When Shingles Becomes Painful Postherpetic Neuralgia
In 10% to 20% of these people, however, the pain of shingles keeps hanging on after the rash is gone. “These folks go on to get postherpetic neuralgia, and we’re not exactly sure why,” Ralph tells WebMD. “Either the pain of shingles never leaves, or it resolves, comes back, and never goes away completely.”
PHN typically occurs in the area where the shingles occurred. The pain can be intermittent or constant, and it can take on any of the diverse qualities of shingles pain. Normal touching of the skin can set it off, Ralph adds. This is called allodynia.
The pain of postherpetic neuralgia can interfere with daily activities, exercise, sleep, and sexual desire. Irritability and depression often follow. “Generally, it makes people feel terrible if it can’t be controlled,” Rumbaugh says.
Why the pain of postherpetic neuralgia persists has mystified researchers. It’s not due to ongoing infection by VZV, but is thought to be due to residual damage or inflammation in the nerve after shingles resolves. It’s also impossible to predict who’ll get shingles or postherpetic neuralgia, although age, race, and health seem to have some impact.
What Are The Complications Of Shingles
Symptoms of shingles usually dont last longer than 3 to 5 weeks. However, complications can happen. The main complications that can result from shingles include:
- Postherpetic neuralgia . The most common complication of shingles is called postherpetic neuralgia . This continuous, chronic pain lasts even after the skin lesions have healed. The pain may be severe in the area where the blisters were present. The affected skin may be very sensitive to heat and cold. If you had severe pain during the active rash or have impaired senses, you are at increased risk for PHN. The elderly are also at greater risk. Early treatment of shingles may prevent PHN. Pain relievers and steroid treatment may be used to treat the pain and inflammation. Other treatments include antiviral drugs, antidepressants, anticonvulsants, and topical agents.
- Bacterial infection. A bacterial infection of the skin where the rash happens is another complication. Rarely, infections can lead to more problems, such as tissue death and scarring. When an infection happens near or on the eyes, a corneal infection can happen. This can lead to temporary or permanent blindness.
Why Doesnt Having Chickenpox Earlier In Life Provide Immunity Against Having Shingles Later
After having chickenpox, your body doesnt rid your system of the virus. Instead, the virus stays in a portion of the spinal nerve root called the dorsal root ganglion. In most people, the virus simply stays there quietly and doesnt cause problems. Scientists arent always sure why the virus gets active again, but they know stress can be a cause.
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Help Is Available For Phn
Fortunately,early treatment for shingles can lower your chances of getting PHN.
For some people, the pain becomes refractory, or resistant to treatment, explains Dr. Rosenquist. So we want to treat shingles as fast as we can ideally as soon as somebody feels a tingling or burning sensation, even before a rash develops.
Sheadds that whenever nerve pain is involved, some people respond to treatment andsome dont.
However,medications taken orally or injected that can target the affected nerves may beable to stun the nervous system into behaving properly. That meanstransmitting the appropriate signal to the brain.
Are There Shingles Home Remedies
People who have shingles symptoms and signs should see their doctor as soon as possible, because antiviral medication is effective only if given early. Individuals with facial, nose, or eye symptoms and signs should seek medical care immediately.
- Do not scratch the skin where the rash is located. This may increase the risk of secondary bacterial infection and scarring. Over-the-counter antihistamines and topical creams can relieve the itching.
- After diagnosis and appropriate treatment, apply cool tap-water compresses to weeping blisters for 20 minutes several times a day to soothe and help dry the blisters. This also aids in removing the scabs and decreases the potential for bacterial infection. Tap-water compresses must be stopped once the blisters have dried, so the surrounding skin does not become too dry and itchy. Remember that weeping blisters contain the virus and are contagious to individuals who are susceptible to the chickenpox virus.
- Keep the area clean with mild soap and water. Application of petroleum jelly can aid in healing. Wear loose clothing to avoid extra pain from clothing rubbing against the rash. Avoid close skin-to-skin contact with others who have not had chickenpox, are ill, or who have a weakened immune system.
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Shingles Treatment Near You In Ny Nj Pa And Ct
If you think you might have shingles, please consult a dermatologist immediately. Our experienced dermatology providers can help you with shingles treatment to be pain-free and return to health more quickly.
For appointments, please call Schweiger Dermatology Group at . To find a location near you, check out our location pages.
Can Other People Catch Shingles
This one is confusing! You can catch chickenpox from other people, but you can’t catch shingles from other people. You only get shingles from a reactivation of your own chickenpox infection in the past.
So if you have shingles, and you come into contact with somebody else, they cannot ‘catch’ your shingles. But if they have never had chickenpox, it is possible that they could catch chickenpox from you.
To put it another way, no, you don’t ‘catch’ shingles. It comes from a virus hiding out in your own body, not from someone else. But if you have shingles, you may be infectious, as it is possible for people to catch chickenpox from you.
Only people who have never had chickenpox are likely to be at risk of catching chickenpox from your shingles. People who have had chickenpox should be immune from catching it again. If the rash is in a covered area of skin, the risk of anyone with whom you are not in close contact catching chickenpox is very low.
