Understanding Shingles Treatment: Causes, Symptoms, and Effective Solutions

Introduction to Shingles

Shingles is the term used for the herpes zoster virus infection that can cause a painful rash or blisters on the skin. It is caused by the reactivation of the Varicella-Zoster virus (VZV), the same virus responsible for chickenpox in childhood. In this article, we will understand Shingles, their treatment, and also discuss its causes, symptoms, and effective solutions with a simple case presentation.

Reactivation of the Virus

Chickenpox is a viral infection caused by VZV in childhood. It appears as small, fluid-filled, itchy blisters on red bases, often described as "dew drops on a rose petal," which are the hallmark of the disease. Chickenpox can spread easily among people who haven't had the disease or haven't gotten the chickenpox vaccine. In chickenpox, children often have Koplik spots (white spots around 1 mm on red buccal mucosa). Once the symptoms go away and the patient becomes asymptomatic, the virus remains in the body in a latent or dormant form within the nerve ganglia (sensory nerve cells) of the body. This virus can reactivate under favorable conditions by traveling along nerve pathways. The favorable conditions for reactivation include a weakened immune system or an immunocompromised state.

Who is at Risk for Shingles?

Anyone who has had chickenpox can get a Herpes Zoster infection, especially with advancing age or a weakened immune system. People at higher risk include:

• Individuals with HIV/AIDS

• Cancer patients

• Those with chronic kidney disease (CKD)

• Those with type 2 diabetes mellitus (T2DM)

• Individuals with lung disease

• Organ transplant patients

• Those with rheumatoid arthritis or ulcerative colitis

• People with recent illness, trauma, or stress

• Individuals receiving immunosuppressive agents

Common Myths about Shingles

There is a myth that shingles can happen only once in a lifetime, but people living with immunocompromised states can have recurrent shingles.

Recognizing Shingles Symptoms

Shingles appears as itching, tingling, burning, or pain (stabbing or shooting type) in the area of the skin before the rash appears. The rash then appears as a raised area of patch or band, usually on one side of the skin. It can appear over one side of the face, eyelids, neck, trunk, or even over the arms and legs. After 3 to 4 days, the rash typically appears as fluid-filled painful vesicles and blisters. After 10 days, the blisters begin to dry with the formation of crusts, and the scars vanish within 2-3 weeks.

Understanding Pain Associated with Shingles

The pain can range from mild to severe in the skin areas affected by the rash or blisters due to the demyelination of nerve cells through viral invasion. Immune responses, particularly cell-mediated immunity, play a crucial role in pain and burning sensation, also in postherpetic neuralgia (PHN). PHN can persist for several months to years, or in some cases, it could be permanent.

Image 1. Demyelination of nerve cells through viral invasion.

Varicella Zoster Virus Vasculopathy: When VZV infects the blood vessels (cranial or extracranial), it can cause various serious complications. VZV can damage the intima of blood vessels, causing endothelial injury, edema, and vascular remodeling. It can lead to transient ischemic attack (TIA), ischemic stroke, hemorrhagic stroke, monocular loss of vision, aneurysm, and myocardial infarction (MI).

Treatment Options

• Antivirals: Must be started within 72 hours of onset to reduce the severity and duration of illness.

• Pain Relief: NSAIDs can be taken for pain relief. For severe pain, doctors may prescribe opioids. Topical lidocaine or patches can be applied.

• Neuropathic Pain Management: Doctors may prescribe anticonvulsants like Gabapentin or Pregabalin, and tricyclic antidepressants like Amitriptyline.

Role of Ayurveda

In Ayurveda, immunity is known as Vyadhikshamatva. Acharya Charak has discussed various Rasayanas in Rasayan Chikitsa Adhyay to maintain individual immunity. For managing the severity and duration of illness:

• Arogyavardhini Vati can be used to prevent blister formation and progression.

• Saptvinshataki Guggulu is better for milder pain management and prevent fluid discharge.

• Sihnaad Guggulu can be used for severe pain management.

• For relief of burning sensation, various Medhya Rasayanas can be used along with the local application of Chandanadi Taila.

Ayurveda works on prakritivaishtya (individual constitution), and every individual has a different prakriti. Therefore, personalized Ayurvedic treatment is preferred, and the treating doctor is the best judge to decide on personalized Ayurvedic treatment.

Case Presentation

A 52-year-old female, known case of ulcerative colitis and anxiety disorder on regular prescription (Mesalazine 1200 mg twice a day), presented in the OPD with complaints of fluid-filled blisters over her right flank associated with mild to moderate pain and burning sensation for 3-4 days. She also had anxiety-related symptoms like palpitations, sadness of mood, irritability, and disturbed sleep, which were insidious in onset. She was taking over-the-counter painkillers for pain relief. A careful history revealed that she had chickenpox (VZV) infection in the second decade of her life.

Examination Findings:

• Conscious, cooperative, and afebrile at the time of examination

• Vitals were stable

• Numerous blisters along with a red rash and reddish papules in the adjoining area.

  
  

  

  Image 2. Numerous blisters along with a red rash and reddish papules in the adjoining area.

  
  

There was no point in prescribing antivirals to the patient as it had already passed 72 hours. Personalized Ayurvedic treatment was started, and the patient responded well. In the next follow-up visit, only Medhya Rasayanas were given for PHN, which also helped in managing her anxiety disorder.

Conclusion and Final Thoughts

Shingles is the common name for Herpes Zoster, caused by the reactivation of VZV in the nerve cells. It can affect individuals with lower immunity who have had chickenpox in childhood. One must consult a doctor on time, as 72 hours is the time limit to start antiviral treatment, whether in Ayurveda or modern health science. Self-medication must be avoided. Shingles can be managed effectively with Ayurveda, as Ayurvedic medicines are more homologous to the body with lower potential side effects. However, self-medication with Ayurvedic medicines can also cause organ toxicity.

Key Takeaways from This Discussion

• Shingles is a painful condition caused by the reactivation of VZV.

• The virus can remain dormant and reactivate under certain conditions.

• At-risk groups must be informed about the factors that increase susceptibility.

• Understanding the myths surrounding shingles can alleviate misconceptions.

• Early recognition of symptoms can lead to timely medical intervention.

• Pain can manifest in various ways, complicating the clinical picture.