Shingles (cont.)
What is postherpetic neuralgia?
The most common complication of shingles is postherpetic neuralgia. This occurs when the nerve pain associated with shingles persists beyond one month, even after the rash is gone. It is a result of irritation of the nerves of sensation by the virus. The pain can be severe and debilitating. Postherpetic neuralgia occurs primarily in people over the age of 50 and affects 10%-15% of people with shingles. There is evidence that treating shingles with antiviral agents can reduce the duration and occurrence of postherpetic neuralgia.
The pain of postherpetic neuralgia can be reduced by a number of medications. Tricyclic antidepressant medications (amitriptyline [Elavil] and others), as well as antiseizure medications (gabapentin [Neurontin], carbamazepine [Tegretol], pregabalin [Lyrica]), have been used to relieve the pain associated with postherpetic neuralgia. Capsaicin cream (Zostrix), a derivative of hot chili peppers, can be used topically on the area after all the blisters have healed, to reduce the pain. Lidocaine pain patches (Lidoderm) applied directly to the skin can also be helpful in relieving nerve pains by numbing the nerves with local lidocaine anesthetic. These options should be discussed with your health-care professional.
Can shingles be prevented with a vaccine?
In May 2006, the U.S. Food and Drug Administration (FDA) approved the first
vaccine for adult shingles. The vaccine, known as Zostavax, is approved for
use in adults ages 60 and over who have had chickenpox. The shingles vaccine contains
a booster dose of the chickenpox vaccine usually given to children. Tests
over an initial four-year period showed that the vaccine significantly
reduced the incidence of shingles in these older adults. The single-dose
vaccine was shown to be more than 60% effective in reducing shingles
symptoms and it reduced the incidence of postherpetic neuralgia (PHN, see
above) by at least two-thirds. Studies are ongoing to evaluate the
effectiveness of the vaccine over a longer term.
People with weakened immune
systems due to immune-suppressing medications, cancer treatment, HIV
disease, or organ transplants should not receive the shingles vaccine because it
contains live, weakened viral particles.
Since vaccination against VZV is
now recommended for children, the incidence of chickenpox has been reduced.
This is also expected to reduce the incidence of shingles in adults as these
children age.
- Shingles is caused by the same virus that causes chickenpox
and can be spread to people who have not had chickenpox.
- Shingles, also known as Herpes zoster, is not related to
the sexually transmitted herpes virus disease called herpes genitalis.
- Shingles may cause pain that can continue after the rash
disappears.
- Steroids and antiviral drugs can help prevent long-term
pain after shingles if they are started within the first two days of the
appearance of the rash.
- A vaccine is available for people over 60 years of age to reduce the incidence and severity of shingles.
Previous contributing author: Frederick Hecht, MD, FAAP, FACMG
Last Editorial Review: 4/13/2009
- amitriptyline. Elavil, Endep - Learn about amitriptyline ((Elavil, Endep) an antidepressant drug used to treat depression. Drug interactions and side effects are also included in the information.
- Vaccination Schedule for Adults and Adolescents - Read the vaccination schedule for adults and teens, and learn about recommended immunizations for MMR, HPV, Td/Tdap, varicella, tetanus, shingles, hepatitis and typhoid.
- Rash - Learn about rash causes, symptoms, diagnosis and treatment. Common skin rashes include poison ivy, hives, shingles, eczema, contact dermatitis, ringworm, psoriasis and impetigo.
Latest Medical News
Skin RSS