A Viral Journey: From Chickenpox to Shingles
By Dr. Daniel C. Wilson
Most adults had chicken pox some time in their childhood. If they remember anything at all about it, they remember itchy spots and maybe a little extra tender care from mom.
But our bodies never forget.
That’s because the virus that causes chickenpox, the Varicella Zoster virus, lives on for years after the spots heal up, lying dormant in the nerves along the back. In many people the virus flares up again years later as a nasty case of shingles.
What are Shingles?
Shingles appears as a painful rash, usually in a band that begins on the back and stretches around to the chest. The rash can also appear on the face, near the eyes. Patients say the pain is excruciating. In most cases shingles clears up within 10 days, but in some patients the virus may cause persistent nerve irritation and pain.
Anyone who has recovered from chickenpox may develop shingles. According to the Centers for Disease Control and Prevention, one out of every three people will suffer a bout of shingles, with an estimated 1 million cases each year. Children can get shingles, but the risk of disease increases as a person gets older. About half of all cases occur among men and women 60 years old or older.
Shingles begins in the nerve and spreads as a burning, painful sensation. Sometimes the pain comes before the rash. Patients in my internal medicine practice at Wake Forest Baptist Medical Center often think they’ve pulled a muscle. Some people mistake the radiating pain for a heart attack. Others mistake the pain for a gallstone, a kidney infection or heartburn. When the rash appears, patients often mistake it for cellulitis, an allergic reaction to a drug or some other rash.
Think of shingles as a viral infection of the nerve; when a nerve gets irritated it fires all the time and causes persistent pain. The shingles rash generally follows the path of the nerve, beginning in the back in a band about two inches wide and spreading to the front. While most cases resolve in a week or so, in some patients the nerve pain persists in a condition called postherpetic neuralgia. These cases may take months, if not years, to resolve.
In some cases shingles can appear near the eyes and risks affecting vision. Should you develop a painful rash near the eyes, see your doctor or go to the emergency room immediately.
Shingles, like other viral infections, heals on its own. When diagnosed early, we can shorten the length of illness with antiviral medication. These must be given within two or three days of onset of symptoms to do any good. And since people often mistake the symptoms for something else, we often miss the window to treat. Patients can treat the pain with over the counter analgesics such as such as ibuprofen.
The virus’ dormant phase is not well understood. Varicella Zoster is part of the herpes family, the viruses responsible for cold sores and genital herpes. After a case of chickenpox, the body’s immune system eliminates the virus in most of the body, but some lodge in the nerves adjacent to the spinal cord or at the base of the skull.
The virus generally lies dormant for 50 or 60 years until some stressor triggers a flare-up of shingles. Often shingles seems to strike randomly. The stress can be an injury or something as simple as a bad week at work or a cold.
Five years ago, a vaccine against shingles, called Zostovax, was developed. The CDC recommends it for anyone over age 60, except in patients with a compromised immune system. Most of my patients opt for the vaccine. Almost all of them know someone who has had shingles and they will do anything to prevent it.
These days, most infants are vaccinated against chickenpox. The vaccine has been available since 1995, and the first children to be vaccinated today are teenagers. The chickenpox vaccine has come close to wiping out chickenpox in children, but it’s too soon to tell whether it will immunize adults against Varicella Zoster. We’ll know more in 30 years when those children have reached their 50s.
I know plenty of parents who once exposed their kids to chickenpox to “get it over with.” It’s always been regarded as a harmless illness – even though children do develop complications and die. But when Varicella Zoster flares up years later years as shingles no one ever thinks of it as a harmless disease.
Think about getting vaccinated against shingles and remember the symptoms so that you can get treated early and reduce the chances of complications.
Dr. Daniel C. Wilson is an instructor in the Department of Internal Medicine at Wake Forest Baptist Medical Center.