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What Is The Prognosis For Shingles What Are Possible Shingles Complications
Many cases of shingles go away by themselves, with or without treatment. The rash and pain should be gone in two to three weeks. However, shingles may last longer and be more likely to recur if the person is older, especially older than 50 years of age, or if they have a serious medical problem.
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Higher Intensity Of Pain With Internal Shingles
While both regular shingles and internal shingles can cause preherpetic neuralgia, this condition has been found to be more severe in the latter case.
One study found that at the onset of symptoms, after one month, and after three months, internal shingles patients had consistently more severe and persistent pain. Overall, however, preherpetic neuralgia occurs much more frequently in regular herpes zoster patients.
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Can You Get Shingles From The Covid
There have been a few reports of shingles happening in people who were vaccinated against COVID-19. The varicella-zoster virus was reactivated in these people.
A note from Cleveland Clinic
If youve had chickenpox, youre at risk of developing shingles later in life. Shingles causes a rash that is contagious and painful. The disease can have serious complications. The best thing you can do to reduce your risk is to get the shingles vaccine. The vaccines are safe and effective.
What Treatments Are Available For Shingles
As soon as you think you have shingles, make an appointment to see a dermatologist. Although shingles are not a life-threatening condition, you can develop complications from shingles without treatment. Additionally, the pain and discomfort from shingles can last much longer if no medication is taken. If you have shingles on your face, consult a doctor immediately because shingles near the eye area can cause permanent damage to the eyes.
Before treatment, in some cases your dermatologist may scrape the blisters on your skin to get a sample and then send it to a lab to verify that you have shingles.Treatment for shingles can include anti-viral medications, steroids, and pain medications. The quicker you can begin a prescription of anti-viral medication, the better off your prognosis will be.
Topical antibiotic creams can also be applied in some cases to rashes to help prevent infections. In some cases, pain can persist even after rashes have disappeared. This is known as postherpetic neuralgia or PHN. If you are diagnosed with PHN, a doctor might prescribe medications such as painkillers, anti-depressants, and topical anesthetics to help you cope with the pain.
The best treatments for shingles include:
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Can I Give Shingles To Others
No one can catch shingles from you. But the virus can be spread to a person who has never had chickenpox. The virus lives in the blisters that shingles causes. It can be spread until the blisters are completely healed. If you have blisters that have not crusted over yet, you should stay away from:
- Anyone who has never had chickenpox
- Babies under 12 months old
- Very sick people
Tell your doctor if you live with children who have not had chickenpox. They may need to be vaccinated.
Shingles Linked To Stroke Heart Attack
Not only do shingles flare-ups hurt, research says they can increase your short-term risk of heart attack and stroke following the virus outbreak.
Shingles was found to raise the risk of stroke by 35% and the risk of heart attack by nearly 60%, according to a study of more than half a million people. The risk of stroke was highest in those under age 40.
Its been known for a while now that zoster causes stroke, said Dr. Gwen Wigand-Bolling, an internist at . The inflammation it creates causes heart attack and stroke, and shingles causes increased blood clotting in the arteries, she added.
The risks of both stroke and heart attack were highest in the first year after the onset of shingles and decreases with time, researchers said.
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What Specialists Treat Shingles
Primary care physicians, including internal medicine specialists, family medicine specialists and/or specialists in infectious diseases, can appropriately treat some patients. An emergency medicine physician may start the initial care. However, if there is a chance the eye may be involved, an ophthalmologist should be consulted. If a person is pregnant and gets shingles, they should consult with their ob-gyn physician immediately. For long-term or chronic pain involved in postherpetic neuralgia, a neurologist and/or pain specialists may be involved in the care of the patient.
Where Does Shingles Come From
When you have chickenpox as a child, your body fights off the varicella-zoster virus and the physical signs of chickenpox fade away, but the virus always remains in your body. In adulthood, sometimes the virus becomes active again. This time, the varicella-zoster virus makes its second appearance in the form of shingles.
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Key Points About Shingles
- Shingles is a common viral infection of the nerves. It causes a painful rash or small blisters on an area of skin.
- Shingles is caused when the chickenpox virus is reactivated.
- It is more common in people with weakened immune systems, and in people over the age of 50.
- Shingles starts with skin sensitivity, tingling, itching, and/or pain followed by rash that looks like small, red spots that turn into blisters.
- The rash is typically affects just one area on one side of the body or face.
- Treatment that is started as soon as possible helps reduce the severity of the disease.
How Is Shingles Diagnosed
As with most other diseases, doctors will typically review your symptoms first. Be sure to take note of how long youve experienced symptoms, what your exact symptoms are, and their severity. Doctors may suspect internal shingles if your symptoms involve more than your skin. They will often suspect eye or nervous system involvement based on the location of the shingles rash. However, if you have a painful rash along with a cough, severe headache, or abdominal pain, you may have a more serious complication of shingles.
Doctors may perform the following tests to confirm your diagnosis of shingles:
- direct fluorescence antibody stain
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Treatment Of Herpes Zoster
The treatment of herpes zoster has three major objectives: treatment of the acute viral infection, treatment of the acute pain associated with herpes zoster and prevention of postherpetic neuralgia. Antiviral agents, oral corticosteroids and adjunctive individualized pain-management modalities are used to achieve these objectives.
