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Shingle Rash

An acute, unilateral, self-limiting inflammatory disease of the central nervous system, specifically the cerebral ganglia and the ganglia of the posterior nerve roots, and peripheral nerves caused by the Varicella Zoster virus which presents initially as a red rash that later accumulate fluid to form vesicles is a disease called Shingles. It is also referred to as Herpes Zoster, or simply, Zoster. Beginning as red, slightly elevated, circumscribed lesions that, in the course of 7-10 days, develop into vesicles and later dry up forming crusts in the characteristic and definitive Shingle Rash.

CHICKEN POX VS. SHINGLES

Varicella Zoster virus is the main culprit of both these two clinically distinct diseases. Primary infection of the mentioned virus causes Chicken Pox. It is characterized by vesicular rash or lesions developing of the face, trunk and extremities. The rash usually starts midline of the person’s body and spreads towards the sides and extremities. Herpes Zoster, also well known as Shingles, results from the awakening or reactivation of endogenous latent Varicella Zoster virus. This form of disease is characterized by a painful, unilateral, vesicular rash, which usually occurs in a restricted band along the skin following the underlying affected nerve pathway.

 

CLINICAL MANIFESTATIONS OF SHINGLES

The Shingle Rash

The rash of Herpes Zoster starts as erythematous papules (red, circumscribed elevation of skin with no visible fluid), which quickly evolve into clustered vesicles (small, fluid-filled skin sacs or blisters measuring less than 5 millimeters in diameter) or bullae (fluid-filled skin blister more than 5mm in diameter). Within three to four days, these fluid-filled lesions become more elevated and occasionally hemorrhagic. In immunocompetent hosts, or those people of strong immune system, the Shingle Rash will dry up and crust by 7 to 10 days and are no longer considered infectious.

The inflammation is usually unilateral, involving the thoracic, cervical, or cranial nerves in a band-like configuration. The blisters are usually confined to a narrow region of the face or trunk. The region of the skin affected that follows the underlying affected nerve path is called the dermatome. The Shingle rash is often found clustered and confined within a dermatome. This dermatome can remain depigmented and hypoalgesic, or having little to no sensitivity to pain.

Herpes zoster in generally healthy adults is usually localized and benign. The Shingle rash and inflammation is commonly limited to one dermatome in healthy hosts, but can occasionally affect two or more neighboring dermatomes. However, in immunosuppressed patients, the disease may be severe and may be acutely disabling.

Acute Neuritis or Nerve Pain

Pain is the most common symptom of Herpes Zoster. Approximately 75% of affected people experience prodromal pain on the affected dermatome where the Shingle rash will subsequently appear. Prodromal pain, which may radiate over the entire region supplied by the affected nerves. The pain may be burning, lancinating (tearing or sharply cutting), stabbing, or aching. The pain may be constant or intermittent preceding the Shingle rash for several days to weeks. Some individuals describe the pain only when the affected region of the body is touched or induced by simple mild brushing against the skin.

This pre-eruptive pain precedes the rash for several days and is often misdiagnosed. It is often mistaken as Myocardial infarction, dental pain, biliary or renal colic and other gastrointestinal disturbances such as duodenal ulcer and appendicitis.

Atypical Pain without Shingle Rash

This phenomenon is called “zoster sine herpete”. The nerve pain is not accompanied nor preceded by a skin lesion eruption, though this is noted in very rare cases only.

 

COMMON NERVE PATHWAYS AFFECTED

Before getting into the specifics of the nerve pathways affected by this dreaded Herpes Zoster, let us first review the basics of the Peripheral Nervous System and nerve paths. A picture will be presented below to clearly illustrate the different groups of peripheral nerves, namely the Cervical, Thoracic, Lumbar and Sacral nerves, and the body regions it corresponds. These body regions are the so-called dermatomes that the nerves are responsible in both the sensory and motor abilities. 

