Pain after shingles? Sounds like post-herpetic neuralgia

Resolving shingles/zoster/herpes zoster. Post-herpetic neuralgia is pain that lasts after the rash heals. Imagine courtesy of Wikipedia user Mariegriffiths.

Post-herpetic neuralgia refers to the pain that follows the shingles (aka zoster or herpes zoster) outbreak. Even after the rash subsides, you can be left with pain. The pain can be burning, deep, aching or shooting and cutting. Some individuals will also feel pain when the area is touched.

Post-herpetic neuralgia is more common in older individuals and the pain in these individuals can last for a while — even more than a year.

What treatments can help post-herpetic neuralgia? Early on in the outbreak, oral antiviral agents are helpful in decreasing the duration and severity of the shingles outbreak. Pain control can be achieved by the usual pain medications such as acetaminophen (Tylenol), NSAIDS (e.g. Motrin) or even stronger pain medications such as those with opiates (e.g. oxycodone, codeine, Percocet, etc.) Short term relief can be achieved with topical anesthetic such as lidocaine patches, gel or cream or with topical capsaicin (a compound from peppers). Some oral medications that may be helpful also include gabapentin (aka Neurontin), amitriptyline, nortriptyline or desipramine. Botox (botulinum toxin) injections have also been noted to help with the pain in a few cases.

What is shingles? (aka zoster or herpes zoster)

Shingles of the chest. Shingles is also known as zoster or herpes zoster. Blisters and a painful red rash are present. Courtesy of wikipedia use Fisle.

Shingles is also known as zoster or herpes zoster. It is caused by a virus called the Varicella Zoster Virus (VZV) — the same virus that causes chicken pox. The name “herpes zoster” is sometimes confusing because people usually think of the Herpes Simplex Virus (HSV) which causes genital herpes, oral herpes, etc. when they hear of herpes. However, both the Herpes Simplex Virus (HSV) and the Varicella Zoster Virus (VZV) belong to the herpes family of viruses. So just a bit of confusing terminology and names.

Why does shingles occur? After prior chicken pox or vaccination, VZV virus stays in your cells. Often with increasing age or when your immune system is down, the virus can reassert itself. That’s why singles is more common in older individuals and in those with a weak immune system (such as in HIV patients).

What does shingles look like? Individuals can actually feel tingling, numbness or pain before the rash even starts. The rash then manifests as red patches or bumps which then develop blisters. The blisters can then pop and crust over. Because the virus travels from nerve roots, the rash will often be in a localized area of just one half of your body (called a dermatome). Shingles can be quite painful and the pain can last even after the rash subsides (aka postherpetic neuralgia).

Is shingles contagious? As long as your blisters remain, you are contagious and you will “shed” the VZV virus. Stay away from older individuals, newborns and young babies, and those with weakened immune systems (patients getting chemotherapy, HIV patients, individuals taking medications that suppress the immune system, etc.) Because the blisters contain virus, don’t pop them or scratch them and spread the virus to other areas.

Is shingles serious? What are some complications? See your doctor if you are concerned you may have shingles. Shingles involving the eye can lead to blindness. Shingles involving the bones around your mouth can lead to destruction of those bones and cause you to lose teeth. Shingles can also affect the ear causing deafness. One important complication is called postherpetic neuralgia where pain lasts after the rash disappears. More on this on a separate post.

What is the treatment for shingles? There are medications that fight the virus. Some that are often used are acyclovir, valacyclovir or famciclovir. They can decrease the length of time you have shingles and can decrease the severity of your outbreak.

Hand rash in health care workers

Did you know that health care workers are much more likely to develop a hand rash called irritant contact dermatitis? This happens due to frequent handwashing, exposure to disinfectants or cleansers, or other irritating substances. The skin becomes dry, pink or red, and scaly. Fissures can occur. The rash can itch, burn or sting. If you develop the rash, seek evaluation with a doctor. Special medicated creams or ointments can be used to help speed up recovery. Also, avoid contact with irritants and unnecessary exposure to water. Moisturize with a thick cream after washing the hands.

