By Gary Webb, MD, MS, FAAFP
Shingles – a disease that’s so painful and yet prevalent that most of us have at least heard of it. It is a disease we should try hard to prevent, so a re-read of the what’s, why’s and if’s may be worth your review.
Shingles is a severe outbreak of rash or blisters of the skin caused by the varicella-zoster virus — the same virus that causes chickenpox. After you’ve had chickenpox (or the chickenpox vaccine), the virus finds itself a home around nerve cell clusters in the brain and along the spinal cord. There it lies, waiting, but can be awakened from its incubation into what is called, shingles or Herpes zoster.
Although shingles can occur anywhere on your body, it most often appears as a single band of pink or red blisters that wraps around either the left or the right side of your trunk and around the waistline. It can also appear on one side of face. The blisters present on the skin but are seeded deep down in the nerve fibers below.
About 1 million cases of shingles occur in the United States (U.S.) each year. One in three people in the U.S. will get shingles during their lifetime. Your risk of getting shingles and having serious complications increases with age, and older adults are more likely to experience longer lasting and more intense pain, because of weakened immune systems. While not usually life threatening; shingles can nevertheless cause severe complications, especially if shingles appear on the face and/or if you are immune comprised. Recognizing the early symptoms and getting treatment as soon as possible is pivotal.
Symptoms: Some people are able to detect shingles symptoms even before the tell-tale rash. It may initially present flu like – fever, headache, chills, and fatigue – plus pain, itching, tingling or burning in the area where the rash will soon appear. After several days to a week, a rash of fluid-filled blisters, similar to chickenpox, appears in one area on one side of the body. Shingles pain can be mild to severe. Some people have mostly itching but some can feel intense pain. Typically, blisters grow larger, burst, and then form a scab. For most healthy people whovreceive treatment soon after the outbreak of blisters, the lesions heal, the pain subsides within 3 to 5 weeks, and the blisters often leave no scars.
Complications: The most common complication of shingles is long-term nerve pain called, postherpetic neuralgia (PHN), affecting up to 20 percent of shingles sufferers. PHN occurs in the areas where the shingles rash was, even after the rash clears up. It can last for months or years after the rash goes away. The pain from PHN can be so severe and debilitating that it interferes with daily life. Your risk of PHN increases with age. Shingles on the face can affect the eyes, and may lead to serious complications involving the eyesight, including blindness. It is pivotal to seek medical attention for lesions on the face.
Treatment: As a prevention, the U.S. Center for Disease Control recommends most Americans age 50 and older to get two doses of the recombinant (not live) shingles vaccine. Adults 19 years and older who have weakened immune systems because of disease or therapy should also get two doses of the vaccine. Immunity stays strong for at least the first 7 years after vaccination, according to the CDC. The recombinant shingles vaccine reduces risk of shingles and post-herpetic neuralgia by more than 96 percent. The recombinant vaccine cannot cause shingles. If you do get shingles, you can significantly reduce the severity and duration of a shingles episode by getting immediate medical treatment with antiviral drugs, which include Acyclovir, Valcyclovir, or Famcyclovir. These antivirals also help stave off the painful after-effects of PHN. Other treatments for PHN include steroids, antidepressants, anticonvulsants including Pregabalin and Gabapentin, and topical agents.
Transmission: A person with shingles cannot give shingles to someone else. However, a person with shingles can transmit Varicella zoster to a person who is not immune to the virus. In that case, the person would develop chickenpox, not shingles. Transmission occurs via the fluid from the shingles blisters. A person is infectious from the time the blisters appear to the time the blisters crust over and no longer contain fluid. Accordingly, people with shingles blisters are advised to avoid bringing blistered areas in contact with others.
Shingles and shingles vaccines can be managed by your primary care provider (PCP). Dr. Gary Webb is a board certified PCP, who specializes in general family health care for patients of all ages to include preventive care, acute illness, geriatrics and management of chronic conditions such as hypertension, diabetes and heart disease. In addition, he specializes in treating asthma, thyroid, gastrointestinal issues, anxiety and depression. His direct-care practice provides comprehensive primary care services, including immediate appointment scheduling and home visits. As a direct-care provider, Dr. Webb contracts with you – the patient – rather than an insurance company. His practice requires a monthly membership. Visit Dr. Webb’s practice webpage at, https://www.docplusmedpc.com, to learn more.
Gary A. Webb, MD, MS, FAAFP
A board-certified family physician and fellowship trained geriatrician.
Dr. Webb did his medical school training at the American University of the Caribbean.
His third year of training took him to Epsom England just south of London and for his fourth year he went to Metro Health In Cleveland, Ohio.
His residency was at the University of Nevada where he also was the Chief Resident. His fellowship in geriatrics took him to the University of Hawaii John A Burns School of Medicine. He has had a private practice in the past, was the medical director of West Hawaii Community Health Center, a physician in a critical access hospital in the Panhandle of Texas where he not only did family medicine but also was the emergency room physician, hospitalist, Nursing Home Medical Director and Director of the local hospice. He is a fellow of the American Board of Family Medicine and can treat all aspects of family medicine. He is knowledgeable in Diabetes management, hypertension, hyperlipidemia, thyroid disease, anxiety and depression, dementia, asthma, COPD and other general care problems. A great attribute of Dr. Webb is his ability to listen. Dr. Webb is married to his lovely wife Olivia and share 5 daughters and 5 grandchildren.
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12272 Tamiami Trail East, Unit 401, Naples. FL. 34113
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