Nerve Dermatomes

 

Cranial Nerves. When the virus invades the cranial nerves, the skin lesions, inflammation and pain is felt in most the face. Patient may have eye pain, or may experience the opposite, which is loss of feeling in one or both eyes. Infection in the cranial nerves often contaminate the ophthalmic nerves thus the eye involvement. The infection may even threaten one’s vision. The rash may appear starting from the scalp, around the eyes then down to the tip of the nose, called the Hutchinson’s sign. The prodromal pain will be felt upto the ear area and may can temporary hearing loss of some ringing in the ears. Loss of taste and dry mouth may also be detected.

Cervical Nerves. The Shingle rash is usually seen starting from the back of the neck or the nape, central line and spreading to either left or right side of the body, to the shoulders down to the forearm. This dermatome is supplied by the cervical nerves. The skin lesions will be contained in this dermatome, usually along a single band. The inflammation and skin lesions may cause pain with the slightest touch or movement.

Thoracic Nerves. The thoracic nerves are responsible for the motor and sensory of the trunk, including the anterior and posterior chest, abdomen, down to just above the buttocks area. When the Varicella Zoster virus infects the thoracic nerves, the skin rash and inflammation are more likely to be seen at the above mentioned body regions. The classical pattern for shingles follows a nerve root from the spine, along a rib, to the front of the chest. The spread follows a media-distal pattern, or from the center of the body outwards to the extremities. The inflammation and skin rashes may cause pain also with the slightest touch especially with clothing with is excruciating and almost miserable.

 

TAKING GOOD CARE OF SHINGLE RASH

Avoid picking at and, let alone, scratching the skin sores. (Doing so will further deepen the sores, or maybe open up those already dried up lesions.

Cool, moist compresses over the lesions. (This can be done if doing so helps ease the discomfort. This can help decrease the itchiness because cold compresses constrict blood vessels that will therefore lessen sensory.)

Use calamine lotion after compresses, though not recommended.

Apply cornstarch or baking soda to skin blisters. (The cornstarch and baking soda can help dry up the skin sores quickly. This is not recommended especially when the blisters are open for it may contaminate the lesions. Use with caution.)

Use tap water or Burow’s solution soak. (Soaking the skin lesions help clean put crusts, decrease oozing and soothe the itchy skin.)

 

Remember, the Shingle rash will get the best out of you. But knowing what to expect and what to do will lessen the burden.

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Can a Child get Shingles?

Most of you may be wondering, “Can a child get shingles?”. The answer is a big fat YES. You can get Shingles at almost any age, and about five percent of cases occur during childhood, or in persons aged fifteen and below.

A battle with the itchy Chicken pox rash used to be a battle almost every child endure. But thanks to the developments in the world of vaccines, we can say goodbye to that annoying itch. Though being in this modern of an age, some still suffer this condition. And the earlier in life the child get Chicken pox, especially acquiring Chicken pox before turning three years old or being a child of a mom with Chicken pox during her third trimester of pregnancy, the bigger the chance he or she can acquire this dreadful Shingle rash during childhood. So, Yeah! To state the unfortunate truth, a child can get Shingles.

Herpes Zoster, or Zoster, or Shingles is assumed to be a reactivation of a latent or dormant, or in layman’s term, sleeping varicella virus infection and is perceived to be due to lowered immunity. After being itch-free and finishing the Chickenpox course (more like a curse), it is believed that this creeps aka Varicella Zoster virus lie dormant inside the nerve cells near the central nervous system (brain and spinal cord). When these sleeping viruses are awakened and reactivated, Lo and behold, the occurrence of Shingles.             

 

SHINGLES FAST FIVE

  1. Shingles is also known medically as Zoster or Herpes Zoster.
  2. Shingles in caused by the Varicella Zoster Virus, similar to the cause of Chicken pox.
  3. Shingles can occur only, and only if, someone already has had run the course of Chicken pox. It is assumed to be a reactivation.
  4. Shingles in children are pretty rare and are usually occurring with mild clinical manifestations.
  5. Shingles is self-limiting, similar to almost all viral infections, and resolves in more or less, a month or thirty days.

