Zoster is an eruption of the skin that is one of the most dreaded conditions that a person can have. Shingles and zoster are the same condition, and they come up as an eruption of an old chicken pox virus travelling down a nerve root. The full name of the virus is the Varicella Zoster Virus (VZV). The area affected may have pain that starts days before there are any visible lesions of zoster. The pain is often thought to be orthopedic or even cardiac depending on the location that the virus is coming up in. The first visible sign of shingles may be a red patch or patches and these are typically in a line that traces the nerve root. The skin area of a nerve root is called a dermatome and on the trunk a dermatome extends from the spine to the center of chest or abdomen. On the extremities or head dermatomes are also linear, and in areas there is usually a near perfect cut off of lesions at the mid-line. After redness, the next thing that is typically seen is a cluster of vesicles and blisters. These blisters are the classic picture of zoster and when a patient states that they have a line of blisters it is likely that they have zoster.
Most people who have zoster can remember that they had chicken pox. I saw a gentleman from Fort Mill, South Carolina who remembers all of his siblings having the pox together, nearly 80 years ago. You cannot “catch” or “get” zoster from another person, it is an old chicken pod infection that has resurfaced along a nerve route. The virus has remained dormant in the nerve root, often for decades. A person with zoster can give the chicken pox virus to others and this has been well documented. One reason I have seen so many people from Fort Mill with zoster is that there is a growing population of those over fifty years old retiring to the area. The older one gets, the more likely zoster is to occur. It may be difficult to get an emergency dermatolgy visit in Fort Mill and hopefully a person in need can find the right care quickly because the faster that medicine is started, the more it can help.
The pain of zoster can be a nightmare. The pain may begin before the rash and can last for months and even years. The long term pain is called post-herpetic neuralgia. There are many treatments for this but the best treatment is likely vaccination to decrease a person’s chances of getting shingles, or early treatment of the infection. The areas of zoster may scar and this is especially significant on the face. The upper face can get zoster and the real danger there is that the virus can involve and damage of the eye.
The older a person is the more likely that zoster occurs. I have seen cases younger than five, but most often see people over fifty. The zoster vaccine, Zostavax, is a new option to try and prevent cases of zoster. It is the same vaccination as that given to children for preventing chicken pox. Just as children may still get an eruption of chicken pox after getting vaccinated, adults can still have an outbreak of zoster even though they have been vaccinated. The vaccine does lower the odds for an eruption, and the zoster that does happen appears to be less severe. The vaccine is approved for those over fifty and people with certain medical conditions. It is definitely something worth considering to try and prevent the pain of zoster. I recently saw a woman from Fort Mill, South Carolina with Zoster who had been vaccinated. There were only a few months between vaccination and her zoster and happily she had only a mild eruption and minor pain. The pain of the vaccination is minor compared to the pain of actual zoster.
So, remember to think of zoster if there are painful blisters, especially in a linear pattern. The medications for treating zoster are excellent, but they need to started early to be effective. So if you see linear blister and feel pain, please get seen.
David Schulman
Pineville Dermatology, South Charlotte Dermatology. Matthews Dermatology, Ballantyne Dermatology