Since almost everyone gets chickenpox as a child, most of us are susceptible to developing shingles as adults. Each illness is caused by the same virus, which is called varicella in children and herpes zoster in adults. After the chickenpox ends, the virus goes into hibernation in the nerve cells along the spinal cord. Then, many years later, when the immune system is weakened in some way–by age, stress, certain drugs, illness (even the flu)–the virus awakens. At some point along the spine, it travels along a nerve, producing a painful rash along the band of skin served by that nerve. Herpes zoster means “belt of fire”–the name is apt.
At WholeHealth Chicago, we suggest you start both conventional and alternative therapies immediately. Call your doctor or visit an Urgent Care Center to confirm the diagnosis and get a prescription for an antiviral medicine that will speed healing faster than anything alternative medicine can do alone.
What are Shingles?
Shingles is a viral infection medically known as 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 someone with a compromised immune system, shingles can cause a severe systemic infection, affecting internal organs and the central nervous system. Particularly vulnerable are those undergoing cancer chemotherapy or who are suffering from an HIV infection.
Shingles itself is not contagious; rather it is a reactivation of the same virus that produces chickenpox, which many people have during their 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 literally reawakens and travels the length of the nerve, finally breaking through the skin.
Infection: While shingles is not considered a communicable disease, people exposed to open shingles sores who have never had chickenpox before may come down with chickenpox–and from then on be susceptible to shingles. You cannot contract shingles, however, from someone who has an oozing shingles lesion.
Incidence: Although painful, shingles is a common and usually harmless condition, mainly affecting people over age 50. Its incidence rises with age, however. Some 95% of Americans are exposed to the chickenpox virus before they’re 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 the 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.
- 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 remains, a condition known as post-herpetic neuralgia (PHN).
What Causes Shingles?
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, there are only two clinical manifestations of VZV: chickenpox and shingles.
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, and even injury to the affected area may all 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.
Once shingles is suspected, most doctors start antiviral drug therapy immediately, without necessarily waiting for the results of diagnostic tests.
There are good 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 usually responds 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, such alternative approaches as acupuncture, biofeedback, and 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 even on the ear. The eye gets red and may be painful as well. Someone with ophthalmic shingles should really be under the specialized care of an ophthalmologist; antiviral medications, which may include eyedrops, are the first line of treatment.
Drugs used to treat shingles begin with antivirals 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.
Antivirals: 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 the pain. At the first sign of illness, doctors almost always start shingles patients on such antivirals as acyclovir, famciclovir, or valacyclovir. The last two are newer and seem to heal lesions and reduce pain more promptly than the first.
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 are administered intravenously.
Pain-relievers: Doctors usually suggest over-the-counter remedies, such as aspirin, Tylenol, or one of the nonsteroidal anti-inflammatory drugs (NSAIDs) to control shingles discomfort. For severe pain, they may prescribe Darvon, codeine, or one of the codeine derivatives, such as Vicodin or Percodan.
Topical medications: As the blisters dry, they may become extremely itchy. Once scratched, however, they can easily get infected. To relieve the itch and help prevent infection, most doctors recommend applying calamine lotion, or towels moistened with either zinc sulfate (0.25%) or Burow’s solution (aluminum acetate). All three are available over-the-counter.
Antibiotics: If there is evidence that a blister has become infected, doctors usually prescribe an antibiotic. This may either be an oral or a topically applied medication.
Drugs for post-herpetic neuralgia: Doctors agree that the treatment of persistent shingles pain can be extremely difficult. Current medications include Neurontin (a medication usually used for epilepsy); amitryptiline (Elavil) or fluphenazine (Prozac), both antidepressants; corticosteroids; and a variety of prescription pain-relievers.
Tests and Procedures
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 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.
Treatment and Prevention
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: Once you’ve had a case of shingles (and this condition reoccurs in about 1% to 5% of patients), taking some steps to prevent a second attack becomes an important priority. Strategies to prevent shingles basically involve keeping yourself in good shape and avoiding excessive physical and emotional stress.
If you do not remember whether you’ve ever had chickenpox, then avoiding a household where a chickenpox infection is present is strongly recommended. Although a vaccine is currently available for chickenpox and widely administered to young children, it is too early to tell if this will prevent or lessen the severity of shingles later in life.
The National Institutes of Health (NIH) is currently sponsoring a five-year clinical trial of an experimental vaccine for shingles, with more than 37,000 participants nationwide. Its results will directly affect the availability of a commercial vaccine.
