Learn About Shingles
What are Shingles?
Key Symptoms
What Causes Shingles?
Conventional Treatments
Medications
Tests and Procedures
Treatment and Prevention
How Supplements Can Help
Self-Care Remedies
Alternative Therapies
When to Call a Doctor
Evidence Based Rating Scale
References
Shingles is a viral infection medically known as Varicella (herpes) zoster. The word "shingles" probably comes from the Latin cingulum, meaning belt or girdle; "zoster" is the Greek word for belt. Both words reflect the fact that shingles often appears as a blistering rash on a single strip of skin in the midsection of the body, forming a painful "belt." The infection typically surfaces only on one side of the torso; more rarely, it affects the limbs, face, and eyes.
Although shingles usually produces a painful rash on the skin, it is actually an infection of the nerve pathway that supplies the skin in the affected area. In persons with a compromised immune system, shingles can cause a severe systemic infection, affecting internal organs and the central nervous system. Patients undergoing cancer chemotherapy or who are suffering from an HIV infection are particularly vulnerable to shingles.
Shingles itself is not contagious; rather, it is a reactivation of the same virus that produces chickenpox, which many people have during childhood. Although most of the original virus gets destroyed as the chickenpox clears up, some remnant virus remains in nerve cells along the spinal cord. After lying dormant, usually for decades, the virus reawakens and travels the length of the nerve, finally breaking through the skin.
Infection: While shingles is not considered a communicable disease, those who have never had chickenpox but who are exposed to open shingles sores may come down with chickenpox, and from then on be susceptible to shingles. However, shingles cannot be contracted through contact with an oozing shingles lesion.
Incidence: Although painful, shingles is a common and usually harmless condition, mainly affecting people over age 50. Its incidence increases with age. About 95% of Americans are exposed to the chickenpox virus before the age of 18. And it's estimated that one in five people who have had this childhood disease then develops shingles later in life.
Complications: The two most troublesome complications of shingles occur when the nerves to the eye are affected (herpes ophthalmicus) and when pain persists, even after the rash has cleared up (post-herpetic neuralgia, or PHN).
Because shingles injures the peripheral nerves, PHN pain may continue for one to three months--and sometimes for years--after the rash has healed. PHN causes the skin to become unusually sensitive--to clothing, to a light touch, even to temperature.
Those with shingles-related eye or face complications may be at increased risk for developing post-herpetic neuralgia. In addition, the severity and duration of PHN pain appears to increase with a person's age.
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Initially, excessive skin sensitivity, tingling, burning, or even itching in the area that will be affected. Sometimes, flulike symptoms are present, with low-grade fever and fatigue.
Later, actual pain begins in the sensitive area; this can be so severe that it may be mistaken for such conditions as pleurisy, appendicitis, or sciatica.
After three to five days of pain, the rash (or lesions) appears, with the small red spots developing into full-blown, fluid-filled blisters.
During the next few days, the blisters dry up, turn yellow, and crust over. Within two weeks, the crusts fall off, sometimes leaving slight pitted scars or discoloration.
For some people, even after the rash clears, significant pain (PHN) remains.
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Shingles, or herpes zoster, is caused by a reactivation of a virus in the herpes family known as varicella zoster virus (VZV). Although VZV is in the same general group as other herpes viruses, it's not the same virus that causes either cold sores (herpes simplex type 1 virus, or HSV-1) or genital herpes (herpes simplex type 2 virus, or HSV-2). In fact, chickenpox and shingles are the only two known clinical manifestations of VZV.
Just why the hibernating VZV infection should suddenly "awaken" and cause shingles to develop is not clear. The immune system probably plays a role. Some precipitating factors appear to include:
- Age. Since shingles occurs most frequently among older people, scientists believe that the natural weakening of the immune system that accompanies the aging process may contribute.
- Stress. Physical and emotional stress, illnesses such as flu, Hodgkin's disease, or injury to the affected area may have adverse effects on the immune system.
- Drugs. Certain drugs that suppress the immune system increase the risk of developing shingles. These include corticosteroids, cancer chemotherapy, and the drugs administered after a bone marrow transplant.
- Unknown factors. In many cases of shingles, however, no precipitating event is ever found. Recently, nutritionally oriented doctors have begun to suspect that the low levels of Vitamin D found in the elderly population may be a factor in their susceptiblity to viral infections.
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Once shingles is suspected, antiviral drug therapy often is started immediately, without necessarily waiting for the results of diagnostic tests.
There are several reasons for this tactic: First, once the lesions appear, the clinical diagnosis is usually quite clear. Second, the newer antiviral medications are most effective when taken early on. And finally, the drugs themselves are all quite safe, with a low incidence of side effects.
Although the pain of shingles may respond to mild over-the-counter painkillers, such as aspirin or Tylenol, sometimes a stronger medication, such as codeine, is needed. Special strategies are often needed to treat the complications that may arise from a shingles infection.
