STORY BYWhen Late Night host David Letterman returned to television in early April 2003 after a month-long absence, he talked about his painful bout with shingles. “I was beyond crazy.”
Letterman had shingles in his eye, “a particularly severe form that affects the nerves in the face,” explains infectious disease specialist Luis Ostrosky-Zeichner, M.D., assistant professor of medicine at The University of Texas Medical School at Houston.
At age 55 at the time and in a stressful profession like television, Letterman was a prime candidate for the common neurological disorder that targets people over 50 who had chickenpox in childhood. The same virus that causes chickenpox “somehow stays dormant in your body, especially in the nerves, and many, many years later you have stress and it pops back up – it reactivates,” says Ostrosky-Zeichner.
Letterman confessed that he knew nothing about shingles before he got it, even though close to a million cases are diagnosed each year.
But while the majority of those affected are in their 50s or older, younger people can also get the disease, particularly if their immune systems can’t fight off the virus. That includes HIV and chemotherapy patients and others undergoing medical treatments that affect the immune system.
In older people, stress is what usually triggers a shingles attack. But before blisters appear, the disease is often mistaken for other conditions.
“Until the rash shows up, sometimes all you feel is the pain,” says Asra Ali, M.D., clinician and assistant professor of dermatology at the UT Medical School at Houston “When the virus is traveling along a nerve route in the chest area, sometimes people think they’re having a heart attack. If the abdominal area is affected people may think they have appendicitis or gallstones.”
Any nerve in your body can be affected by shingles. The most common is the area at the waist, but it can also appear on the back, chest, head, face and lower part of the spine or neck.
The first sign is often “severe pain in the affected area, pain that doesn’t go away with Tylenol or Advil,” says Ostrosky-Zeichner. Even the slightest touch hurts, including contact with the sheets on your bed. Then small red spots or blisters appear. In two to four weeks the blisters heal, but the pain may last a month or more.
The key to treating shingles is starting antiviral drugs immediately, within 24 to 72 hours after the rash appears. Early treatment with antiviral drugs can reduce the risk of Postherpetic Neuralgia (PHN), severe pain in the affected area that persists for months and sometimes years after the rash has gone. More than half of all shingles patients over age 60 will develop PHN, a condition that’s difficult to treat and frustrating both to patients and their doctors.
“Our biggest challenge has been to decrease the pain,” says Ali. Treatments range from anti-convulsant drugs (used off-label for nerve pain) and anti-depressants to topical creams, “but there’s not always one thing that works,” she adds. “Sometimes you have to do a combination.”
Shingles is not contagious—you can’t “catch” it. The virus causing shingles can be passed on to others, but they will develop chicken pox—not shingles—and only if they haven’t already had the childhood disease.
The virus responsible for shingles and chicken pox is actually part of the whole herpes family of viruses called varicella-zoster virus. Some of its relatives cause cold sores, fever blisters, mononucleosis and genital herpes.
Unfortunately, having the disease once doesn’t insure immunity. But it most often re-occurs in the same area, says Ali, because the virus remains latent in a nerve root. When there is reactivation, lesions will occur on the skin along that same nerve highway.
Sunlight may also be a factor. A study done last year found that those in the study had more outbreaks of shingles – and most often on sun-exposed areas – in summer months, leading to speculation “that the sun is inducing some suppression of immunity,” explains Ali.
The good news about shingles – if there is any – is that children are now being vaccinated against chicken pox. That means they have a decreased risk of a shingles outbreak later in life.
Even better news is the development of the shingles vaccine for persons 60 and older who have never had an outbreak.
Meanwhile, those looking for more in-depth information may find it at www.vzvfoundation.org
UPDATED: 7-18-2006
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Dr. Luis Ostrosky-Zeichner is an assistant professor in the Division of Infectious Diseases at the UT Medical School.
See Dr. Ostrosky also at:
Dr. Asra Ali is an assistant professor of dermatology at the UT Medical School.
See Dr. Ali also at:
Men: Pay Attention
to Your Bicycle Seat
Men who bike more than three hours a week should be aware that standard bicycle seats, ridden for extended periods, can cause temporary numbness and, in some, more serious problems, such as erectile dysfunction.
Such problems are caused by compression of an artery and a nerve connected to the penis. New seat designs to minimize compression are now available.
Other preventive measures you can incorporate:
