Zoster or Shingles?

Actually, it's both

A good friend developed a painful rash on her arm and was properly diagnosed by a new doctor as having "shingles", or herpes zoster. Proper treatment (an anti-viral drug and pain medication) was begun and she improved.

On a follow up visit, her provider's slightly off-the-wall comments about shingles destroyed, for her, his budding credibility.

Shingles, or zoster, is one of the top ten painful curses of mankind, on a par with migraine, labor pain and toothache. The only good thing about it is that the acute phase, without treatment, is usually over in about two weeks.

Briefly, zoster is caused by chicken pox virus, which, having lain dormant for a number of years in a nerve root ganglion, awakens, stretches, and begins to make its victim take notice. Overall compromise of one's immune system, including, at times, the effects of a stressor, may precipitate this virus resurrection. During a pre-eruptive phase of a few days, there is pain in the distribution pattern of the affected nerve. Erroneous diagnoses made are related to the area of involvement. If in the flank, kidney stones are suspected. If in the chest, perhaps a heart problem will be considered. You get the picture. Since there is no specific diagnostic test for zoster the rash is sole confirmation.

If started within three or four days of appearance of rash, anti-viral drugs are effective, reducing the duration and intensity of zoster. Some physicians will use other drugs (high dose cortisone is one) for extensive disease in older patients. This may help reduce the major complication of zoster, which is persistent painful post-herpetic neuralgia or PHN.

PHN is usually worse with older patients, after more extensive involvement, and with upper body and facial eruptions. PHN is the reason zoster is a curse. Treatment is not perfect, and involves drugs with troublesome or even dangerous side effects. Only a limited number of patients will need treatment for PHN. And here we have the reason our friend with zoster lost respect for the doctor of the moment.

When she returned after initial treatment, several things happened. First, she was advised that this problem would, "Last the rest of her life." Second, she was told that most of the problem was in her mind. And lastly, she was given a prescription for Neurontin (brand name for gabapentin, whose purpose is to reduce the pain of PHN) and advised she must take it, "Or else!".

Since her symptoms had already subsided to nearly nothing, it's hard to imagine this "lasting all her life." Second, although an occasional patient gets zoster as a result of severe mental distress, this particular patient was not in that category, and in fact has a very nice normal mind.

Lastly, she did not have PHN, is unlikely to have PHN in the future (doesn't now, five months later), and she didn't take the medication. Bravo for her! No, make that bravissimo in spades!