 

HOW COMMON IS SHINGLES?       

       Disease Occurrence and Prevalence

Almost one out of three (33.33 percent) of people in the United States of America will develop Shingles or Herpes Zoster in the course of their lifetime. It is estimated that there are four cases of Herpes Zoster per one thousand (4 in 1,000) population. Nearly a million Americans go through this excruciatingly painful and itchy experience every year. Older adults are more likely to get the disease. About half or 50 percent of all cases occur in men and women aged 60 years and/or older. The incidence among people 60 years of age and older is about 10 cases per 1,000 people annually. And, only about five percent of cases (5 in 10,000 cases) occur during childhood, or in people aged 15 and below.

       Repeat Episode Occurrence

Studies show that Shingles can occur, and then reoccur, in an average of two to three episodes during a person’s lifetime, though the annual incidence of repeat episodes is still not known. Although usually, throughout one lifetime, a person can only manage 2 repeat episodes unless he or she is severely immuno-compromised. Such as children and adults with cancer and other immuno-depressive conditions.

 

SHINGLES SYMPTOMS IN GENERAL

The red rash is small, fluid-filled blisters, that shows up in clusters following a path of a nerve. The lesions is commonly accompanied or preceded by pain, which may be contained or spread throughout the entire dermatome of the affected nerve pathway. The pain may still be present after 30 days since the rash began.

 

SHINGLES SYMPTOMS IN CHILDREN Herpes-zoster-child

Shingles presentation in adults and children are somewhat similar and different in many ways. Classic Herpes Zoster symptoms that present in adults are not at all detected in children suffering the same disease, which may make diagnosis difficult. It is often misdiagnosed as other more common skin rashes in children, such as impetigo, eczema or even poison ivy.

The Shingles rash occurring children often don’t have much pain, or even, don’t have any pain at all. They still get the same red rash which appears in clusters in a single band following a nerve path. A child that gets Shingles won’t have to worry getting the rash all over his or her body because the Herpes Zoster rash stays along its band of skin supplied by the affected nerve pathway called the dermatome, and it usually occurs only to one side of the body.

Usually occurring with less pain or no pain at all, children affected with Shingles also less frequently experience postherpetic neuralgia, or a pain in the affected nerve that last for 30 days or a month.

Children getting Shingles won’t really feel sick or ill, and usually is afebrile during the course of the disease.

 

TAKING CARE OF CHILDREN WITH SHINGLES

Despite the aforementioned self-limiting feature of Herpes Zoster, one may still want to do some interventions for such a disease. In taking care of children with Shingles, the same goes with adults too, the approach is really just symptomatic care or palliative care. This means, the interventions will be directed not to directly eliminate the cause, which in this case is the Varicella Zoster Virus (this one seems impossible since a virus can only be dormant but not totally killed), but to only provide relief to the discomfort brought about by the clinical manifestations.

Most children as said above, will experience less pain or none at all. Only if needed, one can give Acetaminophen or Ibuprofen. The itch of the rash can be alleviated through frequent bathing. No cream or ointment is needed for the rash. Also scratching, picking or bursting the rash is highly discouraged.

Children with Shingles or Herpes Zoster can transmit Chickenpox, but not Shingles, to others. Transmission will occur through direct contact with the rash. Though not as contagious as children with Chicken pox, the child affected is advised to stay out of school unless the rash can be kept covered until it dries and crusts over.

 

CAN A CHILD REALLY GET SHINGLES?

After all that’s been said, bottom line is, no one is safe from Shingles, of course with exemption to those vaccinated against Varicella Zoster Virus. Shingles or Herpes Zoster saves no one from its extremely itchy and painful clustered red rash. No regards of a person’s age and/or gender. Ensure a child is of optimum health to avoid being one of the 5 in 10,000.