Skin condition shingles is tricky, and very painful

By Alexandra Buelow Jan 2, 2012, 3:07 GMT

Berlin - It often begins with mild itching on the back, chest or below the ribs - annoying, but nothing dramatic. But tingling, burning and stabbing pain in the affected area soon follow.

After about three days blisters or lesions appear on the skin and spread in a band on one side of the torso or rib cage. By then the diagnosis is clear: Herpes zoster, a viral skin condition commonly known as shingles.

Shingles can only occur in people who have had chickenpox, which includes well over 90 per cent of the adult population. The reason, explained the German Green Cross (DGK), an independent organization dedicated to improving disease prevention and health communication, is that shingles is caused by the varicella-zoster virus, which also causes chickenpox.

Some fears surrounding the condition are unfounded.

'The belief that you'll die if the band of blisters completely encircles the torso is utter nonsense,' remarked Uwe Meier, chairman of the Professional Association of German Neurologists (BDN).

The virus is, however, sneaky. It causes chickenpox the first time it invades the body, but does not go away when the chickenpox fades. Rather, it travels to nerve cells called dorsal root ganglia near the spinal cord, where it remains for the duration of the person's lifetime.

'It lies dormant there and causes no symptoms,' noted the DGK's Andrea Grueber.

But this can change. If the person's immune system has been weakened - for example due to illness, cancer treatments or stress - the virus can become active again.

'Suddenly the virus causes another rash along the skin segments served by these nerves. That's why the pain and blisters extend along this nerve area,' Meier said.

The blisters are not only unsightly, Grueber said, 'they contain the varicella-zoster virus, which can be transmitted by direct contact with the blisters' contents. People who have never had chickenpox can become infected and develop chickenpox.'

Klaus Doubek, chairman of the Wiesbaden branch of Germany's Association of Gynaecologists, warned pregnant women who have never had chickenpox to 'make sure the affected areas of skin are carefully covered when you have contact with shingles patients.'

According to the BDN, shingles is contagious until the blisters have scabbed. It takes them a week to 12 days to dry up, and the skin is completely healed in about three weeks, the DGK said.

Patients take an antiviral drug orally for about a week. 'This checks the virus and limits the extent of the illness,' Meier said. 'It can be supported topically with analgesic ointments.'

The pain is extremely discomforting for most patients, he noted. 'Stimuli are felt more intensely. The slightest touch can be torture,' he said.

Some patients still have pain weeks after the rash has cleared up, a condition known as post-herpetic neuralgia. 'The skin is intact but the nerve can be damaged,' Meier said. 'The entire pain-processing system may even change.'

To help ease the severe pain, Meier added, a doctor may prescribe an anticonvulsant or antidepressant. These drugs subdue the overexcited nerves or disrupt their transmission of pain signals to the brain. 'The right dosage must be found for the patient, and the drugs don't take effect right away,' he said. 'This can be burdensome for affected persons.'