Shingles & Stress

Shingles is a condition characterized by painful skin blisters that erupt on one side of the face or body. Typically, these blisters occur along the chest, abdomen, back, or face, but they may also affect the neck, limbs, or lower back.

Blisters caused by shingles can be extremely painful, itchy, and tender. These blisters heal and form scabs after one to two weeks but the pain remains. The name “shingles” comes from the Latin word for belt. That's because the blisters follow the nerves and usually appear in a line, most often on one side of the back only. Most people get shingles only once in their lifetime.

The cause of shingles

This condition is caused by the herpes zoster  — the same virus that causes chickenpox. After a person contracts chicken pox, typically during childhood, the virus can lie dormant in the sensory nerves for decades. The virus is reactivated when the immune system is weakened by age, disease or unmanaged stress. The immune system is unable to suppress the dormant organisms any longer and they become active again, causing a shingles infection. The infection is occurring along the pathway of the nerve.

Incidence

Approximately 300,000 cases of shingles occur every year in the United States. About 20 people of those people who had chickenpox as children develop shingles at some time in their lives. People of all ages, even children, can be affected, but the incidence increases with age. The incidence of post-herpetic neuralgia, the most common complication of shingles, also increases with age. By age 40, the risk of prolonged pain lasting more than one month increases to 33 percent. By age 70, the risk increases to 74 percent. Some people, however, develop shingles more than once.

The symptoms of shingles

There are several symptoms of shingles which can be grouped in certain phases.

The symptoms of the first phase include:

• general feeling of sickness,
• chills,
• fever,
• headache,
• fatigue,
• nausea,
• diarrhea

Some people feel only a tingling, painful, or itching sensation in one area of the skin, often on one side of the face, back, or upper abdomen. These are the same areas most commonly affected by chickenpox.

In the second phase, a cluster of small, fluid-filled blisters erupts in an area of reddened skin. This area may be extremely sensitive to the touch.

During the third phase of shingles, the blisters begin to dry and scab. It is important to remember that all symptoms of shingles are usually gone within three to five weeks. However, some people may suffer nerve damage that causes the pain to continue for months or even years after the rash is gone. This condition is called post-herpetic neuralgia.

Disease progression

This is typically how the disease progresses:

• Several days before the skin outbreaks occur; patients usually complain on fatigue, fever, chills, and sometimes gastrointestinal upset.
• On the third to fourth day the skin area becomes very excessively sensitive.
• On the fourth or fifth day, characteristic small blisters that crust and hurt erupt along the path of a nerve so that the reddened outbreak affects a strip of skin that forms a line.

This usually occurs over the ribs in the thoracic area and is usually limited to one side. Rarely, it can affect the lower part of the body or the face.

• The affected area is very sensitive and the pain may be very severe.
• The eruptions heal about five days later.

Is shingles contagious?

Shingles itself is not a very contagious disease. However, being in contact with someone who has the rash may cause small children to develop chickenpox. Pregnant women, adults who have never had chickenpox, and persons with impaired immune systems should be careful because direct contact with anyone suffering from shingles could cause them a serous infection. If you have shingles, it is crucial to avoid sharing towels and clothes, or even a bed, with your partner or other members of your household.

Triggers for the condition

It has been proven that shingles can affect both adults and children who have already had chickenpox, but is much more common in older people. Reactivation of the virus is most common in elderly people whose immune system is weakened, and who have not been vaccinated. There are various possible causes of immunosupression:

• conditions that affect the immune system, including HIV infection
• periods of increased stress
• excess alcohol intake
• long term courses of steroids
• chemotherapy or radiotherapy - cancer treatments
• medications used after organ transplants - the meds called immunosuppressants

Shingles and stress - hypothesis

The very important question whether stress can increase our susceptibility to viral infections like Herpes and Shingles. Several researches have found that stress really plays an important role. The researches have been conducted on astronauts during and after space flight because there were evidence of frequent reactivation of chickenpox. The researches have shown that 30% of astronauts saliva during and after the flight showed such activation while less than 1% did before the flight suggesting that the stress and anxiety of space flight increased risk for shingles. These results indicate that VZV can reactivate sub-clinically in healthy individuals after non-surgical stress.

Diagnosis of shingles

The diagnosis is usually not possible until the skin lesions develop, but once they develop, diagnosis is easy because the pattern and location of the blisters and the type of cell damage displayed are very characteristic of the disease. So, in most cases a common physical examination would be enough.

Although tests are rarely necessary, they may include the following:

• Viral culture of skin lesion
• Microscopic examination using a Tzanck preparation - staining a smear obtained from a blister. Cells infected with the herpes virus will appear very large and contain many dark cell centers or nuclei.
• Complete blood count (CBC) may show an elevated white blood cell count (WBC), a nonspecific sign of infection
• Rise in antibody to the virus 

Possible complications

Complications are very rare but possible, especially in people who have a weakened immune system. If shingles affects the area near the eye, an ophthalmologist should be consulted because the surface of the eye can be scarred, which can damage vision.

When shingles affect the ear it is causing earache, dizziness, deafness and paralysis in the face. This is called Ramsay Hunt syndrome. It is possible, though really rare, for the virus to infect the brain causing an inflammation called encephalitis. Symptoms can include high fever and confusion.

Very important thing to know is that having shingles can be really serious during pregnancy because it can lead to pneumonia or even miscarriage. 
 

Treatment of shingles

Spontaneous healing

Shingles almost always resolves spontaneously and may not require any treatment except for the relief of symptoms.

Symptomatic treatment
 
A cool, wet compresses may help reduce pain. If there are blisters or crusting, applying compresses made with diluted vinegar will make the patient more comfortable. Most of the patients reported that soothing baths and lotions such as colloidal oatmeal baths, starch baths or lotions, could be really helpful in relieving itching and discomfort. 

Antiviral medications

Antiviral drugs such as acyclovir, Valacyclovir, and famciclovir can be used to treat shingles.
These drugs can't really cure the disease but may shorten the course of the illness. The earlier the drugs are administered, the better. The side effects of typical oral doses of these antiviral drugs are minor and include headache and nausea. 

Corticosteroids

Some researches have suggested that corticosteroids, such as Prednisone, may be used to reduce the inflammation. The only problem is that they interfere with the functioning of the immune system. 

Other medications

In cases of post-herpetic neuralgia, the wort complication that can occur from shingles, the doctor may prescribe tranquilizers, sedatives, or antidepressants to be taken at night.
 

Alternative treatment

It is proven that supplementation with vitamin B12 during the first one to two days and continued supplementation with vitamin B complex, high levels of vitamin C with bioflavinoids, and calcium, could be beneficial in boosting the immune system.

Herbal antiviral substances such as Echinacea can be effective in fighting infection and boosting the immune system.

Topical applications of:

• Lemon balm (Melissa officinalis) or licorice (Glycyrrhiza glabra) and peppermint (Mentha piperita) may reduce pain and blistering
• Rhus toxicodendron for blisters,
• Mezereum and Arsenicum album for pain,
• Ranunculus for itching.
• Getting lots of rest, eating a healthy diet, exercising regularly, and minimizing stress are always helpful in preventing the disease;
• Self-hypnosis, acupressure, and acupuncture could be beneficial in relieving pain.