Chickenpox and shingles

What is chicken pox / shingles?

Symptoms of chicken pox

Managing chicken pox

Shingles

Shingles treatment

What is chicken pox / shingles?

Chicken pox (herpes zoster, shingles, zoster, zona, varicella-zoster) is a contagious viral disease. Most people are infected as children. However if chicken pox is first contracted as an adult it is more serious, and especially if pregnant (see a doctor).

Note: Herpes zoster is NOT the same disease as herpes simplex despite the name similarity.

After an episode of chickenpox has resolved the virus is not eliminated from the body. Years or decades after the initial infection it can occasionally emerge to cause shingles, an illness with very different symptoms (such as a painful rash). Although the rash usually heals within two to four weeks, some sufferers experience residual nerve pain for months or years, a condition called postherpetic neuralgia.

Most adults are infected with the varicella-zoster virus. In those with a healthy immune system, the virus remains latent / dormant in the body. Increasing age and a compromised or weak immune system seem to be the greatest risk factors for an outbreak of shingles years after the initial herpes zoster infection. As the virus comes out of remission it can cause severe symptoms.

Worldwide, the yearly incidence of herpes zoster ranges from 1.2 to 3.4 cases per 1,000 healthy individuals, increasing to 3.9 to 11.8 among those older than 65 years.

The infected person is extremely contagious after the rash appears, and until their rash has developed crusts.

Symptoms of chicken pox

In children the symptoms tend to be mild, whereas in adults the symptoms can be more painful and severe, and longer lasting.

Between one and three weeks after contact with the source of infection, a child may have a headache, mild fever and malaise.

Next may come sensations of burning pain, itching, tingling, pricking, stinging, numbness, over-sensitivity or "pins and needles".

In most cases after 1-2 days, but sometimes after as long as 3 weeks, the above symptoms are followed by the appearance of the characteristic chicken pox skin rash. The pain and rash most commonly occurs on the torso, but can appear on the face, eyes or other parts of the body. The rash appears in a characteristic strip or belt-like pattern. Initially the rash is similar to hives, but then itchy or painful blisters develop that crust over after 7-10 days. Usually the crusts fall off and the skin heals, but scarring can occur.

The rash and pain usually subside within 3-5 weeks, but in a few cases much longer.

In 10-25% of cases, the eye can be infected. Rarely, other symptoms include conjunctivitis, keratitis, uveitis, and optic nerve palsies that can sometimes cause chronic ocular inflammation, loss of vision, and debilitating pain. If the ear is infected, this can cause loss of hearing or vertigo.

Managing chicken pox

• Keep to an alkaline diet with plenty of raw sour fruits, lemon juice with water, and vegetable juice.
• Stay in a well-ventilated room.
• Bath every day in lukewarm water to relieve itching.
• Wear light, loose, clothing. Preferably cotton, avoid wool.
• Cut children's nails short to reduce scratching.
• Wear cotton gloves at night to prevent scratching during sleep.

See a doctor if: There is any chance of pregnancy; pus filled spots or blisters develop near the eyes; there are convulsions, breathing problems, headache or earache.

Shingles

Shingles, also known as herpes zoster, is a disease that triggers a painful red, sometimes spotty skin rash. It is caused by the same virus as chickenpox. Shingles used to be a rare disease, but today about one in three adults who have had chickenpox will develop this condition later in life.

Shingles is caused by the reactivation of the varicella-zoster virus years or decades after a chickenpox infection. The varicella-zoster virus is never cleared from the body, but instead it settles in sensory nerve ganglia (clusters of nerve cell bodies) along the spinal cord, the head/face area, and in the gut.

More than 90% of people who suffer a bout of shingles never experience a second occurrence.

The virus can reactivate due to aging, stress, illness, or immunosuppression. It travels down the nerve in which it reactivates to the skin, causing shingles (herpes zoster) in the corresponding dermatome (the area of skin supplied by a single spinal nerve root). This is why shingles, when it occurs, is restricted to a specific part of the body and does not go elsewhere.

Shingles usually occurs in the thoracic dermatomes, which supply the chest, abdomen, and mid-back. This region accounts for roughly 50% to 53% of all shingles cases. The virus reactivates from a single nerve root, creating a distinctive band-like rash that wraps around only one side of the body without crossing the midline.

Other common shingles areas are:

Cervical (C2-C8) 20%. The side of the neck, shoulder, or running down one arm.

Trigeminal (Cranial Nerve V) 15%. The face, scalp, and jaw. Most often strikes the ophthalmic branch (V1), presenting around the eye and forehead. Note: shingles around the eye is a medical emergency because it can cause permanent damage to eye or even blindness if not treated promptly. Symptoms include burning, tingling, throbbing, or deep aching pain on one side of the forehead, scalp, or around the eye socket, skin pain even from a light touch, low grade fever, fluid-filled blisters on a red base appearing on the upper eyelid, forehead, scalp, and around the eye socket, vision changes, swelling and Hutchinson's sign - a single blister on the tip of the nose.

Lumbosacral (L1-S5) 11%. The lower back, hip, buttock, or wrapping down the front or back of the leg.

Shingles treatment

Doctors will offer antiviral drugs (valacyclovir, famciclovir, or acyclovir) that ideally are taken within 72 hours of rash onset, especially if suffering shingles of the eye area. Doctors may also offer pain relief medications.

Vitamin D. The most important remedy for shingles is vitamin D sufficiency. People with shingles are three times more likely to be vitamin D deficient than the general population. Your health care provider should monitor your vitamin D level and ensure that it is at least 70 ng/ml (175 nmol/L). If you can't get sufficient sunlight or are older than 50 years, take 40,000 IU of vitamin D3 supplement per day while monitoring your vitamin D level. Do not get even the slightest bit sunburned even though it is important to get out in the sunshine. Also take 500 mg to 1000 mg of magnesium (on the skin) and 150 mcg of vitamin K2 (not K1) per day, as they are important cofactors for optimising vitamin D3 supplementation.

Get a vitamin D cream and spread it directly on the rash.

Reduce or eliminate foods relatively high in arginine, mainly legumes, nuts and seeds. Increase use of foods relatively high in lysine, particularly cheese, eggs and shellfish.

Topical treatments like calamine lotion or capsaicin cream are available from stores and chemists.

Geranium essential oil directly on the rash may reduce the pain. Do not use on open sores.

Cool, wet compresses or oatmeal baths to soothe itching/blisters.

Keep the rash clean and dry; wear loose clothing.

Those with shingles often suffer from hypertension, which can be managed through diet and lifestyle.

Manage stress.