- For post-herpetic neuralgia (PHN): With shingles, the real challenge may be to successfully treat the residual discomfort of PHN. In severe cases, this condition can be very difficult to manage. There are a number of prescription medications that help relieve the pain. Sometimes, patients with acute neuralgia are referred to physicians specializing in pain management; in addition, alternative approaches such as acupuncture, biofeedback homeopathy, or hypnotherapy can be beneficial.
- For ophthalmic shingles: A shingles infection can also develop in the eye, often in combination with a lesion on the forehead or on the ear. The eye gets red and may also be painful. Someone with ophthalmic shingles should be under the specialized care of an ophthalmologist: antiviral medications, which may include eyedrops, are the first line of treatment.
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Drugs used to treat shingles begin with antiviral medications to combat the virus itself, and then move on to painkillers, topical treatments for the skin, antibiotics for secondary infections, and specialized medications for post-herpetic neuralgia.
- Antiviral therapy: Remarkably useful for shingles, these medications help to shorten the course of the illness, hasten the clearing of the lesions, and reduce the severity of pain. At the first sign of illness, initial treatment is usually an antiviral medication such as acyclovir, famciclovir or valacyclovir.
Antivirals are most effective when taken within 24 to 72 hours of the appearance of the rash. Most are oral medications. However, in the rare case that an immunocompromised patient has widespread infection, the antivirals can be administered intravenously.
- Pain-relievers: Over-the-counter remedies, such as aspirin, acetominophen, or a nonsteroidal anti-inflammatory drug (NSAID) may be recommended to control discomfort from shingles. For severe pain, Darvon, codeine, or one of the codeine derivatives, such as Vicodin or Percodan, may be prescribed.
- Topical medications: As the blisters dry, they may become extremely itchy. If scratched, however, they can easily get infected. To relieve the itch and help prevent infection, applying calamine lotion, or towels moistened with either zinc sulfate (0.25%) or Burow's solution (aluminum acetate) may help. All three are available over-the-counter.
- Antibiotics: If there is evidence that a blister has become infected, an antibiotic may be prescribed. This may either be an oral or a topically applied medication.
- Drugs for post-herpetic neuralgia: Most doctors agree that the treatment of persistent pain from shingles can be extremely difficult. Current medications include gabapentin (Neurontin)--a medication usually used for epilepsy; the antidepressants amitryptiline (Elavil) or fluphenazine (Prozac); corticosteroids; and/or a variety of prescription pain-relievers.
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Most physicians rely on symptoms described by the patient and the physical appearance of the rash itself to make a diagnosis of shingles. When in doubt, however, a scraping from a lesion is cultured or examined under a microscope to detect the presence of unusual cell changes, evidence that the virus is present.
In addition, blood tests can measure antibodies to VZV. As the disease runs its course, the levels of certain antibodies rise over the course of several weeks. Although this antibody increase is considered key to the diagnosis of chickenpox or shingles, the tests are rarely ordered because the diagnosis is usually straightforward without them.
However due to the epidemic deficiency of Vitamin D in the industrialized countries, WholeHealthMD recommends that people with shingles have their Vitamin D blood levels measured and take adequate Vitamin D to restore healthy blood levels and get the proven boost of immunity from healthy levels of Vitamin D.
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Seeing your physician at the very first sign of shingles and taking your medicines exactly as prescribed is the most effective way to heal the lesions promptly and reduce your chances of developing post-herpetic neuralgia.
Prevention: Strategies to prevent shingles basically involve keeping yourself in good shape and avoiding excessive physical and emotional stress. Once you've had a case of shingles, taking some steps to prevent a second attack becomes an important priority as this condition reoccurs in about 1% to 5% of patients.
If you do not remember whether you've ever had chickenpox or varicella vaccine, then avoiding a household where a chickenpox infection is present is strongly recommended. The vaccine to prevent chickenpox has been available since 1995 and widely administered to young children.
In 1995, the National Institutes of Health (NIH) sponsored a five-year clinical trial of an experimental vaccine for shingles, with more than 38,000 participants nationwide. Results from the study indicate the vaccine (Zostavax) markedly reduced the incidence of shingles – preventing about half of cases – and dramatically reducing its severity and complications, such as PHN. The FDA approved the vaccine in May 2006. (1, 2), and the Centers for Disease Control are presently considering whether to recommend it for all adults over 60.
