shingles

Are Shingles Chickenpox for Seniors?

Published On November 19, 2015 | November/December 2015

Learn who’s at risk, prevention, and treatment for this painful virus

by Katherine Voss

Sixty-two-year-old, Walter, had piles of work on his desk, his boss had left several messages to call him back, his wife was in the hospital undergoing medical treatment – he had a lot of stress in his life. And now he has a burning rash on his right side above his waist. It tingles and hurts, surprisingly badly. So, what’s the diagnosis? Shingles. Lianne Marks, MD, PhD, Internal Medicine Physician at Baylor Scott & White – Round Rock, describes shingles and offers some advice on its treatment.

What Is Shingles?
“Shingles is caused by a virus — identical to chickenpox but resurfacing later in life – called varicella zoster. It’s a latent infection that resides in your nerves if you had the chickenpox virus when you were younger,” says Dr. Marks. “Shingles is not considered serious or life threatening, but it’s very painful. It can be brought on by stress, or through decline of protective immune function with normal aging,” says Dr. Marks. Shingles affects around one million people in the United States each year.

Who Is Most at Risk?
Anyone who’s had chickenpox is at risk for developing shingles. The Centers for Disease Control and Prevention reports that more than 99 percent of Americans age 40 and older had chickenpox as children, even if they don’t remember it. Shingles is most common in people ages 60 to 69, though it can affect any age. The older you are when you get shingles, the greater the likelihood you’ll have severe effects. Dr. Marks says, “People with weakened immune systems are more at risk of developing shingles.” They include people who have:

• Cancer or are undergoing radiation or chemotherapy
• Leukemia or lymphoma
• HIV or AIDS

Generally people have only one shingles flare-up in their lifetimes, but on occasion it is possible to have shingles more than once.
What Causes Shingles?
Once you get the chickenpox infection, the virus stays inactive in your body for the rest of your life. People older than 60, who are eligible for the shingles vaccine, occasionally tell me they don’t need it because they never had chickenpox. However, often chickenpox infections had no symptoms, so they didn’t know they had it. “This same stealthy virus that was hidden on the initial infection can come back with a vengeance, causing significant pain and suffering,” explains Dr. Marks. When you are under a lot of stress or if your immune system is suppressed, the virus can manifest itself in the form of shingles, in most cases a much more painful condition than the original chickenpox.

What Are the Symptoms of Shingles?
• Localized painful itching or tingling several days before the shingles develop
• Rash that turns into painful, fluid-filled blisters that scab over a week later
– Rash occurs in a bold band, called a dermatone, on either your right or left side
– Rash may occur on your face (and can cause hearing and/or vision loss – a medical emergency)

Other symptoms include:
• Fever
• Headache
• Chills
• Pain (which can be severe and come on before during or after the rash. This can last days, months, weeks, or years)

Is Shingles Contagious?
Yes and no. It is rare for a person with shingles to transmit the virus. People can get chickenpox from your rash if the fluid that seeps from shingles blisters is touched, presuming they did not have protective immunity from a previous infection or vaccine. Shingles is contagious when blisters are present; when the blisters have crusted over, you’re no longer contagious. However, if you have a rarer condition called disseminated shingles (shingles that is located in more than one place on the body), it is contagious via the respiratory route (in the air) and can be particularly dangerous if pregnant women are exposed.

How Long Does Shingles Last?
In most cases, shingles lasts about two to four weeks. It generally leaves no scarring or ill effects. However, some people develop a complication of shingles called post-herpetic neuralgia (PHN), which is severe and sometimes debilitating pain in the areas where they had shingles.
“Post-herpetic neuralgia occurs after the shingles and the rash are gone. This neuropathic pain can last for weeks, months, or longer,” Dr. Marks says. Ibuprofen and topical creams containing capsaicin may be helpful in controlling the pain associated with PHN. Dr. Marks says, “Greater than 20 percent of patients over 60-years-old can develop PHN.”

How Is Shingles Prevented?
Dr. Marks says shingles can be prevented with the shingles vaccine. The vaccine has an efficacy rate around 70 percent. The shingles vaccine is available at most clinics and at some pharmacies and grocery stores.

How Is Shingles Treated?
Because shingles is caused by a virus, “It’s treated symptomatically with medications for the pain and inflammation and with antiviral medication,” explains Dr. Marks. “Ibuprofen or acetaminophen may be helpful for the pain and swelling. We prescribe antivirals in particular, but you have to start it in the first three days or they really don’t help shorten the duration of the illness.”

About Dr. Lianne Marks, MD, PhD, FACP
Dr. Lianne Marks is the Regional Chair for Internal Medicine at Scott & White and Assistant Dean for Educational Development at Texas A&M College of Medicine in Round Rock. She focuses her practice on patients with diabetes mellitus. Dr. Marks is board-certified and received her BS cum laude in Molecular Neuroscience at the University of Florida in Gainesville and went on to receive her MD and PhD, Immunology, at the University of Miami School of Medicine. Her specialty training includes Bridges to Excellence®-Recognized Diabetes Care Provider. She is a member of the American Medical Association and Texas Medical Association. She serves on the Board of Directors, Texas chapter, of the American College of Physicians Williamson County Medical Society, and serves on the Board of Directors of the Community Montessori School in Georgetown. Dr. Marks enjoys scuba diving, windsurfing, snowboarding, cycling, sailing, racquetball, tennis, and gardening.

For more information, visit www.roundrock.sw.org.

Dragan Vorgic/bigstock.com
http://dermatology.about.com/od/infectionvirus/a/shingles_vacc.htm

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