Recently, a relative sent me a picture of his face, full of blisters, on the right side, below the lower eyelid. The blisters went all the way to his upper lip. He said it was very painful and he had lost sensation in the right side of the face and upper lip. He was feeling lousy and had no appetite. He could not drink anything hot or too cold because of the loss of sensation. There was constant headache.
This is a classic case of herpes zoster, commonly known as shingles. Now, do not confuse this with the shingles on the roof of your house or a short hair cut on a pretty lady. Shingles does not look pretty and unlike your shingles on the roof it does not provide any protection.
Shingles is caused by varicella zoster virus (VZV). This is the same virus which causes chickenpox. The first indications that chickenpox and shingles were caused by the same virus were noticed at the beginning of the 20th century.
This is what happens. The virus causes chicken pox which generally occurs in children. Once the child gets over the illness the virus does not disappear from the body. Virus can settle down in one of the nerve cell bodies and lay dormant for many years.
When your resistance is low and this can be due to any reason, the virus may break out of the nerve cell and travel down the nerve causing viral infection of the skin in the area supplied by that nerve. This can happen decades after the chicken pox infection. Exactly how the virus remains latent in the body, and subsequently re-activates is not understood.
Early symptoms of shingles are non-specific like headache, fever and malaise. Then there is burning pain, itching and tingling followed by painful rash and blisters in the area supplied by the affected nerve. The pain and rash most commonly occurs on the torso, but can appear on the face, eyes or other parts of the body. If the nerve to the eye is involved then a person may suffer loss of vision.
The rash and blisters heal within two to four weeks but some sufferers experience residual nerve pain for months or years. This condition is known as post-herpetic neuralgia. About 20 per cent of patients with shingles suffer from this.
If the diagnosis of shingles is made early then it helps to start anti-viral medications within 72 hours of the appearance of the rash. This reduces the severity and duration of the illness. The anti-viral medications should be used for seven to ten days. The blisters crust over within seven to ten days, and usually the crusts fall off and the skin heals. But sometimes after severe blistering, scarring and discolored skin remains.
Although a person of any age can suffer from shingles, aging population and individuals with poor immunity (AIDS, renal failure, stress) are more prone to shingles if they have had chickenpox in their younger days.
Is it contagious? Yes, to a point. Until the rash has developed crusts, a person is extremely contagious. During the blister phase, direct contact with the rash can spread the virus to a person who has no immunity to the virus. This newly-infected individual may then develop chickenpox, but will not immediately develop shingles.
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