Shingles: When the Chicken Pox Virus Returns
Chicken pox was once considered a childhood rite of passage, yet very few expect to experience a second eruption of the same virus. But this itchy and painful condition, known as shingles or herpes zoster, strikes one in three adults during their lifetime and a total of 1 million people every year in the United States.
The varicella zoster virus (VZV), responsible for both diseases, doesn’t leave the body when chicken pox resolves. Instead, it settles quietly into nerve cells near the spinal cord for a potential reappearance. A typical case of shingles involves:
- Flu-like symptoms
- Burning, tingling and itchiness in the area where a rash will appear
- A blistery rash appearing as a stripe around one side of the face or body
- Resolution of the rash in two to four weeks’ time
“Why the virus reactivates, we’re not entirely sure,” says Cleveland Clinic dermatologist Christopher Gasbarre, DO. “You develop almost identical lesions to chicken pox. But most people with shingles do well, and things resolve in a few weeks with no complications.”
Who’s at risk?
Anyone can develop shingles — even those immunized with the chicken pox vaccine developed in the 1990s, scientists believe. Yet certain groups are particularly vulnerable, says Dr. Gasbarre. This includes:
- Adults over 60, especially the frail and elderly
- Immune-suppressed patients with cancer or HIV/AIDS, or who take medications for transplant or autoimmune conditions
“The greatest risk factor is age,” Dr. Gasbarre says, noting that only rarely does someone contract shingles more than once. The older you are, the more severe your symptoms are likely to be. “You can also be more susceptible to it if you’re under stress,” he says.
Treatment: The earlier, the better
Because it’s a virus, there is no cure for shingles. But most sufferers can weather the illness relatively comfortably, Dr. Gasbarre says. Much depends on how severe the symptoms are and how early the diagnosis is made. Treatments include:
- Prescription antiviral drugs such as acyclovir, valacyclovir or famcyclovir, which can shorten illness duration if taken at the first telltale signs
- Systemic corticosteroids such as prednisone, which acts as an anti-inflammatory agent
- Cool compresses on itchy or painful lesions
A vaccine for prevention
Until 2006, there was no way to prevent shingles. But the VZV vaccine Zostavax® now offers the chance to avoid the condition. The Centers for Disease Control recommends that all adults over 60 and those with compromised immune systems receive the shingles vaccine.
Researchers have found that the vaccine cuts the expected number of shingles cases by half, and those who develop it despite being immunized experience fewer symptoms and complications. It also reduces the risk of post-herpetic neuralgia (see box below) by 67 percent.
The vaccine is typically administered only once, Dr. Gasbarre says, and immunity should last many years. You’ll need to check with your insurer about vaccine coverage.
“Is there a value to a booster later? I don’t have an answer for that,” he adds. “The vaccine is the best preventive measure. Otherwise, there’s not a whole lot we can do — shingles usually comes as a surprise.”
What to Do When Shingles Pain Lingers
Most people with shingles recover completely and can resume their normal routine after a few weeks. But some shingles sufferers develop a chronic pain condition, sometimes accompanied by persistent itching, that long outlasts the initial outbreak — or that crops up weeks or months later. This condition is called postherpetic neuralgia (PHN).
“Ninety percent of those who get shingles do not go on to develop PHN,” says Englok Yap, MD, a Cleveland Clinic anesthesiology and pain management specialist who sees patients at Hillcrest Hospital and Beachwood Family Health and Surgery Center. “Of the 10 percent who do experience PHN, residual pain might linger for a few weeks, but then life goes on.”
However, in some individuals PHN lasts for years. And in a very few cases, Dr. Yap says, PHN can become extremely debilitating.
Fortunately, relief is available. Dr. Yap recommends seeing a doctor at the first sign of PHN to keep it from worsening. Treatments include:
- Antiviral medications, which may cut the duration of PHN
- Tricyclic antidepressants, such as amitriptyline, which also relieve pain
- Anticonvulsant drugs, which decrease the abnormal firing of nerve cells and can break the “pain cycle”
- Opioid painkillers
- Epidural steroid injections to reduce inflammation in the painful area
- Topical anesthetics, such as lidocaine or capsaicin cream
Tip – Hypertension: Handle with care
Controlling high blood pressure (hypertension) is critical for preventing injury to blood vessels in the heart, brain and kidney. If you are unable to reach your target blood pressure using three or more medications, seek an evaluation from a nephrologist or hypertension expert. You may have resistant hypertension.
Be Well – April 2011 Issue
Male Pattern Hair Loss: Fact vs. Fiction
Every man will experience male pattern hair loss during his lifetime — but timing is everything.
“Most men are very upset when their hair starts to thin. Those with a strong family history of hair loss may notice thinning that starts in their late teens and rapidly progresses in their early 20s. The hair loss can be especially distressing to this group. Other men may experience a more gradual hair loss that doesn’t start until their 30s or 40s,” says Cleveland Clinic dermatologist Melissa Piliang, MD.
No matter when hair loss occurs, misunderstandings abound. Dr. Piliang separates fact from fiction below:
Fiction: Blame your mother’s grandfather if you’re losing your hair.
