Shingles (Herpes Zoster)

RECENTLY IN THE NEWS:

NBC News (3/5/2015) reports on its website that "family practioners, gynecologists and even dentists are getting into the cosmetic procedure business, and dermatologists say they're seeing the side effects."  Several dermatologists "from around the country told NBC News that they've had to the fix the mistakes of physicians who are dabbling in their specialty."  In a statement, the American Academy of Dermatology said, "A dermatologist is a licensed medical doctor and the only residency-trained physician fully educated in the science of cutaneous medicine, which includes medical and surgical conditions of the skin, hair, nails, and mucous membranes."

DRY SKIN CARE:

Keep your bathing to a minimum!  Wash with lukewarm water and keep your bathing to less than 10 minutes.  Wash with a soapless cleanser such as Dove and avoid harsh soaps such as Ivory or Irish Spring.  After bathing, moisturize within a few minutes of patting dry with a towel.  Moisturize with a sensitive-skin moisturizer without fragrance.  If you have a skin condition such as eczema, you will need to moisturize a few times per day.

WOUND CARE:

The day after your procedure, allow the cleanser and water to wash over the site.  That is adequate cleaning of the wound.  Thereafter, apply a generous layer of petroleum jelly (Vaseline) or another greasy substance such as Aquaphor healing ointment.  If the area is in contact with clothing, we advise you to cover it with a dressing.  Repeat the same procedure the next day and every day until the wound has healed.

HOW TO APPLY YOUR TOPICAL RETINOID (ACNE PATIENTS):

Topical retinoids include adapalene (Differin), tretinoin (Retin-A, Atralin, Ziana, Veltin, Tretin-X).  Apply a pea-sized amount to your entire face a few minutes after washing your face at bedtime (since most retinoids are inactivated by sunlight).  If your face is dry with the retinoid, apply a moisturizer prior to the application of the retinoid.  

CARE FOR SKIN IN THE SUN:

Use a daily moisturizer with a sunscreen of SPF 15 or higher on the areas that will be exposed.  If you're going to be directly out in the sun, wear an SPF of 30 or higher and make sure the sunscreen says that it is "broad spectrum."  Remember to reapply after two hours and after swimming or any exercising.  Physical sunscreens which contain titanium dioxide and/or zinc oxide are gentle and will not react with the skin.   Seek shade between the hours of 10 am-4 pm.

Check your skin for any new, changing, non-healing or itching lesions four times a year or every major holiday.  If you notice anything that is new or changing or not healing, please call and get it checked.

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Shingles is a painful rash that is caused by the varicella zoster virus. It usually appears as a band or strip of blisters on one side of the body that goes from the spine around the front to the breastbone. However, shingles can also appear on the neck, nose and forehead.

Shingles derives from the same virus that causes chicken pox. After having chicken pox, the virus lies dormant in nerve tissue underneath the skin. Years later, and with no known reason, it reactivates and causes shingles. Shingles is contagious and can easily pass through touching from one person to another. The virus develops into shingles for people who have had chicken pox and develops into chicken pox for those who have not had it. Shingles appears most frequently among older adults (age 60+) and in people with compromised immune systems. Generally, a person only gets shingles once; it rarely recurs.

Symptoms for shingles include:

  • Pain, burning, numbness or tingling on one side of the body. The pain often precedes any other symptoms.
  • A rash that appears a few days after the pain. It may be itchy.
  • Blisters that break open and then crust over.
  • Fever, achiness or headache.

Some people never get a rash or blisters with shingles, but simply experience the pain.

Shingles is diagnosed based on a medical history and physical examination of the telltale rash. If you suspect you may have shingles, it is important to contact your doctor as quickly as possible. Early treatment can reduce the pain and severity of the episode. Two types of medications are prescribed to treat shingles:

  • Antiviral drugs to combat the virus, such as acyclovir, valacyclovir and famciclovir.
  • Pain medicines, from oral pain pills and antidepressants to anticonvulsants and topical preparations that contain skin-numbing agents.

Shingles usually heals in about 2 to 3 weeks without any problem. However, there is a small percentage of patients (10% to 15%), predominantly over age 50, who experience pain that lasts beyond one month after the healing period. This is called postherpetic neuralgia. Catching shingles early and beginning treatment can reduce the likelihood and severity of postherpetic neuralgia. See your dermatologist for pain relief.

The U.S. Food and Drug Administration has approved a vaccine, called Zostavax, for the prevention of adult shingles. It is approved for adults age 60 or older who have had chicken pox. Essentially, the vaccine delivers a booster dose of chicken pox. The vaccine has proven to be very effective in reducing the incidence of shingles and postherpetic neuralgia.