Shingles Health Article

Diagnosis

Diagnosis is based on history and symptoms. The person must have initially had chicken pox in order to have shingles. Definite diagnosis is difficult before eruption of the characteristic vesicles or bumps on the skin. Often persons with early shingles mistake the reddened, painful area as an accidental burn. Once vesicles appear, however, they are hard to mistake because of their dermatome-bounded distribution on the body. In children, shingles (VZV reactivation) must be differentiated from chicken pox (primary VZV infection). This is normally not difficult, as chicken pox vesicles occur widespread on the body and shingles lesions are usually limited to one area on the person's midsection. Herpes simplex virus can also produce vesicle eruptions similar to those of shingles. If there is doubt about which virus is present, virus from the patient can be cultured.

Treatment team

Unless there are complications such as in a person with AIDS, or a child with leukemia, a primary physician can usually treat shingles.

Treatment

Treatment for shingles is primarily with antiviral drugs, traditionally acyclovir but, more recently, famcyclovir and valacyclovir. Additionally, a live attenuated-virus vaccine for chicken pox has been licensed since 1995. The vaccine was developed to immunize children undergoing cancer treatment because chicken pox can cause severe complications in such children.

The pain associated with shingles, and with the postherpetic neuralgia that may linger (especially in older patients, after the condition has otherwise resolved), is best treated using combination therapy based on antivirals, antidepressants, corticosteroids, opioids (morphine), and topical agents (applied directly to the skin). The inexpensive amino acid lysine has also been reported to ease the symptoms of both herpes simplex infections and shingles.

Recovery and rehabilitation

Recovery from shingles for the otherwise healthy patient is straightforward and generally requires no special rehabilitation aid or therapy.

Clinical trials

As of mid 2004, several clinical trials related to shingles are recruiting patients. One is sponsored by the National Center for Research Resources, University of Texas, and titled "Randomized Study of Two Doses of Oral Valacyclovir in Immunocompromised Patients with Uncomplicated Herpes Zoster." The study seeks to investigate the efficacy of higher-than-standard doses of valacyclovir by assessing quality of life, pain level, and utilization of medical resources of patients treated with a higher-than-standard dose of valacylovir as compared to a control group treated with the standard dose. Contact information is University of Texas Medical Branch, Galveston, Texas, 77555-0209; Stephen K. Tyring is the recruiter, telephone: (281) 333-2288.

Another trial recruiting patients as of 2004 is sponsored by the Baylor College of Medicine, Texas Children's Hospital, and titled "Valacyclovir in Immunocompromised Children." The study seeks to learn how the body handles valacyclovir, its efficacy in treating immunocompromised children with shingles, and the side effects of such treatment. The recruiting inquiries in Pennsylvania is Children's Hospital of Philadelphia, Pennsylvania, 19104; Donna Sylvester, RN, phone: (215) 590-3284. The recruiting inquiries in Texas is Texas Children's Hospital, Houston, Texas, 77030; Susan Blaney, MD, phone: (832) 822-4215, e-mail: sblaney@bcm.tmc.edu, or Lisa R Bomgaars, MD, phone: (832) 824-4688, e-mail: lbomgaars@bcm.tmc.edu.

A third study ongoing in 2004 is sponsored by the drug maker NeurogesX and titled "Controlled Study of NGX-4010 for the Treatment of Postherpetic Neuralgia." NGX-4010 consists of a capsaicin dermal (skin) patch. Capsaicin is the active substance in chili peppers, and is used, paradoxically, both as an irritant and for pain relief. The purpose of this clinical trial is to evaluate the efficacy of a capsaicin patch for relief of postherpetic neuralgia. Contact information varies by state but can viewed at the National Institutes of Health Web site at <http://www.clinicaltrials.gov/ct/show/NCT00068081?order=3>.

Prognosis

Generally, the prognosis for persons with shingles is good. Shingles is almost never a life-threatening disease in otherwise healthy patients, and usually resolves without treatment in a few weeks. However, postherpetic neuralgia, which occurs more often in elderly patients, can be disabling and difficult to treat.

Persons who have an impaired immune system, such as those deficient in cytotoxic T lymphocytes, persons undergoing immune suppression (e.g., for organ transplant), and persons who have AIDS or leukemia may suffer more serious effects from shingles, as the reactivated virus sometimes disseminates from the dorsal root ganglia to other parts of the body. In these cases, complications can resemble those for primary infection of adults with VZV, namely, viral pneumonia, male sterility, acute liver failure, and (in pregnant women) birth defects.

BOOKS

Glaser, Ronald, and James F. Jones, (eds). Herpes Virus Infections. New York: Marcel Dekker, Inc., 1994.

Strauss, James H., and Ellen G. Strauss. Viruses and Human Disease. New York: Academic Press, Elsevier Science, 2002.