Q. I have had shingles for about a year now and was wondering how long they last and what to do about them. I'm on pills now, but I don't want to take them for the rest of my life. Can you recommend anything else?
A. The pain from shingles can be annoying at the least and very intense at worst, especially if it lasts for the length of time you've had it.
Shingles, or herpes zoster, is a viral infection of the nerves. It is a reactivation of the dormant chicken pox virus, Varicella. It is seen more often in older adults and begins with pain and itching in areas of the skin along infected nerve pathways, usually on the trunk and face.
Clusters of small blisters erupt on the skin served by the affected nerves. The blisters pop and leave sores that can eventually form crusty scabs. Shingles typically lasts from two to six weeks. However, the virus never leaves the body, so it can be reactivated, even years later. Shingles returns in approximately one person out of 24.
Antiviral drugs, such as famciclovir or valacyclovir, taken for seven days in a row, are helpful in treating shingles. But they do not eliminate the shingles virus completely from the body.
Other treatments directly lessen the severity of the symptoms. Aspirin and codeine can help control the pain. And the FDA has just approved a patch containing a local anesthetic that controls the pain.
A frequent complication of shingles, especially for older people, is a condition known as postherpetic neuralgia. This condition is characterized by chronic, burning pain that continues in the areas supplied by the nerves that were infected by the shingles virus.
Half of the people over age 60 who have shingles will also have some postherpetic neuralgia. This disorder is more long-term than shingles and can last for a year or more.
Fortunately, in most cases, the pain of postherpetic neuralgia is mild, but it can be severe for some. The pain can be constant or intermittent and may get worse at night or in reaction to heat or cold. No treatment for postherpetic neuralgia has been found to be consistently effective. Even early and aggressive antiviral treatment of shingles does not reduce the chances of having postherpetic neuralgia.
However, once the postherpetic neuralgia has been established, its symptoms can be treated topically with capsaicin ointment. Regional nerve blocks, with or without steroids, or tricyclic drugs and phenothiazines, can help control pain if analgesics are ineffective.
Update on asthma: Before a drug is approved, it is rigorously tested both to see whether it works and whether the side effects or medical problems it causes are sufficiently minimal. However, testing how well it works typically only compares the drug to a placebo or nothing. It's hard then for you or a doctor to know whether one drug of a certain type is better or worse than another drug of the same type.
A study published in the Journal of Allergy and Clinical Immunology demonstrates how important this missing information can be, both to your health and your pocketbook. Two different inhaled steroids (fluticasone and beclomethasone) were tested for their benefits to people with chronic asthma. The results were remarkable.
Fluticasone was shown to significantly improve breathing overall and decrease the number of asthma attacks, with no increase in side effects. At the same, it required fewer puffs and cost 40 percent less than beclomethasone.
Write to Dr. Douma in care of the Chicago Tribune, Room 400, 435 N. Michigan Ave., Chicago, IL 60611.