been shown to provide relief.