A virus from hell

It begins in such a benign manner - a rash, headache, fever, some blisters, a little pain- but then it becomes really really painful as if you are on fire or a constant receipient of electric shocks. The pain may begin as if you are on "pins and needles" with tingling, pricking, or numbness or even sensations of burning but all these soon become agonising "pain that make even grown men cry". Welcome to the world of shingles.

I am only now emerging from its embrace and the memory still chills me. In the intensity of the pain, the constancy of the stress and the inability to think about anything but the next spasm of pain that this virus often brings, it is truly a virus from hell.

To add insult to injury, it typically attacks people over 60! Just when you thought these diseases were in the past, out comes a hammer which flattens you. It seems over 1 million people a year in the US get shingles and over 1 in 3 will be attacked by this virus in their lifetime.

Shingles, or its medical name, Herpes zoster, is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a stripe. The initial infection with varicella zoster virus (VZV) causes the acute but short-lived illness chickenpox, which generally occurs in children and young people. But once an episode of chickenpox has resolved, the virus is not eliminated from the body but can go on to cause shingles—an illness with very different symptoms—often many years after the initial infection. 

This sneaky little zoster virus remains dormant in the nerve of a person who has had chickenpox only to re-emerge years later. Occasionally it will probe your body's defenses, and if your resistance happens to be lower -- more likely as you get older, for example, or if you've recently had an illness that's played havoc with your immune system -- the virus shoots down a nerve, causing the numbness, itching, severe pain, and later the blistering rash associated with shingles.The virus is usually contained to an area of skin called a dermatome. This is the descriptive name for an area of skin supplied by a particular group of nerves. While the rash you have might spread along this dermatome, it almost never crosses into another one. This means that if it isn't already on your face, it won't go there. Stress won't spread the virus, but being stressed will affect your immune system. 

While shingles is not life-threatening per se, but it can be pretty debilitating. If it involves your face or eyes, it can threaten your eyesight. Even after the rash abates, you can be left with pain in that section of the body that can be set off by even trivial stimuli, such as the touch of a shirt against the skin. Sometimes it can prevent people from leaving their house. The older we get, the greater the risk. If you survive to age 80, you have a 25% to 50% chance of having had shingles.

But the rash isn't the worst part, says Karl R. Beutner, MD, PhD, associate clinical professor of dermatology at the University of California, San Francisco, who calls the disease "highly underrated." Before the rash appears on your body, the inflammation in the affected nerve causes a tingling, "creepy-crawly" pain called postherpetic neuralgia that can linger for months and even years. "There have been quality-of-life studies showing that a bad case of shingles is worse than a heart attack in terms of how long the pain lasts," Beutner says. Postherpetic neuralgia is a persistent nerve pain that lasts long after the skin lesions heal. "The incidence of postherpetic neuralgia rises dramatically in people over 50," says Jorizzo. "It's probably due to some sort of scar produced by the inflammation caused by all the viral particles coming down the sensory nerve."


Yet not all hope is lost. There is now a vaccine that can be taken.  The shingles vaccine, Zostavax, contains a weakened chickenpox virus (varicella-zoster virus) which helps stimulate your immune system to battle the disease, reducing the risk of getting shingles in people aged 50 and older. In scientific studies, the shingles vaccine reduces the risk of developing shingles by about 50%.  

If you get shingles, the only other option is to resort to painkillers till the rash dissappears. There again new medicines are now available that tackle the inflamed or damaged nerves that are the cause of the chronic pain.

The bottom line is : it's important to get shingles treated early and aggressively, both to minimize pain in the acute phase and prevent chronic pain after the rash has gone.