Shingles can erupt after long dormancy

On Call

July 02, 1996|By Dr. Simeon Margolis | Dr. Simeon Margolis,SPECIAL TO THE SUN

I was completely healthy until several months ago when, without any warning, I developed shingles on the lower left side of my back. The skin rash disappeared quickly, but extremely annoying pain continues every day. I would like to know what caused me to have shingles and whether anything can be done to ease the pain.

Shingles is caused by the varicella-zoster virus (VZV), the same virus that causes chicken pox (varicella). After an attack of chicken pox, VZV remains in an inactive form in nerve cells along the spinal cord and lower part of the brain. Shingles results when, years later, the dormant virus is reactivated and migrates along the nerve to the skin. The two symptoms of shingles are intense, burning pain and skin eruptions all along the distribution site of the affected nerve. Pain may precede skin changes by 48 to 72 hours.

The rash, which begins as slightly raised, red lesions which quickly turn into small blisters that later crust over, occurs on one side of the body in a band-like distribution, most often midback and upper abdomen. Serious visual complications may result when shingles affects the eyes.

The average duration of the illness is 7 to 10 days; however, it may take a month for the skin to return to normal and pain lasts for many months in up to half of those who develop shingles after age 50.

Shingles is a widespread disorder, with 300,000 cases a year in the United States, and more common in patients undergoing radiation or chemotherapy for cancer and in those with AIDS or other causes of immune system suppression. It's a complication in 35 to 50 percent of patients with Hodgkin's disease and bone marrow transplants.

Most cases of shingles occur in people who are otherwise healthy. About 2 percent of patients have a recurrent bout of the disorder.

The anti-viral drug acyclovir may speed resolution of skin lesions but does not seem to prevent or treat the pain. Although acyclovir is given by mouth in otherwise healthy individuals, multiple daily intravenous injections of the drug are needed in immunosuppressed patients who are likely to have more severe attacks. Persistent pain after shingles is very difficult to treat. Efforts to control the pain begin with analgesic medications but may require the judicious use of narcotics. Some patients respond to anti-depressant drugs like amitriptyline.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

Pub Date: 7/02/96

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