Eating a healthy diet – with more than three servings of fruits and vegetables daily – also may reduce the risk of developing shingles, particularly in adults over 60. A 2006 case-control study evaluating dietary intake of nutrients found in fruits and vegetables (vitamins A, B6, C, E, folic acid, iron and zinc) in 726 adults (243 cases with incident zoster and 483 controls with no history of shingles) found individuals who ate less than one piece of fruit a week had more than three times the risk of shingles compared to individuals who ate more than three servings every day. When considered individually, consumption of some nutrients were not significantly associated with an increased risk of shingles. However, in adults over 60, the nutrients from eating a combination of fruits and vegetables seemed to significantly reduce the risk of shingles. (3)
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Natural therapies for shingles (if followed until blisters heal) can help ease acute attacks as well as the lingering pain of PHN. In addition, regular use of immune-boosting nutrients can support the systems that help keep VZV in its dormant state.
For acute flare-ups, use the supplements together--some are topical for external use and others are oral immune boosters with healing effects.
Just a reminder: If you have a serious medical condition or are taking medication, it's always a good idea to check with your doctor before beginning a supplement program.
The following nutritional supplements can be helpful in managing and preventing shingles:
- Once the rash has appeared, a topical application of aloe vera gel combined with vitamin E oil may bring some relief. The anti-inflammatory properties of aloe vera gel may help reduce swelling, in turn reducing pain and itching. Preliminary in vitro evidence also suggests aloe vera gel is an anti-viral agent, which could help to speed the healing of shingles and reduce the risk of infection from outside bacteria. (4) More research is needed in this area.
- To interfere with viral growth and spread, either melissa (lemon balm) or licorice cream (both commercially available) may be useful when gently applied to the lesions. Licorice--widely used in traditional medicine--has been shown to have anti-inflammatory and anti-viral properties, which may be of potential value in in this area. In vitro studies of glycyrrhizin, a constituent of licorice, have demonstrated anti-viral activity against various forms of herpes virus, including VZV. (5-7) However, while anecdotal evidence indicates efficacy of these topical treatments in treating shingles, scientific evidence in humans is lacking. Research is needed in this area.
- Taking a combination of digestive enzymes orally may improve symptoms of shingles, including pain and redness. A 1995, controlled study of 192 patients treated with either the conventional medication acyclovir or an enzyme combination preparation (120 mg trypsin, 40 mg chymotrypsin, and 320 mg papain) found the enzymes were as efficacious in treating symptoms as acyclovir. (8)
- Natural treatments for frequent outbreaks of shingles include high doses of vitamin E, and injections into muscle of vitamin B12 or adenosine monophosphate (AMP), a byproduct of the body's metabolic process. These last two are available through physicians familiar with natural medicine and should be started at the first sign of a shingles flare-up. In a 1995 randomized, placebo-controlled, double-blind study published in the Journal of the American Medical Association, 32 patients with shingles received either injections of AMP three times a week for up to four weeks or no treatment. AMP moderately reduced pain soon after the start of treatment, decreased desquamation time, and promoted faster healing of the skin than in the placebo group. The injections also seemed to reduce virus shedding and cleared the virus faster than placebo. Neither pain nor lesions recurred from three to 18 months after the end of treatment, and the AMP injections did not produce any side effects or toxicity during or after treatment. (9) Another study indicates AMP may be useful in treating and preventing PHN. (10)
- For the pain of post-herpetic neuralgia, a commercially available cream made from cayenne pepper (or capsaicin) can be very helpful. Several reviews of studies have found cayenne pepper cream to be useful in reducing pain associated with shingles. (11, 12, 13) The cream works by reducing the amount of substance P, a natural chemical that tells the brain which specific site is a source of pain. When the amount of substance P is depleted, pain is reduced because the brain no longer "perceives" it. (14) This active constituent of cayenne has been FDA-approved for this use. Regular topical application of the cream should begin only after the blisters are fully healed.
- Vitamin C and bioflavonoids taken orally appear to prevent viral growth and spread, especially when started early in the course of the flare-up. Adding vitamin A can fight cell damage and beef up the immune system. (15) A deficiency in vitamin A has been associated with increased susceptibility to numerous infectious diseases. A 2002 study of 120 bone marrow transplant patients undergoing immunosuppressive drug therapy found an association between increased incidence of vitamin A deficiency and increased risk of shingles infection. (16, 17) More research is needed to determine whether a causal relationship exists between vitamin A deficiency and increased risk of shingles infection in otherwise healthy individuals.
- The herb echinacea is an immune stimulant that may be helpful both during an acute infection and as a preventive to keep the virus in its inactive form. (18) However, it has not been studied specifically for treating shingles.
- To grow and spread, viruses of the herpes family require the amino acid arginine. This makes a second amino acid, lysine, useful in treating VZV because it interferes with the metabolism of arginine. Taking lysine may speed the healing of shingles lesions and prevent a recurrence of the condition. However, most clinical research is this area has been focused on taking lysine to treat herpes simplex labialis (cold sores).