Herpes, part III: genital herpes

An example of male genital herpes on the penis. Note the small fluid bubbles (vesicles).An example of female genital herpes.

So it was just a matter of time before this herpes thread would reach the topic of genital herpes. Genital herpes can be quite difficult to control and causes a lot of distress and anxiety.

So what is genital herpes? Genital herpes is caused by the herpes simplex virus. Most of the cases are from HSV2 (the herpes simplex virus type 2) although HSV1 (type 1) could cause it too. Genital herpes is a sexually transmitted disease.

What is primary genital herpes and recurrent genital herpes? The herpes virus can infect you after contact with an infected person, and it can take 2-20 days before you get any symptoms. The first episode of the infection is called primary genital herpes. After that, the herpes virus stays dormant and quiet in your cells but then it can be triggered to recur (thus the name, recurrent genital herpes). Keep in mind, even when you don’t have active, painful skin findings, you can still “shed” herpes virus and thus be infectious.

What does it look like? The first time you have genital herpes, you can have little blisters (vesicles) and you can also get fever, a headache, muscle aches, swollen lymph nodes, pain, itching, discharge, etc. Sometimes, the first episode of herpes infection is very severe and people have had to be hospitalized for it.

Recurrent genital herpes often starts with burning or itching and then the little blisters can appear. You can get discomfort and pain as well.

When are you infectious? Even if you don’t have active water blisters, you can still “shed” herpes virus and be infectious. Certain antiviral medications such as acyclovir can reduce the amount of shedding of the herpes virus.

Are there treatments? There’s no cure, but there are antiviral medications such as acyclovir, valacyclovir or famciclovir which can help make the infection more tolerable. Some patients opt for daily antiviral suppressive therapy to help prevent outbreaks. Since everyone’s case is different, discuss with your doctor how best to manage your herpes.

More herpes: cold sores

Cold sore - aka herpes labialis or fever blister. This is caused by the herpes virus.
Cold sores, aka fever blisters or orolabial herpes is caused by… you guessed it… the herpes virus. Usually it’s cause by the herpes simplex virus type 1 (HSV1) but type 2 (HSV2) can cause it too.

How does it present? Usually there can be tingling or a burning sensation before anything appear on the skin. You can then get some redness and little water or pus bubbles in the skin which can then burst and crust over. You may also notice a fever, sore throat or swollen glands or lymph nodes.

How can you treat it? If started early, an antiviral medication such as valacyclovir or acyclovir can shorten the duration and intensity of your cold sores. Ask you doctor about whether these medications are right for you.

Herpes is infectious. Especially when you have open sores, don’t share straws, drinks etc. You can also spread the virus via kissing, etc. Try not to shave over the area either. You could drag the virus to nearby skin.

Another reason to wear gloves: herpes

Example of herpetic whitlow - a herpes infection of the finger. This was in a young child who had in previous few days had developed infection in the mouth. Courtesy of James Heilman, MD.
Believe it or not, herpes infection of the fingers was not uncommon back when healthcare workers did not wear gloves. Touching infected skin, cold sores, mouth lesions etc. with bare hands would transmit the herpes virus. Nowadays, with universal precautions, it’s much less common. Herpetic whitlow is the name given to the herpes infection of the fingers. The finger starts out with pain and tenderness and then little blisters appear. Keep in mind that these little blisters are also infectious.

Nowadays, kids are the ones who most frequently get this herpes infection on the fingers — usually from biting their fingers while they have cold sores. Basically, any touching of any other herpes infection can lead to an infection on your fingers. So be careful where the ungloved fingers go!

Hand eczema tips

Example of hand eczema. courtesy of Wikipedia user Haendels.
October is eczema awareness month — makes sense since the weather starts to get dry around now. I thought it would be appropriate to have a second post on eczema, but this time focusing on hand eczema. Here are some tips tailored specifically for hand eczema.