How Supplements Can Help
Nutritional therapies for shingles can help ease both acute attacks (take them until blisters heal) 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. As a preventative, take the recommended supplements as part of your daily vitamin program.
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. This combination soothes the skin, reduces the pain and itching, speeds the healing, and reduces the risk of infection from outside bacteria.
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.
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.
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.
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.
Natural treatments for frequent outbreaks of shingles include high doses of vitamin E, and injections into muscle of vitamin B12 or adenosine monophosphate, 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.
For the pain of post-herpetic neuralgia, a commercially available cream made from cayenne pepper (or capsaicin) can be very helpful. 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. Regular topical application of the cream should begin only after the blisters are fully healed.
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 it is hard to resist itching, try. You increase the risk that the blisters will become infected from dirt under the fingernails.
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 (0.025%) 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 by putting oatmeal through a food processor.) Add several cups (or follow package directions) to your bath water. Oatmeal can be slippery when wet, so use caution when getting into and out of the tub.
Cover the blisters at night. If shingles pain keeps you from sleeping, cover the blisters with a light dry dressing. Then gently bind the area with a wide elastic sports bandage. Remove the bandage in the morning.
Adjust your diet. Try to avoid arginine-rich foods because this amino acid promotes VZV growth and reproduction. Arginine-rich foods include chocolate, almonds, peanuts, gelatin, and certain grains (including corn and oats). Do try to add some brewer?s yeast and milk products to your diet, however; they are both rich in lysine, an amino acid that counteracts arginine.
Keep your stress level down. Both physical and emotional stress are well-known causes for herpes-related flare-ups, including shingles. Doing breathing exercises at home, or taking regular meditation, yoga, or tai chi classes will likely reduce your stress and help you deal with shingles pain as well as the chronic pain of post-herpetic neuralgia.
For an acute case of shingles, your best bet is to start immediately on the antiviral drugs available from your doctor. However, conventional physicians themselves acknowledge that certain alternative therapies can help relieve both rash itself and/or the chronic pain of post-herpetic neuralgia. Some of these therapies are useful for treating stress as well.
Traditional Chinese medicine. Look for a practitioner skilled in the use of both acupuncture and Chinese herbal therapies. Numerous studies have attested to the positive results that can be obtained from regular acupuncture therapy for the relief of chronic pain. If acupuncture is used at the first sign of post-herpetic neuralgia, it may help prevent or shorten the duration of this painful syndrome. In addition, because Chinese medicine believes that shingles is caused by a damp heat imbalance, herbal formulas may be prescribed to rectify this underlying condition.
Homeopathy. This alternative approach provides shingles remedies for both acute and long-term treatment.
Acute care: Several homeopathic remedies are recommended during the acute stage as a complement to the conventional care you’re receiving from your doctor. All doses are 6C or 30C, with one pellet placed under the tongue every two hours. Remedies include:
–Apis mellifica (recommended for large blisters with swelling and burning sensations that are eased by cool compresses) –Arsenicum album (recommended for reddened skin with merging blisters that are relieved by warm compresses)
–Rhus toxicodendron (for highly inflamed skin with white, itchy blisters)
–Ranunculus bulbosus (for neuralgic pain on trunk or face)
Chronic care: In addition, for chronic and poorly controlled shingles pain, you should see an experienced homeopath who will examine you and then prescribe an individualized remedy.
Biofeedback. This method has been shown to have a significant effect on reducing both stress and pain. In addition to using electronic equipment to help you deal with both of these shingles-related problems, the therapist will also teach you relaxation techniques, such as guided imagery, so that you can actively practice relaxation on your own.
Hypnotherapy. With its ability to enhance the power of suggestion, hypnosis done by a trained therapist can help ease chronic pain from post-herpetic neuralgia. It is also a useful therapy for treating stress.
When to Call a Doctor
- Any time you have the symptoms of shingles. Act quickly, since antiviral drugs work best when taken early in the attack.
- If your herpes zoster is accompanied by eye pain or lesions appear close to the eyes.
- If you feel bruised on one side of the body or face.
- If you remain inflamed for more than 10 days.
- If your shingles blisters become infected.
- If the pain is unbearable.
From David Edelberg, M.D. at WholeHealth Chicago: 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.
How to take the supplements
All the supplements listed here can be taken in conjunction with conventional antiviral prescription drugs.
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.
We at WholeHealth Chicago 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 WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions.
For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700 ext. 2001.
David Edelberg, MD