Rash is puzzling

Q: I’m a 48-year-old male with a history of chickenpox as a child and a minor case of shingles at age 40. My question/concern is since the shingles case, on two occasions I have had episodes of what I would call a “shingles like” rash and small blisters without the pain – just an incredible itch. Both episodes seemed to occur when my stress (work level) was high and nutrition (usually outstanding) low.

Is there such a thing as a muted form of shingles, or could this be something else? And since I have already had shingles, would I be a candidate (and perhaps this would help prevent these episodes) for the shingles vaccine?

A. As you are aware, having chickenpox as a child can lead to shingles as an adult. Generally speaking, shingles causes an extremely painful rash caused by the varicella zoster virus. The pain is so severe a sufferer will be disinclined to scratch the blisters that are present. Did you visit your health care professional the two times the rash was present on your body or did you have such a mild case you didn’t feel it was necessary? Where was the rash? Without these answers, I cannot make an educated guess if your rash was indeed shingles or the result of an unrelated condition. Take the time to think back to where the rash was. You can essentially draw an imaginary line from your head down to your feet. It may have been on the front and back of the torso, for example, but if it appeared on the left and right sides of the body, it wasn’t shingles. The pain isn’t always debilitating but the location of the rash is telltale.

The good news is that you cannot catch shingles from someone else who has it; however, there is a small chance a person with shingles can spread the virus to another person who never had chickenpox as a child or who didn’t get the chickenpox vaccine. In answer to your question, a person can get shingles more than once; up to 4% of individuals will experience a second episode of herpes zoster, although this is more common in those who have a compromised immune system.

Symptoms may begin with a headache or light sensitivity. The individual may feel as though he or she has the flu or is coming down with something. Several days later a rash may appear and blister. The blisters crust over and may or may not leave scars. There are instances in which severe pain will present in the area where the rash will appear within a few days. Visual changes may be present and a physician should be consulted – particularly when there is a question of diagnosis. In the case of shingles, an anti-viral medication and perhaps one for pain may be prescribed.

Zostivax, the shingles vaccine, is available to reduce the risk of shingles in people 60 and older. At this stage, even the Centers for Disease Control (CDC) does not have a recommendation for individuals between the ages of 50 and 59 (or younger) – only because individuals in this age bracket have never been part of a test study. However, the Food and Drug Administration (FDA) has approved Zostivax for individuals in the 50-59 age group. So, in answer to your question and because you are very close to the “acceptable” age, you should pursue this with your personal physician. He or she has access to your medical records and history of conditions. There is no specific waiting period following an outbreak of shingles but you should be assured the rash has disappeared prior to being immunized. It is not recommended for individuals with HIV/AIDS or others with a weakened immune system, those on chemotherapy or radiation treatment, have cancer, leukemia or lymphoma, or have a severe allergic reaction to any component of the vaccine.

A possible cause for your rash may be stress that can have a powerful effect on a person’s skin. It can worsen psoriasis and eczema, cause hives, contact dermatitis from poison ivy/oak or sumac, lead to oral mouth blisters (herpes simplex), and still more. Is there a possibility you ate a specific food (albeit twice) such as an Asian dish with MSG, are allergic to nuts and a nut oil was in a restaurant dish, and had an allergic reaction?

Visual examination is critical for a correct diagnosis. With or without pain, be sure to see your health care professional if you have another outbreak.

Will horse liniment work for human pain?

Q: What do I use for shingles? I was told to use veterinary liniment? Do you recommend that treatment?

A: Let me take a moment to discuss shingles before I advance to veterinary practices. Shingles, also referred to as herpes zoster, is a viral infection that causes, in most instances, an extremely painful rash. It can appear anywhere on the body but is restricted to one side of the body only. The condition is caused by the varicella-zoster virus, the same condition that causes chickenpox in children. The chickenpox virus lies dormant with the body as we age and may or may not reactivate over the years. The condition affects about one of every three people in our country and is most common in older adults and in those with a weakened immune system.

Symptoms begin with often debilitating pain and tingling that is followed by rash, itching, and fluid-filled blisters, fatigue, fever and headache. To confuse the issue, there are instances when an individual will not have a visible rash, just pain, making it difficult to diagnose. In most instances, the patient diagnosed with shingles will not get the disease a second time, although it is possible. Complications include postherpetic neuralgia (pain) that fails to go away within a month. In this case, the pain can last for months or substantially longer. Ear pain and a rash that surrounds the ear, a loss of movement of the facial nerves, hearing loss, ringing in the ears, dry mouth, and a diminished taste sensation may be present.

There is a slim chance the person with shingles can pass the rash on to people who haven’t had chickenpox or the chickenpox vaccine (which would cause chickenpox, not shingles to develop). Anti-viral drugs are routinely prescribed for the virus, as well as pain medication if necessary. These drugs work best when begun within 72 hours of the first symptoms. Because it’s so difficult to zero in on a diagnosis so quickly, this schedule may be rather difficult to adhere to. In 2009 our office received a letter from a reader indicating veterinary liniment helped ease the side effects (postherpetic neuralgia) of shingles. The patient purchased the gel form that she felt was easier to use than the cream form. In any event, her results were amazing. The pain disappeared completely. So, what can I say? If you are bothered by the pain that has not responded to anti-virals, give veterinary liniment a try.

