Let's learn more about that difficult "God's disease" that feels like a belt around the body - that is, shingles?

You've probably heard of something called "God's disease." Some people are afraid of it. But today we're going to talk about a disease that appears like a band on one side of the body, is a little painful, and causes blisters. In medical terms, we call this Shingles or Herpes Zoster . Let's see what it is, how it develops, what are the symptoms, and how to protect yourself from it and get treatment.

What are these shingles?

Simply put, shingles is a painful rash or rash on the surface of the skin caused by a virus that infects the nerves (also called nerves) under our skin. It is also called Herpes Zoster. Most of the time, these rashes only appear on one side of the body , like a belt. That's why some people call it "the belt disease." It appears with a severe inflammation of the skin.

How do shingles develop? What causes it?

The main cause of this is the Varicella-Zoster Virus . Do you remember getting chickenpox as a child? This is the same virus that causes chickenpox.

So, after someone recovers from chickenpox, the Varicella-Zoster Virus doesn't completely disappear from our bodies. It remains dormant, or sleeping, in some parts of our nervous system . It's like it's hiding.

This virus can remain dormant for years without causing any problems. However, sometimes, for some reason – for example, with age (usually after the age of 50), when the body's immunity decreases (i.e. when the body's ability to fight disease decreases), or when there is continuous high stress, or due to certain medications (e.g., cancer medications) – the dormant virus starts to become active again. That's when the disease surfaces as shingles.

This means that anyone who has had chickenpox, whether as a child, teenager, or adult, is at risk of developing shingles later in life. But remember, not everyone who has had chickenpox will develop shingles.

Usually, a person only gets shingles once in their lifetime. The chances of getting shingles a second time are very rare, but not impossible.

Shingles is most common in people over the age of 50. However, as I mentioned before, it can affect anyone of any age.

What are the symptoms of shingles? How do you recognize it?

The symptoms of shingles are a bit unique. Other symptoms may appear before the rash appears. Let's take a look at what they are.

• Early symptoms (before the rash appears): Often, a few days (sometimes 1 to 5 days) before the rash is to be treated, you may experience burning, numbness, tingling, or severe pain at the site of the rash. For some people, this pain can be sharp, like a knife, a needle , or a stinging sensation. For others, it may just feel like a burning sensation. This is often the first sign.

• Blisters: Then, within one to five days, the skin at the site of the pain will turn red and small blisters (small bumps) will begin to appear. These are usually only on one side of the body (right side only, left side only). They may appear as a belt-like band around the waist, or they may appear along one side of the chest, or they may appear as a strip on one side of the face (forehead, cheeks, chin).

Imagine, it looks like someone has drawn a red strip of paint on only one side of the body, with little drops of water on top of it.

• Blister formation: These small blisters develop into pus-filled blisters within a day or two. After 7 to 10 days, these blisters burst and a scab forms . These scabs are yellowish-brown in color.

• Healing: The scabs that form dry out and fall off in 2 to 4 weeks. Sometimes, a small scar or skin discoloration (the skin may become paler or darker) may remain in those areas.

Pain varies from person to person. Some people may only experience mild pain, while others may experience unbearable pain. This pain is especially common in older people, and it is more likely to persist even after the wound has healed (we'll talk about that later).

Is shingles contagious?

This is a problem that many people have. Shingles is not directly transmitted from one person to another. That is, you will not get shingles just by touching someone who has shingles.

But, here's a little something to understand. Those pus-filled blisters of someone who has shingles contain the Varicella-Zoster Virus. So, if someone who has never had chickenpox or has not been vaccinated for chickenpox comes into direct contact with those blisters, that is, if they touch the fluid that oozes from the blisters, that person can get chickenpox, not shingles.

Therefore, someone with shingles:

• You should keep your blisters well covered (e.g. with a clean, non-stick gauze bandage).
• You should avoid scratching or picking at the blisters.
• You should always wash your hands thoroughly with soap.
• Close contact with pregnant women, newborns, and people with weakened immune systems (e.g., cancer patients, HIV patients, organ transplant recipients) should be avoided, especially until the blisters have completely dried and crusted over.

Once the blisters dry and crust over, the virus is no longer contagious.

What are the possible complications of shingles?

Although shingles usually resolves within a few weeks, some people can develop complications . It's important to be aware of these.