– Avoid unnecessary hand washing. Limit hand washing the amount of time needed to clean hands and avoid scalding water.
– Avoid fragrances and harsh detergents and other potential allergens.
– Wear gloves when cleaning the dishes, doing handiwork, etc.
– Liquid bandaid or even a superglue can help seal cracks in the skin.
– Keep hands moisturized. After washing, immediately apply an emollient. Thick moisturizing creams are good (hydrated petrolatum, creams made by Cerave, Vanicream, Eucerin, Cetaphil, etc.) Vaseline is also good. Those creams can get expensive though. If you’re looking for something more cost effective, try Crisco. Yes, that thick stuff you use for baking.
– Don’t scratch.
– See a dermatologist who can prescribe you special medications to put on your eczema and recommend certain pills to help calm the itch. Your dermatologist can also assess whether there is any sign of overlying infection.

Oh Mosquito!

We caught a bit of a break weatherwise up here in the Northeast today. It’s October and we hit a high in the high 70s! (I know this is not big news to those of you who have nice weather year-round but I have to take what I can get!) Anyways, I thought it was time for a t-shirt and shorts and a nice walk through the park with a friend. We stopped down to sit down at a bench under the trees and 30 minutes later… yes, we both had that feeling that we’d been bitten. Shucks. Turns out that the mosquitos are still out and about.

Now, if I weren’t so gung-ho about making a point of wearing a t-shirt and shorts in October in Boston, I would have worn a long sleeved shirt and pants to cover up exposed skin. Sitting in the shady area underneath of the trees and by the grass probably didn’t help either. I don’t normally carry bug spray either, but some DEET containing bug repellant would have been helpful.

We’ll see where exactly these bug bites crop up over the next day or so…  I’ll be juggling between cold compresses, Sarna and trying not to scratch the heck out of the bites!

Pesky foot warts

Warts on the bottom of your feet are called plantar warts and they’re notoriously hard to get rid of. If you’ve had them before (and still have them), then you certainly know what I’m talking about. In addition to being an eyesore, they can be quite uncomfortable and feel like you have a pebble in your shoe.

So what are these warts caused by? They’re caused by viruses (human papillomavirus to be specific) that infect the skin and cause the skin to grow thick and warty.

How do you get rid of them? Sometimes they’ll go away on their own but it’s hard to predict if it’ll disappear and when. Some common home remedies are duct tape or salicylic acid plasters which are available at your local drugstore. You may want to try to carefully pare down the wart or use a pumice stone on the wart to make it a little flatter before applying either of these treatments. If you see a doctor, they might try injecting the wart, applying a medication to the wart or potentially freezing or burning the wart.

Eczema skin care tips

An example of hand eczema. Courtesy of Wikipedia user Topbanana.

It’s getting cool and dry up here in New England and we’re seeing flares of eczema again. Here are some tips for good skin against eczema/atopic dermatitis.

1. Moisturize with a thick hydrating cream. Plain old vaseline works but not everyone can tolerate its greasiness during the day! Some brands that make good thick emollients include Cerave, Cetaphil, Eucerin, etc. Avoid creams with lots of fragrance and avoid watery lotions.

What’s your favorite moisturizer?

2. Minimize contact with water — especially hot water. This means taking lukewarm instead of scalding hot water and limiting the length of time you spend in the shower or bath. If you do a lot of dishwashing, washing your child, or if your job puts you in contact with water (nursing, hairdressing, bartending, etc.), wear gloves to protect your hands. And remember to moisturize your hands after water contact.

3. Try not to scratch the area. The itch-scratch cycle makes eczema tough to beat. Scratching can lead to more itching which in turn leads to more scratching, etc. Keep your nails short and try not to scratch! Your doctor can recommend medications to help with the itch.

4. See your doctor. You may need special medications to help your eczema/atopic dermatitis go away. These may entail creams of ointments. When severe, you may need pills, or even light therapy (aka phototherapy — a fancy light box that you stand in). It’s also important to see a doctor because eczema can get infected with bacteria or viruses.