Shingles

SHINGLES (HERPES ZOSTER) What is SHINGLES? ‫ ڿ‬Shingles is an acute infection and painful viral disease of the peripheral nervous system in which a rash of small blisters develops on the skin overlying sensory nerve trunks. What CAUSES the disease? ‫ ڿ‬Shingles is caused by the varicellazoster virus, the same virus that causes chicken pox. ‫ ڿ‬While the exact cause of shingles is not understood, scientists theorize that during an attack of chicken pox, the virus may invade large clusters of neurons (nerve cells) found on either side of the spinal cord. ‫ ڿ‬The virus may live dormant within these neurons for years, held in check by the body’s immune system. ‫ ڿ‬But if the immune system becomes impaired, perhaps during the normal aging process or as a result of disease, the virus can reactivate, causing neurons to become inflamed. ‫ ڿ‬Blisters develop on the skin that lies above the inflamed neurons. Predisposing Factors?

 People over 50 years.  Immunocompromised patients (e.g., AIDS patients).  Age-related weakening of the immune system.  The disease may also result from overwork, debility or weakness, damp and chilly weather, absorption of certain drugs paricularly compounds of arsenic, or contact with a case of chicken pox. Common Signs and Symptoms ■ In a typical attack of shingles, a person first feels pain in the area that will later break out in blisters. ■ Other initial symptoms include fever, headache, muscle soreness, fatigue, stomach upset, and diarrhea. ■ After three to five days of these initial symptoms, the blisters appear, often accompanied by burning and tingling. The blisters are usually confined to one side of the body, most commonly in an area extending from the upper half of the spine to the breastbone. The face, abdomen, arms, and legs may also be affected. The rash usually goes away after a few weeks without complications.

Management Medical/Therapeutic: ~ If available and as ordered, compresses moistened with Burow’s solution (5% aluminum acetate solution) may be applied to the affected skin areas for 15 to 20 minutes a day. At other times, calamine lotion may be applied sparingly to relieve itching. ~ If the skin breaks, the use of Bacitracin topical ointment will help to prevent infection as as prescribed. ~ Corticosteroid medication as prescribed may be administered during the acute phase of illness. ~ As available and as ordered, an electric heating pad may be applied to the painful area to relieve some of the discomfort. ~ A lidocaine patch, a stretchy bandage coated with a long-acting topical anesthetic, may be applied to the painful area to numb affected nerve endings and temporarily relieve pain. In addition, a physician may prescribe antidepressants and other drugs that help calm inflamed nerves, lessening pain. ~ When shingles is diagnosed in patients with suppressed immune systems, such as those with acquired immunodeficiency syndrome (AIDS) or cancer, the antiviral drug acyclovir may be prescribed. Home management: ~ Remain inactive for 7-14 days while the discomfort is severe. ~ DO NOT OPEN blisters that appear on the skin. ~ It is best to consult a physician in all cases of shingles. ☺

PATIENT TEACHING PREPARED BY: CERIACO, C.B. Sanit Louis University, College of Nursing REFERENCES: Shryock, Harold, et. al., Modern Medical Guide, pp. 374-75. Cimindi, Bandung: Indonesia Publishing House. 1982. Tortora, Gerard, et.al., Principles of Anatomy and Physiology, p. 447, 10th edition. New York: John Wiley and Sons, Inc. 2003.