- Madonna lily (Lilium candidum) has been used in traditional folk medicine in Italy to treat shingles. (19) Practitioners believe saponins in the bulb of the plant have healing properties (20), and anecdotal evidence has found positive results when frying the bulbs in olive oil and applying it externally as a poultice on shingles lesions. Scientific research is needed to determine the plant's potential anti-viral properties in treating shingles.
- Pilot studies examining the Reishi mushroom (Ganoderma lucidum) have found this fungus may help relieve pain from shingles and PHN. In a 1998 case series, two patients with shingles and two patients with PHN had dramatically decreased pain after administration of 36 to 72 g of hot-water-soluble extracts of Ganoderma lucidum. (21) In another small clinical trial, five patients ages 17-74 years with shingles began experiencing pain relief within a few days of treatment with an oral preparation containing Ganoderma lucidum, and pain relief was almost complete within 10 days. No patient in this trial developed PHN after more than one year of follow-up. (22)
- Several small studies have found that Bi Phaya Yaw (Clinacanthus nutans), a small shrub found in Southeast Asia that has long been used for snake and insect bites and other skin ailments, may be helpful in healing shingles lesions and reducing pain. In a 1995 randomized, placebo-controlled trial, 51 patients with shingles were treated with placebo or a topical preparation of bi phaya yaw extract applied five times daily for 7 to 14 days, until the lesions were healed. The number of patients with lesions crusting within three days and healing within 7 to 10 days was significantly greater in the treatment group than the placebo group. Pain scores also were significantly reduced in the treatment group, and no side effects were reported. (23)
- The bee products honey and propolis have also been studied for their traditional wound-healing properties. Preliminary studies comparing honey or propolis to conventional drugs have found the bee products have helped shorten the duration of episodes and speed healing time on patients with HSV. These anti-viral properties may also be useful in the management of shingles. Research is needed in this area.
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- Keep blistered areas clean. Use soap and water to keep the rash area clean. This will help prevent any bacterial infections from developing.
- Don't scratch. Although the itch is hard to resist, try to avoid scratching, which increases the risk that the blisters will become infected from dirt under the fingernails. If necessary, wear cotton gloves to bed to avoid scratching in your sleep.
- Use cool, wet compresses. These relieve both the pain and itching of shingles blisters. Compresses are often more effective than the frequently recommended calamine lotion. At the pharmacy, look for either zinc sulfate solution (0.25%) or Burow's solution (aluminum acetate); both are sold over-the-counter.
- Soak a compress in one of the solutions and apply it for 15 to 30 minutes three times a day. Dry the area gently (use a blow dryer if the area is particularly sensitive), and apply a soothing or antiviral cream (see Supplement recommendations above).
- Take a colloidal oatmeal bath. This will also help to relieve itching. Colloidal oatmeal is a type of finely ground oatmeal (prepackaged as Aveeno),which is sold in pharmacies. (You can make your own
Supplement Recommendations for Shingles
From Joyce Frye, DO/MBA/MSCE at WholeHealthMD:
Natural therapies for shingles help both acute attacks (take them until the blisters heal) and also the pain of post-herpetic neuralgia (PHN) that can linger for months and occasionally even for years.
For acute flare-ups, use all the supplements together--some are topical and others are oral immune boosters with healing effects. Make sure that you are tested for Vitamin D blood levels if you get shingles, there are widespread defiencies of Vitamin D, which may result in increased susceptiblity to viral infectionsl
How to take the supplements
All the supplements listed here can be taken in conjunction with conventional antiviral prescription drugs. Take enough Vitamen D to restore healthy blood levels
For an acute outbreak
Applying an aloe vera gel combined with a vitamin E oil to the blisters may give you some immediate relief. Together, they help calm the nerve endings in the skin, aid healing, and reduce the risk of infection. An herbal cream made with melissa or licorice can be rubbed into the lesions as well. Adding colloidal oatmeal to a warm bath may also help relieve the itching that often accompanies a shingles rash.
Oral antioxidants (vitamin C/flavonoids, vitamin A) fight cell damage and beef up the immune system. The herb echinacea also fortifies the body's immune function and, with the antioxidants, battles the herpes virus and fights bacterial skin infections. To promote healing and encourage healthy skin growth, add the amino acid lysine.
For post-shingles pain
Continue to follow your therapy for acute attacks, but also add oral vitamin E (400 IU twice a day) to prevent cell damage and vitamin B12 (1,000 mcg with 400 mcg of folic acid daily) to enrich the protective sheath that covers the nerves.
Once the shingles blisters have disappeared, topical cayenne (capsaicin) cream can be rubbed into sensitive areas and may also help relieve pain. Initial applications may be quite uncomfortable, but this will lessen as the Substance P in the area is depleted.
Important:
We at WholeHealthMD strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.
Be aware that certain
cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you're taking medications. Key cautions are given in the listing below, but you need to see the
WholeHealthMD Reference Library for a comprehensive discussion of each supplement's cautions and drug/nutrient interactions.