What Is The Outcome For Someone Who Has Shingles
Most people get shingles once, but its possible to get it again.
If you have a healthy immune system, the blisters tend to clear in 7 to 10 days. The rash tends to go away completely within 2 to 4 weeks. The pain may last longer, but usually stops in 1 or 2 months.
For some people, the pain will last longer than the rash. When it does, its called postherpetic neuralgia , which can come and go or be constant. PHN can last for months, years, or the rest of your life. Treatment can help reduce the amount of pain you feel.
Be sure to tell your doctor if you continue to have pain. Treatment can help you feel more comfortable.
For anyone who has a shingles rash, the right self-care can help ease your discomfort. Youll find out what dermatologists recommend at, Shingles: Self-care.
ReferencesCenters for Disease Control and Prevention . About shingles. Page last reviewed 10/17/2017. Last accessed 4/1/2019.
Dooling KL, Guo A, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. Morb Mortal Wkly Rep 2018 67:103-8.
Madkan V, Sra K, et al. Human herpes viruses. In: Bolognia JL, et al. Dermatology. . Mosby Elsevier, Spain, 2008: 1204-8.
Straus SE, Oxman MN. Varicella and herpes zoster. In: Wolff K, Goldsmith LA, et al. Fitzpatricks Dermatology in General Medicine . McGraw Hill Medical, New York, 2008: 1885-98.
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What Causes Shingles Pain
Chickenpox, shingles, and postherpetic neuralgia all result from infection with a single virus called varicella zoster virus . Most people catch the varicella zoster virus as children, itch and shiver through the rash and fever of chickenpox, and get better.
But that’s not necessarily the end of the story of varicella infection. After a bout of chickenpox, our immune systems never completely eradicate the VZV virus. They just chase it into hiding. Varicella retreats into nerve cells deep under the skin, near the spine.
For most of us, VZV lies dormant inside our bodies throughout our lives, never causing further problems. In about one-third of people, however, VZV infection has a second act. The virus emerges from hiding, travels along a nerve to the skin, and erupts in a bumpy, painful rash on one side of the body. This sneak attack is called herpes zoster, or shingles.
How Can I Get Rid Of Clogged Pores And Milia Seeds
Our face is constantly exposed to dirt, bacteria, skin care or cosmetic products. If you dont clean your face thoroughly, its easy for pores to get clogged. The best way to prevent clogged pores is to follow a good daily skin care regimen and exfoliate your skin regularly to remove dead skin cells and excessive sebum.
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Is Shingles Contagious
People cannot catch shingles from another person but it is possible for someone to catch chickenpox from a person with shingles. This can only happen if someone has not had chickenpox or received the chickenpox vaccine.
The varicella-zoster virus present in shingles blisters can be spread if someone comes into direct contact with the fluid. It remains contagious until the last blister has dried up and scabbed over.
The risk of spreading the virus is low if the rash is kept covered. Individuals with shingles should avoid contact with anyone who has not already had chickenpox. This is particularly important in the following cases:
- Gilden, D., Cohrs, R. J., Mahalingam, R., & Nagel, M. A. . Neurological disease produced by varicella zoster virus reactivation without rash. Current Topics in Microbiology and Immunology, 342,, 243253
What Is The Outlook
If you have a particularly severe case of shingles, it could take months to go away. It can also become a long-term problem for some people. If you have postherpetic neuralgia, you may need to see your doctor more often.
Complications that involve the eye or ear may require ongoing care, especially if you have lingering vision or hearing problems.
Most people have shingles only once, but it can recur. This is more likely to happen if you have a weakened immune system.
If you havent had any major complications, your symptoms should clear up within a matter of weeks with few, if any, lasting effects.
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Postherpetic Neuralgia Treatment: Soothing The Pain
Once postherpetic neuralgia occurs, antiviral drugs can’t treat the pain because ongoing infection isn’t the problem. Instead, treatment aims to soothe and quiet the misfiring nerves that are creating the pain.
There are a variety of oils and creams available at drugstores. Some turn to herbal oils and creams, such as extracts from geranium, lavender, eucalyptus, tea tree, and bergamot.
Others use capsaicin cream, made from hot chili peppers. A drug called Qutenza contains “pure, concentrated, synthetic capasaicin,” according to the FDA. Qutenza can be used every three months and is applied by a doctor via a patch or patches placed for an hour on the places on the skin that hurt. Before applying the patch, the doctor spreads a topical anesthetic on the area to be treated.
Ralph said many people find relief from the anesthetic lidocaine, available in low-concentration creams or patches over the counter, or by prescription in higher concentration patches.
“The lidocaine soaks through the skin and numbs the painful nerve endings,” says Ralph. Lidocaine patches are particularly helpful for people with allodynia, Ralph adds.
If topical creams and oils don’t provide sufficient relief, Ralph recommends asking your doctor about prescription medicines that may help, including some antidepressants, anti-convulsants, and opioids.