Aging Begins at 30

The Belt that Can Ache For Years

Did you have chicken pox when you were a child? Ninety-five percent of children have it by the time they are fifteen. It can come calling on you for a second time in your old age. In 1983, the zoster virus was discovered to be the same one that causes chicken pox in children. It lies dormant in nerve roots and then becomes reactivated.

Herpes zoster, commonly called shingles, means a girdle in the old sense of a belt. Herpes is the blister causing virus family that the zoster virus belongs to. This is truly a disease of the elderly, being twice as common over fifty as it is below fifty. The average age to develop shingles is 62.

Walking along the main corridor of the hospital, I met a former patient. I asked her "How long have you had the shingles?" She said "My doctor says it isn't the shingles because the blisters aren't all on one side of my face". There were a couple beyond the mid-line. I said "The heck it isn't! And more importantly, you have a blister on the end of your nose and this is the same nerve that also supplies the cornea. You need to see the eye doctor, not tomorrow, but today." She did and it was a good thing. The virus had already invaded her cornea. Prompt intervention saved her eyesight.

Zoster is common in the elderly but now we can do something about it. Basically, it is a viral infection of the nerves that "drain" the skin in belt-like areas. A patient may complain for three or four days of a tingling, burning, itching, searing or knife-like pain along the lowest ribs. I have twice thought I had either a diagnosis of gall bladder disease or pleurisy in a patient, only to be surprised a few days later with the characteritc grouped blisters along the belt-like area. These blisters are varied in size, usually 8-10 to a group, and are based on a reddened swollen skin area. If it had been herpes simplex (the cold sore virus), the blisters would have been uniform in size. In two to three days, the blisters become pussy and go on to scale and crust in seven days. The crusts fall off in about twelve days. Rarely this is a new infection, but in the vast majority of cases it is a reactivated chicken pox virus which laid dormant in the nerve roots close to the spine.

The virus can also break out associated with cranial nerves. The nerve that supplies the face and jaw area is affected in about 8%, the nerves of the chest in fifty five percent, the neck in 16%, and the lumbar sacral area in 15%. When the face and jaw nerve is affected, one has to be careful about involvement of the eye.

Once the blisters have come out, the diagnosis is not difficult, but a smear of the area can be examined by Tzanck dye, immunoflourescent dye, or by electron microscopy making the diagnosis. A virus culture can be made but it takes 8 days to grow and is therefore not very helpful. A diagnostic problem arises when the patient has zoster for the second time. This can happen in about two percent, but it is more often a mimicker disease caused by the herpes simplex virus.

The main complication is post-herpetic neuralgia or severe burning or stabbing pains in the area supplied by the nerve which can go on for years. This is diagnosed when pain lasts for more than two months and can occur in 70% of people over 60.

The good news is that a compound acyclovir was discovered in 1979. It is a methyl guanine which fools the virus into "thinking" it is a cyclic sugar guanosine it needs for growth. This wrong-key drug blocks a metabolic keyhole and kills the virus. The host cells are 80 times less in need of it than the virus infected cells. Initially only available intravenously, it is now given orally in doses of 800 mg five times a day for ten days. This drug will decrease the virus shed from the blisters, will reduce the time to crusting and healing, and will make the patient pain-free faster.

Shingles is not the scourge it used to be, but prompt diagnosis and treatment are necessary to get the benefits of this new treatment.

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See related Patient Topics Brain and Nervous System, Infections, Seniors' Health or Shingles (Herpes Zoster).

See related Provider Topics Brain and Nervous System, Infections or Seniors' Health.

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