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Week of 9 April 1999 Vol. II, No. 30 Health Matters Shingles: chicken pox revisited My neighbor says he is suffering from a painful disease called shingles. What is this condition and is it contagious? Your neighbor is not alone. Each year, some 300,000 people suffer from shingles, a painful disease of the skin and nerves also known as herpes zoster. According to Debra Gerson, M.D., clinical instructor of family medicine at Boston University School of Medicine and a board-certified family physician in the department of family medicine at Boston Medical Center, your neighbor can blame the virus that causes chicken pox -- varicella-zoster -- for the disease. This virus lies dormant in certain nerve cells of the body after a bout with chicken pox and can awaken at some point and cause trouble in the form of shingles, usually in individuals over 50. An equal opportunity condition, shingles affects both men and women. "What prompts the reactivation of the virus is unclear," Gerson says. "What we do know is that the older you are, the greater your chances of developing the disease. While even children can develop shingles, symptoms are generally less severe. "Particularly susceptible are those with a weakened ability to ward off disease," she says, "such as cancer patients, individuals with immune-damaging diseases, such as AIDS, and those taking drugs that inhibit the immune system." Signs and Symptoms The first sign of shingles is usually a burning pain or tingling, which may be accompanied by fever, headache, malaise, and tenderness in one area of the body where one or more sensory nerves emerge from the spine. In a day or two, clusters of small, itchy blisters appear on one side of the body, following the pathways of the affected nerves where the virus is stored. The most common site is the trunk, from which the term originates -- shingles comes from the Latin for belt or girdle. The blisters usually disappear within two to three weeks, although unfortunately the pain may last longer. Approximately 30 percent of patients over 40 develop postherpetic neuralgia (after-pains), a persistence or recurrence of the pain more than a month after the onset of shingles. This pain may be continuous and burning, with increased sensitivity in the affected areas, or may be a more spasmodic shooting pain. Shingles is usually not contagious, but it can be spread through broken blisters and cause chicken pox in those who have not had the disease. The virus may be present in blisters as long as a week after the rash appears, so you may want to keep your distance from your neighbor if you haven't had chicken pox. If there are any pregnant women in the neighborhood who have not had chicken pox, they should also avoid contact with your neighbor. The onset of shingles in pregnant women can cause the baby to develop chicken pox in utero. Treatment If you do have the misfortune of developing shingles, antiviral drugs, such as acyclovir, can reduce pain, speed healing, and may help prevent complications. Rest is important, says Gerson, and cool, wet compresses should be applied to the rash to reduce the itching and pain. When bathing, wash blisters gently and soak in a tub of water to which cornstarch has been added. The old standby, calamine lotion, may also help relieve the itching. Postherpetic neuralgia may be difficult to treat successfully, and the patient may be referred to a pain clinic. See a doctor right away if you notice any symptoms indicating the disease. If symptoms occur on the face, it is particularly important to get medical help quickly to prevent vision or hearing damage. "Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information about shingles or other health matters, call 638-6767.