Medicine Up to the Minute- SHINGLES

Charles A. Bertrand, M.D., FACP, DIM-CD
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina

SHINGLES - PROMISING MEDICINE

The VZV virus is the cause of chickenpox in children and young adults. The same virus is also the cause of herpes zoster (known as shingles) in adults. It is believed that the virus enters via the respiratory tract and then goes to the bloodstream. Eventually it affects a nerve and produces a small vesicular (small round blebs filled with fluid) rash with associated pain in the same location.

The most common location of shingles involves the chest. There are twelve ribs on each side and there is a small groove under each rib ? a nerve is located in each groove. When the nerve is invaded by the virus a rash occurs along the course of the nerve and is associated with pain in the same area. These two characteristics comprise shingles.

The rash usually lasts for about a week or two, sometimes with residual discoloration of the skin. People under the age of 50 usually do not have much pain but in those above the age of 50 pain is commonly found and may persist for weeks or months. The pain can be quite severe and debilitating to the patient.

Treatment has generally not been very successful although a variety of medications have been used. Antibiotics are of no value for the treatment of shingles. Other types of treatment have been employed but with varying degrees of success. Acyclovir can be effective against the virus but works best when given during the first few days of the illness; unfortunately patients are generally not seen that early.

The most troublesome problem is pain ? pain that persists well beyond the time that the rash fades. This may cause considerable disability. The current issue - January 2000 - of the Mayo Clinic Health Letter discusses a new medication known as lidoderm that is used for post-herpetic pain.

Lido comes from Lidocaine and derm means skin. Lidocaine is in the same family as novocaine ? you may have heard your dentist say, "Do you want me to numb it for you?" before drilling your tooth. In this case the medication comes in the form of a patch which is applied over the area of the rash, or where the pain is located.

To quote from the article "it appears very effective. In one study, nearly 80% of those who used the lidoderm patch reported significant or complete pain relief." This is impressive. And for those who suffer from such pain it certainly is wise to consult your doctor with regard to this medication as well as other types that may be helpful.

The advice provided on this website is intended to be general in nature and should not be relied upon for specific treatment. If you need personal medical attention please contact your physician.

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