• Postherpetic Neuralgia (PHN): This is the most common and distressing complication. It is characterized by severe nerve pain that persists for months or even years after the shingles rash has cleared. It is more common in older people (over 60 years of age). The pain may be constant throughout the day or may come and go. Sometimes, the pain can be unbearable, even when clothing rubs against the skin or when the wind blows. This can have a significant impact on quality of life.
• Skin infections: When blisters break, they can become infected with bacteria if not properly cared for. The area can then become red, swollen, and pus can collect.
• Effects on the eyes: Shingles on the face, especially on the forehead, around the eyes, and on the side of the nose (called ophthalmic zoster) , can affect the eyes. It can cause vision loss, glaucoma, and even blindness. Therefore, if you have symptoms of shingles on the forehead or near the eyes, you should see a doctor immediately, preferably an ophthalmologist.
• Other nervous system problems: Very rarely, shingles can affect the brain (encephalitis) or spinal cord (myelitis). For example, it can affect the facial nerves, causing facial paralysis, ear pain, and dizziness, known as Ramsay Hunt syndrome . Loss of balance and hearing loss may also occur.

This is why it is important to seek medical advice as soon as you start experiencing symptoms of shingles.

What are the treatments for shingles?

If you suspect you have shingles or have symptoms, it's best to see a doctor as soon as possible.Especially if treatment is started within 72 hours (3 days) of the onset of symptoms (the appearance of the first blister), the disease can be cured quickly, pain can be reduced, and the risk of developing the complications we talked about (especially PHN) can be reduced.

The main treatments are:

• Antiviral medications: These control the multiplication of the virus, shorten the duration of the illness, speed up the healing of the blisters, and reduce pain. For example, medications like `(Acyclovir)`, `(Valacyclovir)`, `(Famciclovir)` may be prescribed by the doctor. These are given for about 7 to 10 days. It is very important to take these in the prescribed dose for the prescribed period.
• Pain relievers: You can use over-the-counter pain relievers like Paracetamol or NSAIDs (e.g. Ibuprofen ) to control pain. If the pain is severe, your doctor may prescribe stronger pain relievers, or even medications specifically for nerve pain (e.g. Gabapentin, Pregabalin).
• Other creams and medications: You can use creams like calamine lotion to reduce itching, or other creams recommended by your doctor. Sometimes, steroid creams may be given for a short period of time to reduce swelling.

Things you can do at home:

• Keep the blister area clean. Wash it at least once a day with lukewarm water (without soap or using a mild soap) and pat it dry with a clean, soft towel.
• You can apply cool compresses. Soak a clean cloth in cold water, wring it out, and place it on the blister for about 15-20 minutes. Do this several times a day.
• Wear loose, cotton clothing that allows your skin to breathe. Wearing tight, rough clothing can cause blisters and increase pain.
• Avoid scratching or picking at the blisters. Scratching can lead to infection and scarring.
• Get plenty of rest. Eat nutritious food. This will give your body the strength to fight the illness.

Can shingles be prevented?

Although there is no way to completely protect yourself from shingles, there are things you can do to reduce your risk.

• Chickenpox vaccine: The vaccine given to children to prevent chickenpox can somewhat reduce the risk of developing shingles later in life. This is because if chickenpox has not occurred, the virus that causes shingles will not enter the body.
• Shingles vaccine: This is the most important and effective way to prevent shingles. It is usually given to people aged 50 years or older.This vaccine is recommended. In Sri Lanka, this vaccine may not be very common yet, but it may be available in some private hospitals. This vaccine can significantly reduce the risk of developing shingles and the complications that may occur if you do develop it (especially PHN). You can talk to your doctor about whether this vaccine is suitable for you and when you should get it.

Maintaining a strong immune system is also important. This can be achieved through a well-balanced diet, adequate sleep, regular exercise, and stress management.

Finally, things to remember (Take-Home Message)

Okay, so I hope you now have a better understanding of the shingles we talked about.

Remember, shingles is a painful blistering condition that usually appears on one side of the body, caused by the reactivation of the same virus that causes chickenpox (Varicella-Zoster Virus).

• If you or someone you know has these symptoms, don't panic or panic, and see a doctor as soon as possible . Prompt treatment can reduce pain and prevent complications.
• If you have a rash, especially on your face or near your eyes, consider it an emergency and seek immediate treatment. Don't delay.
• Since chickenpox can be transmitted from someone with shingles to those who have not had chickenpox (especially pregnant women, young children, and those with weakened immune systems), it is important to stay away from others and be careful until the blisters have healed.
• If you are over 50, ask your doctor about the shingles vaccine. It is a good protection.

I hope this information is useful to you. Stay healthy and happy everyone!

`Shingles, herpes zoster, chickenpox virus, varicella-zoster, skin diseases, nerve pain, postherpetic neuralgia, shingles vaccine