Shingles: Chickenpox Strikes Back, In Adulthood

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If you had chickenpox as a child, chances are you will not contract it as an adult. But the same virus that causes chickenpox, the varicella-zoster virus can rear its ugly head once more to cause shingles in adults.

Research since the 1950s has shown that when we recover from childhood chickenpox infection, the virus remains dormant in certain nerve tissues for many years. It can reactivate as shingles due to various reasons such as illnesses, immunosuppressive drugs, severe stress or age and cause excruciating pain.

Almost all older adults will get shingles. The CDC estimates that 1 in 3 adults will get shingles in their lifetime. Fortunately, for most, it is not a life-threatening condition. But the older you are, the more serious the consequences can be. Shingles is not contagious but the virus can still spread to others and cause chickenpox in individuals who have not had it before, especially young children and pregnant women.

Shingles causes a burning sensation, shooting pain, tingling or severe itching usually on one side of the body or face. For some, this may be accompanied by fever, chills, nausea, diarrhea, and difficulty urinating. The signature rash will usually appear after the itching and pain. It will begin with reddish bumps which then turn into fluid-filled blisters within a few days. These will usually harden and fall off after 7 to 10 days. Even after the rash disappears, the skin colour at the affected site may be changed.

Also, in some individuals nerve pain may persist at the site – a condition called post herpetic neuralgia (PHN). In the USA, it is estimated that 1 in 5 people who get shingles will suffer from PHN. This statistic has implications for Malaysia as we become an aging population. A growing percentage of our population, Malaysians above 50, will be at risk of developing shingles and consequently PHN. As we age, we become more susceptible to shingles and cases will rise.

The pain from PHN can be particularly painful and agonising. Even gentle, soft and light contact on the skin can be extremely painful. In most individuals, PHN usually lasts a few weeks to a few months. However, PHN can persist for many years causing debilitating, long-lived pain.

This pain can be so severe that it can lead to depression, lethargy, weight loss, poor eating and interference with daily activities such as dressing, bathing and eating. Although very rare, shingles can also lead to scarring and bacterial skin infections, pneumonia, hearing problems, blindness, encephalitis (infection of the brain) or death. You will most likely only have one episode of shingles in your lifetime but recurrent cases of shingles can occur.

Shingles is largely untreatable and difficult to diagnose but it can be avoided. A shingles vaccine has been available in the USA since 2006. It is also available in Singapore, Korea and Hong Kong.

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