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The Revenge of Chickenpox

If you had this childhood ailment, you're at risk for a painful disease called shingles

by Bill Doherty

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At first, Jill Pierce assumed the stabbing pain she felt just below her chest was the result of overexerting herself while renovating her home in Arlington, Virginia. When a patch of blister-like lesions appeared a day or so later, the 60-year-old assumed it was an allergic reaction to a compound she’d used to remove wallpaper.

When the pain became so agonizing that it made her eyes well with tears, however, Pierce went to the doctor. His diagnosis: shingles, an excruciating condition caused by the same varicella-zoster virus that causes chickenpox.

If you were born before 1995, when the FDA approved a vaccine, you’ve probably had chickenpox, which puts you at risk for shingles. That’s because chickenpox never really goes away. Long after the itchy “pox” have disappeared, the virus that caused them simply retreats into the body’s nerve cells, where it may lie dormant for decades.

Under certain conditions, usually related to aging or a weakened immune system, the virus can reactivate and begin to reproduce. Once “alive” again, it travels along the path of a nerve to the skin’s surface, where it triggers a blistering rash that usually appears in a well-defined band on one side of the body, typically on the torso or on the face around the nose and eyes, says Michael Tomeo, MD, section chief of dermatology at Holy Redeemer Hospital and Medical Center in Philadelphia.
Half of the nearly 1 million shingles cases in the United States, each year, occur in people age 60 and older, like Pierce, says the American Pain Foundation. But there’s hope. Last year, the FDA approved a varicella-zoster virus vaccine (Zostavax) for use in people 60 and older who have had chickenpox. The drug is now available, and studies show that it may reduce the incidence of shingles in the older population by half.

Is It Shingles?

It’s very common for people to misdiagnose themselves, as Pierce did. “Because the nerve pain shows up prior to the rash, people with shingles mistakenly believe that the pain is from kidney stones, gallstones, appendicitis, or even a heart attack, depending on the location of the affected nerve,” says Will Rowe, MD, executive director of the American Pain Foundation.

That pain can be debilitating. Contact with the softest article of clothing or even the water in the shower can feel like a lick of flame lashing your skin. “I couldn’t sleep without pain for two full months,” recalls Pierce.
If you think you have shingles, see your doctor right away. “The sooner you go to the doctor and have your shingles treated, the less your chance of suffering from postherpetic neuralgia (PHN), a serious and very frustrating condition,” says Dr. Rowe. The pain of PHN can last for months or even years because the virus, left untreated, causes serious nerve damage.

Shingles Symptoms

Itching, tingling, stabbing pain and/or a burning sensation.
A rash that appears within a few days of the pain. It usually begins as clusters of small bumps, which soon develop into pus-filled blisters. The blisters can wrap around the middle of your back and one side of your chest to the breastbone, following the path of the nerve where the virus was stored, says Dr. Rowe.
Shingles can also affect your eyes, causing swollen eyelids, redness, and pain. Your family physician may send you to an eye specialist because shingles can leave scars that affect vision, says Dr. Rowe.

How It’s Treated

Once you’re diagnosed, your doctor will prescribe medicines to both control the virus and lessen the pain. Oral antiviral medications, such as acyclovir (Zovirax) and valacyclovir (Valtrex), help control the outbreak by thwarting reproduction of the virus in the nerve cells.

Although over-the-counter painkillers such as ibuprofen, naproxen, and acetaminophen can be effective, your doctor may also prescribe higher doses or other non-steroidal anti-inflammatory drugs (NSAIDs). If the pain is severe, he may add a stronger pain reliever, such as codeine or oxycodone, says Dr. Rowe.

“The good news is that most people have only one attack of shingles in their lives,” says Dr. Tomeo. According to the Centers for Disease Control and Prevention, only about 4 percent have repeat attacks.

That gives Pierce peace of mind. She used antiviral drugs and NSAIDs to knock out the painful condition in about eight weeks. “I wouldn’t wish shingles on anyone,” she says. “I’m someone who can handle pretty much everything that life throws at me, but I wasn’t myself for the two months that I had this.”

Are You Contagious?

You can’t pass shingles to someone else, but if you have it, you can transmit chickenpox to anyone who hasn’t had or hasn’t been vaccinated against this once-common childhood ailment. The varicella virus is active in shingles blisters and is contagious until they heal completely.

To prevent transmission, avoid anyone who hasn’t had chickenpox, especially pregnant women and children younger than 12 months who have not been vaccinated, says Michael Tomeo, MD, of Holy Redeemer Hospital and Medical Center in Philadelphia.

The first dose of the varicella (chickenpox) vaccine is recommended for children between 12 and 15 months of age. If you’re in close contact with unprotected children, they may need to be vaccinated immediately. “That’s an important point because most of the people with shingles are of grandparent age,” says Dr. Tomeo.