Fact: Multiple genetic factors from multiple family members, including mom and dad, come into play in male pattern hair loss. “Just because your dad is bald doesn’t mean that you’ll be,” says Dr. Piliang. “You have to go back several generations and look at both men and women.”
Fiction: Wearing hats all the time causes hair loss.
Fact: Just a coincidence, says Dr. Piliang: “Young men whose hair might be thinning are often the ones who are wearing baseball caps. Then once they notice their hair starting to thin, they wear their hats more — both of which may make it seem like the hair loss was caused by the hats.”
Fiction: Diets and supplements do nothing to preserve hair.
Fact: Eating a balanced diet, taking a men’s multivitamin and starting on supplements that combine biotin, B complex and zinc can help improve hair. Staying trim and consulting a dietitian about drastic dietary changes are also key. “We see increased hair loss when men try to lose a lot of weight or to bulk up,” says Dr. Piliang. Vegetarianism can also increase hair loss because meat is our most common source of iron, protein and zinc— nutrients critical to hair growth.
Fiction: Washing your hair too often accelerates hair loss.
Fact: Problems can occur from not washing your hair often enough. “You can get yeast overgrowth on your scalp and develop seborrheic dermatitis, a common dandruff condition,” says Dr. Piliang. Severe cases can inhibit hair growth, cause shedding and trigger scratching of itchy scalps that damages hair.
Fiction: Some shampoos can cause you to shed hair.
Fact: Anti-dandruff shampoos containing an antifungal agent called ketoconazole and zinc pyrithione may help to preserve thinning hair. “Studies have shown that these ingredients can have a modest effect on hair growth and density,” says Dr. Piliang.
Fiction: There’s nothing you can do to stop male pattern hair loss.
Fact: In the early stages, applying over-the-counter minoxidil (Rogaine®, Ronoxidil®, Vitadil-2A®, etc.) to the scalp can be quite effective. “Minoxidil helps many men maintain or even re-grow some of the hair they’ve lost,” says Dr. Piliang. “It takes a good six to nine months to see results, and you have to stay on it.”
Fiction: You lose all your hair as soon as you stop minoxidil.
Fact: Men who stop taking minoxidil only lose the hair the drug was maintaining. “Male pattern hair loss is a chronic, progressive process, so this is hair that would have been lost if you had not been on the medication,” explains Dr. Piliang. “If you start using minoxidil at age 25 and you stop at age 40, then you have had 15 years with hair.”
When to see a dermatologist
If you’ve tried minoxidil and experienced itching or a rash on the scalp, or find that it doesn’t work for you, it’s time to see a dermatologist. “Some men prefer finasteride (Propecia®, Proscar®), a once-daily prescription pill, to minoxidil. It also works quite well,” says Dr. Piliang.
For men with more advanced hair loss, Cleveland Clinic’s Cosmetic and Plastic Surgery Center offers a range of options. “It’s not one size fits all. Hair transplants might be appropriate for men with receding hairlines or for men who don’t get an adequate response to minoxidil and finasteride,” says Dr. Piliang. Scalp reduction surgery and scalp expanders or tissue extenders may be recommended for men with significant hair loss.
Be Well – April 2011 Issue
Eighty to 90 percent of us will suffer from back pain at some time during our lives. Learn more about how back pain — from low back pain and sciatica to spinal deformity and spinal stenosis — is diagnosed and managed in our Center for Spine Health.
Recipe: Roasted Italian Vegetable Pasta Salad
1 pound cherry tomatoes, halved
1 medium zucchini, quartered and cut into ½-inch cubes
1 medium summer squash, quartered and cut into ½-inch cubes
1 shallot, minced
1 fennel bulb, cut into ½-inch slices and diced
1 small red bell pepper, seeded and cut into ¾-inch cubes
1 garlic clove, quartered, plus 1 clove, minced
1½ tablespoons extra virgin olive oil
½ teaspoon kosher salt, optional
Freshly ground pepper
8 ounces whole wheat rotini (spiral-shaped pasta)
2 tablespoons balsamic vinegar
2 tablespoons freshly grated Parmesan cheese
¼ cup fresh basil, torn into large pieces
Preheat the oven to 425°F.
- Place the tomatoes, zucchini, squash, shallot, fennel, bell pepper and quartered garlic clove in an ovenproof nonstick skillet.
- Toss with the oil, salt (if using) and ground pepper.
- Roast for 6 minutes; turn and continue to roast for another 6 minutes. Remove from the oven.
- While the vegetables are roasting, cook the pasta, following package directions.
- Drain the pasta, reserving 2 tablespoons of the cooking water, and return to the pot.
- Toss the pasta, roasted vegetables with their juices, reserved pasta water, vinegar and minced garlic.
- To serve, plate the vegetable pasta salad and top with the cheese and basil.
Makes 4 Servings
- 330 calories (19% calories from fat)
- 7 g total fat (1 g saturated fat)
- 12 g protein
- 60 g carbohydrate
- 12 g dietary fiber
- 0 mg cholesterol
- 65 mg sodium
- 950 mg potassium
One of more than 150 heart-healthy recipes from the Cleveland Clinic Healthy Heart Lifestyle Guide and Cookbook, available from Broadway Books and wherever books are sold.
Be Well – April 2011 Issue
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