A vaccine known as Zostavax was introduced in 2006. It is recommended for individuals 60 and older and is available in some local pharmacies, health clinics, or at your physician’s office. Because the virus can attack an individual again, albeit an unusual circumstance, those who have had had shingles can receive the vaccine. Side effects are minimal but might include temporary pain and slight rash at the injection site. At this writing the CDC does not have a recommendation for people between the ages of 50 and 59; however they have approved the vaccine for this age group. Those that should not get the vaccine include women who are or may become pregnant, have cancer that affects the lymphatic system or bone marrow, those diagnosed with HIV/AIDS, or are on steroid treatment.

Readers who would like related information can request Dr. Gott’s Health Report “Managing Chronic Pain” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order payable to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

Shingles pain brings woman to her knees

DEAR DR. GOTT: I am a 73-year-old female who is suffering from shingles night and day. This has gone on for about seven weeks now and I am really depressed and miserable. I was diagnosed early and was put on an anti-viral medication (Valtrex) within two days of the first pains. I have a red, blotchy band from the navel to the spine. It has gotten a lighter pink. A weird fact to anyone I’ve asked is, nobody seems to know why I have not had any blisters, just the red. The most painful spot is on my rib, right under my right breast.

I have tried several pain medications including Oxycodone, Tylenol Extra Strength, lidocaine patches which seemed to help a bit at first but irritate my skin now, ice cubes wrapped in a soft cloth, and amitriptyline. [Read more…]

Shingles without chickenpox?

DEAR DR. GOTT: I am a 59-year-old female. I was told that I had never had chickenpox; however, I came down with shingles. I have been on prednisone and famciclovir for a week. The spot (about the size of a quarter) is drying up. How long can I expect pain? Should I be immunized again shingles? Can I get shingles without ever having had chickenpox? Some days I can tolerate the pain but at other times it’s very uncomfortable.

DEAR READER: Whomever told you that you never had chickenpox was incorrect. However, it is possible that you had a very mild case with few lesions that may have gone unnoticed. I can say this with certainty because shingles cannot occur without the varicella-zoster (also known has the herpes zoster) virus which can only be present after having had chickenpox. So to simplify, if you never had chickenpox, you could not be suffering from shingles now. [Read more…]

Post-herpetic neuralgia from shingles

DEAR DR. GOTT: I am a 70-year-old woman who developed shingles on my right leg last June and am now left with neuropathy. It went from the middle of my leg all the way down to my foot and toes. I was immediately put on an antiviral and a prednisone pack, so the doctor was surprised that I developed post-herpetic neuralgia. My leg and foot are completely numb and I cannot bend the right foot upward, so I wear a boot and go from a wheelchair to crutches and then to bed. It is causing excruciating pain.

I have seen two neurologists, who both ordered MRIs of my spine, an EMG and nerve conduction tests. Both dismissed me, saying there is nothing more they can do for me. The last neurologist suggested I see a pain management doctor. I saw one two weeks ago and am getting epidurals in my spine. The first one didn’t help, so I am hoping to get some relief with the second one, because as soon as I can get out of some of this pain, I can try a physical therapist to help me walk with this dropped foot.
[Read more…]

Readers question shingles vaccine

DEAR DR. GOTT: I just took the shingles vaccine at a local drugstore. I filled out papers but nowhere did it mention that anyone who had a history of cancer should not take the vaccine. Please advise.

DEAR DR. GOTT: In your recent column, you said that the shingles vaccine should not be given to former cancer patients. I am in remission from large B cell non-Hodgkin’s lymphoma. I have Wegener’s granulomatosis, which although in remission, is still there. The Wegener’s is the reason that a shingles vaccine is recommended. I will be having CD19 level blood testing before any vaccination, but with my history, should I still have the vaccine?
[Read more…]

Shingles vaccine not right for everyone

DEAR DR. GOTT: There seems to be some confusion about whether or not an older person should take the shingles shot. My husband is over 70 and has been advised that, because he can’t remember having chickenpox (even though he might have been exposed to it), he does not need to take it. In fact, if he takes it, it might even prove harmful.

He has been further advised that there is a simple test his doctor should administer before giving him the shingles shot if he (my husband) is unsure as to whether he ever had chickenpox or not. Please advise. Thank you.
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Uncommon form of shingles needs time

DEAR DR. GOTT: I’ve been diagnosed with Ramsay Hunt syndrome. I’ve been treated with prednisone and antiviral drugs. I ask every doctor I’ve seen, “What can I do to be proactive?” The answer is always, “Nothing, only time.” I understand that, but what can I do to hasten healing? Massage, physical therapy, acupuncture, anything? Each doctor says I can do whatever I want but nothing is going to help. Isn’t there anything I can do?

DEAR READER: Ramsay Hunt syndrome occurs when the facial nerve to one of the ears becomes infected by the shingles/chickenpox virus.
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Rare disorder has limited treatment options

DEAR DR. GOTT: About a year and a half ago, I was diagnosed with NMO, or Devic’s disease. I have a mild case so far. It started with shingles and morphed into the NMO. My left side is numb, with my left hand hypersensitive. The right side of my neck is what bothers me. I cannot get it, my hips and shoulders to stop aching. The treatment for NMO is steroids, and I am also on Imuran.

There isn’t much information on NMO/Devic’s. Do you have any idea how to treat this kind of pain? Any natural pain alleviations?
[Read more…]

Another shingles remedy

DEAR DR. GOTT: There have been a lot of people writing you with questions about shingles. I would like to give you a “recipe” my mother-in-law gave me. I know it worked for her, my father-in-law, my husband and me.

Simply take this combination three times per day: one 400 IU vitamin E, two 100-milligram B-complex and four 1,000-milligram slow-release vitamin C tablets. When the shingles symptoms are gone, stop the vitamin E and B-complex and taper off the vitamin C slowly. If you have diarrhea symptoms, eat cheese.
[Read more…]