If you have had chicken pox before, watch out for a red, blistering rash that might appear suddenly.
It could mean that you’re suffering from a shingles outbreak. Also known as herpes zoster, shingles is an infection of the nerve endings due to the same virus that causes chicken pox.
Dr Tan Kian Hian, consultant at the Department of Anaesthesiology, and director of the Pain Management Centre at Singapore General Hospital, explains: “The chicken pox virus – or varicella zoster virus – can lie dormant in the nerves linked to the spinal cord for years. Then, when there is a dip in the immunity system, it erupts in a shingles outbreak.”
So if you are undergoing steroid treatment, radiotherapy or chemotherapy, have a history of bone or lymphatic cancer or suffer from medical conditions like HIV/AIDS, you stand a higher chance of developing shingles since your immune system is compromised.
Other risk factors include being over 60 years old and being under high stress. There is no known food or environmental triggers.
Symptoms of shingles
Most shingles sufferers first notice the pain. “Usually, patients report a burning pain, tingling sensation and itching – like having ants crawling all over you. Even a tee-shirt brushing against the affected skin area can cause discomfort,” says Dr Tan.
Next up, there will be more noticeable symptoms – a red rash that begins a few days after the pain, as well as fluid-filled blisters. Most commonly, these symptoms appear on one side of the body, usually at the level of the chest or abdomen.
Dr Tan adds: “Seek professional treatment once you notice symptoms like a rash and blisters, especially if they are accompanied by fever and body ache. You need to be treated within 72 hours to reduce the pain and prevent complications.”
When shingles heal… is that it?
A major complication of shingles is post-herpetic neuralgia (PHN).
“PHN occurs when the virus stays in the body and causes pain even after the shingles have healed,” explains Dr Tan. “Those above 55 years old are 20 per cent more likely to develop PHN because of decreased immunity.”
Such pain can be constant or episodic, and it can worsen at night. “Patients can have trouble falling asleep because of the pain, so night medications for PHN have to be stronger,” he says.
In severe cases, the pain can disturb the patient’s emotional and psychological wellbeing. A shingles attack typically lasts three to five weeks.
Is there a cure?
To date, there is no cure for shingles. But you don’t have to suffer in silence.
“We cannot completely eliminate the virus from the body,” explains Dr Tan. “But proper treatment will drastically reduce the severity of the pain.”
Doctors usually prescribe anti-viral medications and strong painkillers, as well as calamine lotion and anti-itch medications to stop the itch.
For those who suffer from PHN, doctors may prescribe topical painkillers like local anaesthetic plasters to apply on the affected areas. “These are especially helpful at night when elderly patients are trying to get to sleep,” says Dr Tan.
Antidepressants may also used to relieve the pain. Dr Tan adds: “These are actually not used to deal with emotional issues. Instead, they alleviate nerve-related pain by blocking the neurotransmitters.”
Chicken pox vaccine can help
The ultimate goal is to help PHN patients improve their quality of life. “At the Pain Management Centre, we take a very holistic approach. Besides medication, intervention and surgery, we also have psychiatrists to provide psychological and emotional counselling,” says Dr Tan.
Also, those who are above 60 can consider taking the chicken pox vaccine to reduce the incidence of shingles. As the vaccine can work as a booster, this is effective even if you have had chicken pox before.
“It is even better if you have young grandchildren who have already been vaccinated. Just being around them can work as a booster for you,” says Dr Tan.
Old wives’ tales about shingles
Myth: If the shingles blisters stretch around your chest, you will die.
Fact: The Chinese describes the ring of shingles as a “creeping snake”. And it is said that if this “snake” grows around your chest or abdomen, it will cause death. This is not true. Dr Tan explains: “There is no scientific evidence behind this claim.”
Myth: To deal with shingles, one has to kill the “creeping snake” by burning incense on affected areas.
Fact: Such traditional remedies do not help to alleviate the pain or eliminate the virus from the body. “Patients have approached me with burn marks on their shingles,” says Dr Tan. “This actually may cause infections, not to mention excruciating pain. It would have been better for them to seek proper treatment.”