Shingles and Postherpetic Neuralgia

What is Shingles?

Shingles is caused by the Varicella Zoster virus, more commonly known as Chickenpox – one of the eight herpes viruses. The initial infection is transmitted via airborne particles shed from the skin of an infected person – the new host breathes in the particles which then enter the mucous membrane in the respiratory tract, here the virus builds up, multiplying and creating the characteristic Chickenpox rash.

postherpetic neuralgia

The outbreak of Chickenpox is the primary infection, following recovery of the acute illness, the Varicella Zoster virus lies dormant in the nervous system, usually for many years. Shingles occurs as a result of the reactivation of the virus, which then causes some of the nerve cell bodies to die off. The virus travels down the sensory nerves causing pain on the skin of the affected area. This develops into a painful rash, located along the sensory dermatome of the affected nerve.

As is the case with the herpes simplex virus (responsible for common cold sores), Varicella Zoster infects the neurons of the dorsal root ganglia – a cluster of nerve cell bodies containing sensory neurons, whose function is to bring information from the periphery nerves to the spinal cord, transmitting sensations such as touch, temperature or pain.

Shingles is more commonly seen in patients over sixty years of age, it is estimated that approximately one third of the population will suffer from an outbreak of Shingles at some stage in their lives.

Symptoms of Shingles

The first symptoms may include feeling generally unwell, fatigue, headaches and/or a raised temperature. A tingling and often painful sensation may occur in one area of the skin, this is generally followed by a blotchy red rash, which turns into small, painful and itchy blisters that secrete a clear fluid. Shingles typically only affects one area of the body – most commonly occurring on the thoracic trunk, it does not usually cross over onto the other side of the body.

After a few days, the blisters will dry out, scab over and begin to heal. However, in some cases, pain may remain in the affected area for weeks after the rash has disappeared – this is known as Postherpetic neuralgia.

Postherpetic Neuralgia

The most commonly reported complication of Shingles – Postherpetic neuralgia is due to damage to the sensory nerves caused by the reactivation of the virus. It is characterised by areas of depigmentation, variable symptoms of pain from discomfort to severe stabbing or burning pain with marked alterations in sensations (allodynia), this describes a constant sensitivity to stimuli that would not usually be painful, such as clothes touching the affected area, a light tap, the wind, cold weather etc. Postherpetic neuralgia can be long lasting and extremely disruptive to everyday life.

Other Complications of Shingles

Ophthalmic Shingles

In some cases, reactivation of the Varicella Zoster virus may occur in part of the trigeminal nerve, causing the Shingles rash to appear on one side of the face and sometimes in one eye. The eye becomes inflamed and typically develops conjunctivitis like symptoms – vision may become impaired.

Other serious complications include:

  • Encephalitis
  • Meningitis
  • Pneumonia

These are more likely to effect patients with a pre existing condition such as HIV/AIDS which compromises the immune system.

Treatment for Shingles and Postherpetic Neuralgia

A course of antiviral medication can help to stop the virus from multiplying and is likely to be more effective when taken at the onset of initial symptoms.

Some patients find over the counter remedies sufficient during an outbreak of Shingles – such as calamine lotion, cooling gels and analgesics and anti-inflammatories.

However, in more severe cases of both Shingles and Postherpetic neuralgia, a pain management consultant can offer expert advice on medication treatment including both topical and oral drugs for pain relief, as well as other forms of pain reducing treatments such as pulsed Radiofrequency treatment and Botox to the affected area – which can be very helpful in the long term.

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