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Friday, November 28, 2014

Dr. Pegs Prescription

A pox on both your ages: shingles a blight on young and old

Q: Recently, I had a rash and I went to the doctor’s office and was told it was shingles.

Isn’t that for old people? I have seen ads for a shingles vaccine but it’s for people who are at least 50 years old. Why did I get this when I am young? Is this going around?

A: So sorry to hear you have shingles. I know that can be really painful. I know, because I had it when I was young too. It happened during my fourth year of medical school, on the famously brutal surgery rotation. Up every morning at 5, I hustled to the hospital, where I checked on my patients, drew morning bloods, and prepped for rounds. During rounds I presented my assigned patients to the rest of the team, straining my brain to answer tough and sometimes nitpicking questions posed by the attending physician.

Then it was off to the operating rooms, where I stood for hours holding retractors, fielding anatomy pop quizzes, and hoping the surgeon would reward me by letting me stitch up the skin. After that I’d check my ward patients again, do more chores, grab a quick dinner, go on rounds again, write chart notes, and hustle home to fall into bed. Partway through the rotation, I started having pains in the side of my head, and then I broke out in the classic rash on my face. Small wonder. Shingles loves stress.

So no, it is not only an old people problem, although it is more common among the elderly. We see plenty of shingles at SHAC.

However, that doesn’t mean it is “going around.” That would imply you can catch it from someone, and shingles is not contagious, at least not directly. You can’t get shingles from someone who has shingles — but you can get chicken pox.

Let me explain. Back when you were a kid, you had chicken pox.

Chicken pox is caused by a virus called varicella zoster that causes little red, pus-filled bumps that itch like crazy and are preceded by fever, sore throat and headache. The liquid inside the bumps is full of the virus, and chicken pox is easily spread from kid to kid. You don’t get it from chickens, in case you were wondering.

The name comes either from the resemblance of the bumpy sores to chickpeas — isn’t that appetizing — or to the peck marks chickens make with their beaks. After a few days of itchy misery, the pox begin to dry up, and about a week later the kid can go back to school.

But that is not the end of the varicella virus. Varicella stays in the body; it retreats from the skin and hides way deep in the nerves, at their very roots in the spine.

In most people, the varicella virus goes into permanent hibernation and that is the end of it. But in some unlucky citizens, varicella awakens. It yawns, stretches and strolls out to cause trouble. This usually happens when the immune system is in a weakened state — for example from stress, illness, or, yes, old age. But this time around, varicella’s reach is limited. It can only travel along nerves, which run in a specific pattern from spine to skin. Each nerve has its own pattern, and its own area of skin, called a dermatome. Shingles rashes break out in classic dermatome stripe distribution, on one side of the body only. The one-sidedness is one clue we use to diagnose shingles.

Preceding the rash are a few days of pain. This pain can be quite severe, and is usually described as stabbing or shooting, radiating from the spine to the skin, often around the body in an arc pattern that echoes the nerve path. After the rash begins, the pain usually starts to subside.

Shingles is treated with anti-viral medications that help shorten the course. Pain pills might be prescribed but aren’t usually much help. Sometimes we’ll use steroids, or topical medicines. In most people, shingles is a limited illness. An unfortunate few will have persistent, chronic pain after shingles, though this complication is much more common in old people.

I said you couldn’t catch shingles from shingles. However, that sleepy varicella virus still has a little potency, and if you rub your shingles on someone who hasn’t had chicken pox, they could break out in regular chicken pox from the virus. Chicken pox can be dangerous in people with compromised immune systems, so stay away from people with HIV or cancer.

Just to make things even more confusing, the medical name for shingles is herpes zoster. It is not caused by the herpes simplex virus, or the herpes anything virus. The word herpes literally means creeping skin rash, so someone thought it made sense to call a creeping skin rash caused by varicella zoster “herpes zoster.”

Go figure.

There is a vaccine for shingles, and a vaccine for chicken pox. They are not the same, although they are related. They are both made from varicella virus, but the shingles vaccine is much more potent. The purpose of the shingles vaccine is to poke the older person’s sluggish immune system so that it will keep the varicella in the nerve root and prevent the shingles outbreak.

For those of you who haven’t had chicken pox, or aren’t sure, you can come to our allergy and immunization clinic at SHAC and get tested or get a vaccine. Call 505-277-3136 for an appointment.

Peggy Spencer is a student-health physician. She is also the co-author of the book “50 ways to leave your 40s.” Email your questions directly to her at pspencer@unm.edu. All questions will be considered anonymous, and all questioners will remain anonymous.