Shingles
Shingles is a viral infection caused by the chickenpox virus (varicella-zoster virus), and can only develop in a person who has already had chickenpox (varicella). After an episode of chickenpox, the virus lies dormant in nerve cells near the spinal cord, causing no harm, or signs and symptoms, but can re-activate later to cause shingles (herpes zoster).The majority of the Australian population is at risk of developing shingles, as over 95% of adults over 30 years of age are exposed to the chickenpox virus. Approximately 150,000 Australians suffer an attack of shingles each year. It is estimated that by the age of 85 years, one in every two Australians will develop shingles.
Shingles may occur at any age, but is more common in people over 50 years of age. Fortunately most people only have shingles once.
Shingles affects nerve fibres, causing a painful, blistering skin rash in the area of the affected nerves. Shingles often starts with a burning, tingling, itching or sensitive feeling on an area of skin. A painful red rash with fluid-filled blisters appears a few days later. The blisters slowly dry up, crust over, and heal.
The shingles rash can look like chickenpox, but is usually more painful and less itchy. It can feel so sensitive that even a light touch causes severe pain. Some people, especially children, have no pain, whereas other people have pain with no rash. Shingles generally affects only one side of the body.
No-one knows exactly why the chickenpox virus re-activates. Factors that may play a role include increasing age, conditions or medicines that weaken the immune system, and stress or illness.
Shingles can also cause a condition called post-herpetic neuralgia, in which the affected area stays painful or sensitive for weeks or months after the shingles rash has cleared. Post-herpetic neuralgia is caused by nerve damage. Shingles can also cause other problems, e.g. shingles on the face or in an eye has the potential to damage eyesight.
Treatments for shingles include antiviral medicines, pain-relieving medicines (analgesics) and soothing creams, gels and dressings. Antiviral medicines (e.g. famciclovir, valaciclovir, aciclovir) stop the virus from replicating. Early treatment with antiviral medicines can speed healing, as well as reduce pain and other complications. Antiviral medicines must be prescribed by a doctor, and can only be subsidised on the Pharmaceutical Benefits Scheme for treatment of patients with herpes zoster within 72 hours of the onset of the rash.
Pain-relieving medicines such as non-prescription simple analgesics (e.g. paracetamol, ibuprofen) may help to relieve the pain, and you can buy them from a pharmacy. Stronger analgesics (e.g. opioids and medicines for nerve pain) must be prescribed by a doctor, and these prescription-only medicines may be required to relieve shingles pain and post-herpetic neuralgia.
Creams, lotions, gels and wound dressings can help to relieve the pain and protect the affected area. Once the rash has healed, capsaicin cream or lignocaine gel may also help to relieve post‑herpetic neuralgia.
Vaccine protection is also available:
Chickenpox (varicella) vaccine – this vaccine can prevent both chickenpox and shingles (as shingles only occurs in people who have had chickenpox). In Australia, the chickenpox (varicella) vaccine is offered to all children at 18 months of age, through the National Immunisation Program (NIP). Ask your doctor or pharmacist about the NIP Schedule and vaccination for older children and adults.
Shingles (herpes zoster) vaccine – people over the age of 50 years can have this vaccine to prevent shingles. Ask your doctor or pharmacist for advice.
Our local pharmacy is your health destination. Our Pharmacists are here to provide advice, counselling and professional services along with dispensing prescription medicines and supplying non-prescription medicines. Treatments for shingles are all available from our pharmacy. If you think you may be developing signs and symptoms of shingles, visit your doctor as soon as possible (within 72 hours of the onset of the rash), and pharmacist to discuss treatment options.
You can get more detailed information on shingles from the Self Care Fact Card titled Shingles available in our pharmacy.
Reproduced from the PSA Health Column 9/12/15
