Editor’s Note: Beyond the Blisters
Educating Patients About the Consequences of Shingles
When most people think about shingles, they probably imagine a fierce, intensely painful blistering rash that may last for weeks. It’s all that, but much more. Shingles, known as herpes zoster, is a reactivation of the varicella-zoster virus, which, after causing chickenpox, remains dormant in nerve cells. According to the CDC, more than half of all cases occur in individuals older than 60. Older patients, especially those who may have weakened immune systems due to age or illness, are not only particularly susceptible to developing shingles but also at increased risk for significant secondary consequences. Patients need to be aware of the common and rare complications so they can take steps to prevent becoming infected and get timely treatment for any consequences should they get shingles.
One of the most common and debilitating complications is postherpetic neuralgia—pain that continues long after the rash is gone. In addition, bacterial infections may arise in blisters that don’t get prompt and proper treatment. More concerning, if the shingles rash occurs near the eye—herpes zoster ophthalmicus—it can cause conditions such as uveitis, conjunctivitis, and keratitis. In the worst cases, it may impair vision and even cause blindness. Neurological complications may include facial paralysis, hearing loss, loss of balance, and inflammation of the brain.
A rare but potentially serious complication occurs when the rash spreads and affects different parts of the body. Called disseminated shingles, it may occur in older adults and people with compromised immune systems, such as those who are being treated with chemotherapy or immunosuppressive medications or who have HIV/AIDS. Disseminated shingles, in turn, may affect organs other than the skin and can result in encephalitis and pneumonia.
Mark Coggins reports on a growing number of studies about a less well-known consequence of shingles—an increase in the risk of acute cardiovascular events such as heart attacks and stroke.
— Kate Jackson