Counseling Sheet

(HERPES ZOSTER)
The word "shingles" means zone or band. Shingles is a viral infection of a nerve and corresponding skin band overlying the nerve. The distribution of the skin lesions follows the nerve. The skin lesions are characterized by small blisters filled with pale tan fluid surrounded by redness. The skin eruption develops in an area of pain and discomfort which precedes the eruption by about three to seven days.

Shingles represents an acute reactivation of an infection by the chickenpox virus or Varicella. Since the primary attack of chickenpox, the virus has remained dormant in the sensory nerve center or ganglion.

Shingles occurs in approximately 2 of every 1,000 persons per year, increasing in incidence with age. It is rare in childhood and most frequently seen in persons over age 50. Half the people reaching 85 have suffered at least one attack of shingles. Rates are higher in persons with malignancies or diabetes and inpatients receiving any kind of immunosuppressant drugs such as cortisone or antihistamines,¹ or patients who have received radiation therapy.

While chickenpox has usually been suffered by the patient in childhood, it occasionally happens that, 2-5 weeks after exposure of an older person to childhood chickenpox, the older person comes down with shingles. Chickenpox can be contracted from a patient with shingles.²

The usual drug medications used in treatment of shingles are all worthless and should not be used. Especially cortisone should not be used, because while it may reduce the pain, there is a significant risk of widespread scattering of the shingles and a fatal complication.³ It has been reported that cortisone therapy used for another condition activated a case of shingles.⁴ Penicillin is also reported to have activated a case of shingles. Shingles should be treated early, and the usual pain killers, cortisone, and other medications do not help shorten the course of the case. One report a number of years ago said "Analgesics, sympathy, and a liberal helping of hope are all the doctor at present has to offer."² Not much has changed since then.

The eruption of shingles is often preceded by feeling bad and fever for 2 or 4 days, then pain or some kind of sensory unpleasantness along the skin overlying the nerve where the rash will break out, usually five days after the pain starts. The pain begins with superficial tingling or burning sensation and varies from deep severe pain suggesting appendicitis or gallbladder attack, pleurisy, or other problem, to a very mild itching. The pain may be intermittent or constant. The regional lymph nodes may enlarge. After the skin lesions have cleared up entirely, the pain over the area often persists for months or even years, especially in older people. This persistent pain is called post herpetic neuralgia.

The most common place for shingles is on the chest, being involved in over two-thirds of cases. The head is next in frequency, and headache may be a common symptom in any case of shingles. It may even involve the eye, with resulting blindness. A person may have more than one attack of shingles; in fact, it is slightly more likely that one will have a second attack.

Some home remedies for treating shingles have been quite effective, and we recommend many of these remedies as being capable of assisting in pain and in preventing post herpetic neuralgia.One important thing that can reduce pain is the wearing of a snug fitting body suit that does not slip across the skin, as light touch of the clothing moving across the skin seems particularly irritating. Any garment fixed firmly against the skin that does not move tends to give relief from the rubbing of lightweight clothing.

Chilling drafts should be avoided, both to prevent the development of shingles and to hasten the healing. Rough washing of the skin eruptions should be avoided, as the skin is quite tender and may be made to crack by rough handling. During the time when blisters are present, the area should not be bandaged, except by a light gauze that may prevent staining of the clothing from the blisters.

Moist compresses to the skin may give much relief. Applying a wet dressing in which a wet cloth is laid over the area and allowed to evaporate until dry gives considerable comfort. Calamine lotion may be used in the same way, since the water (actually the most active ingredient in Calamine lotion) is soothing as it evaporates.

Direct heat in the form of hot compresses or fomentations may be used to good advantage. The application of a thermophore or heating pad can be most helpful.

A charcoal compress applied over the skin lesions in a wide band has been effective in reducing the likelihood of the dreaded post herpetic neuralgia. Charcoal tablets by mouth are also helpful. Such general measures as sun baths, total body massage, exercise to tolerance, and a simple diet of fruits, vegetables, and whole grains (avoiding fats, sugars, and all refined nutrients, including nutritional supplements) are helpful.

A dusting powder, common corn starch, or talcum may be used on the skin to assist in pain control. In the acute stage, melted paraffin has been used, applied to the skin by a cotton sponge and allowed to harden while making successive applications of fresh liquid paraffin until a thick layer, one-quarter to one-third inch thick, has been accomplished. A thick dressing of absorbent cotton followed by gauze taped in place to apply slight pressure can be miraculous in reducing pain. It can also be tried for post-herpetic neuralgia, but is less effective in these cases.⁵

Post-herpetic neuralgia can be nicely treated by ice massage. The technique is quite simple. Place a towel in a position to catch the runoff water and hold a cube of ice in a wash cloth while gently rubbing the skin over the entire area back and forth, up and down, keeping the ice moving. After about 12-20 minutes the pain should be much relieved, and relief should continue for at least four hours, and in many cases, overnight. The ice massage may be repeated as often as 2 or 3 times daily, but is usually unnecessary more often than once in 24 hours.⁶ A paper or styrofoarn cup may be filled with water and frozen; this can be used in place of the ice cube. Just cut or peal away the bottom of the cup, then place this bottom portion on the top of the ice to protect your hand from the cold as you massage. Continue to peal away the bottom of the cup as the ice melts. Because of the tapered shape of the cup, the ice will not fall out the narrow bottom end.Another nice treatment for the post-herpetic neuralgia is the application of a tincture of cayenne. The daily application of this tincture will take up p substance, a neurotransmitter of the pain impulse. To make the tincture, place a quantity of cayenne pepper in a jar and then pour in enough rubbing alcohol to cover the pepper by one to two inches. Swirl the mixture daily for three weeks. At the end of this time, pour the alcohol into a clean jar and discard the pepper. Simply rub the resulting capsaicin-laden alcohol tincture over the area of pain daily until all symptoms cease. Be careful not to get this mixture in the eyes.It is a good idea to make this tincture up ahead of time as it takes three weeks to gain its full strength. It may, however, be used after even the first day. Once made, store it in a dark bottle and it will keep indefinitely. Mark it well and never, never use it internally.

This tincture can also be used for arthritic pain, and other pains in the joints and muscles, much the same as you would use such products as Heet and Nostrix.

Permanent scarring of the skin and permanent muscle weakness and neuralgia are occasional complications of shingles.⁷ The extent, duration, and dissemination of lesions in shingles are inversely related to the amount of interferon found in the vesicles, and this affects the course of the disease. Anything that will increase the effectiveness of the immune system, such as exercise, a simple diet-even fasting a meal or two, freedom from stress, heat treatments, a cold mitten friction treatment, healthful clothing warm and loose, and an abundance of fresh air, water and sunshine, should help produce interferon.‍

REFERENCES‍

1. The Lancet, December 18, 1971, pgs 1349-1350

2. British Medical Journal, January 6, 1979, pg 5

3. Modem Medicine, July, 1981, pg 79

4. The Lancet, January 15, 1972, pg 151

5. Journal of the American Medical Association 79(24):1979-1980, December 2, 1922

6. Physiotherapy 57:374, August, 1971

7. American Journal of Nursing 54 (10):1217-1219, October, 1954