Herpes zoster (shingles) normally occurs in a limited area that follows a dermatome (see the “dermatome” picture). In individuals with damaged immune systems, herpes zoster may be widespread (disseminated), causing serious illness. We present the case of a 63-year-old white woman with characteristic signs and symptoms of RSDS in the left upper limb that appeared 3 weeks after she had a typical herpes zona involving the left C5-C6 dermatomes. Most people who get shingles are more than 50 years old or have a weak immune system. For example, you might get shingles if you have cancer, take medicines that weaken your immune system or have the virus that causes AIDS (acquired immunodeficiency syndrome). The rash begins with raised reddish bumps. In a few days, these bumps turn into blisters.
You might feel a stinging or burning pain. The rash may wrap around your back and chest, or it may be on one side of your face. The blisters crust over and fall off after 7 to 10 days. You may see changes in the color of your skin when the scabs fall off. In bad cases, the color changes last forever. Even though the rash gets better or goes away in a few weeks, the pain may last longer. In most people, the pain goes away in 1 to 3 months.
Shingles can also affect your eyes, causing swollen eyelids, redness and pain. Shingles of the eye can cause scars that affect your vision. It can also lead to glaucoma later in life. Glaucoma is an eye disease that can cause blindness. Shingles is often treated with acyclovir (brand name: Zovirax), famciclovir (brand name: Famvir) or valacyclovir (brand name: Valtrex). Your doctor can help you decide which of these medicines might work for you. These medicines work better if you start taking them in the first three days after you get the rash.
To help with the pain of shingles, your doctor might have you take an over-the-counter pain medicine like acetaminophen (brand name: Tylenol) or ibuprofen (brand names: Advil, Motrin). Aspirin is not recommended because you might also get Reye’s syndrome, a liver problem. Putting a medicated lotion (brand name: Caladryl) on the blisters might help the pain and itching. Putting cool compresses soaked in an astringent liquid (brand name: Domeboro) on the blisters and sores also might make them hurt or itch less. “Postherpetic neuralgia” is the name used when the pain of shingles lasts for a long time after the rash is gone. About 1 in 5 people with shingles gets postherpetic neuralgia. Most people with postherpetic neuralgia get better with time.
Almost all of them are free of pain within 1 year. A few people have chronic pain (pain that doesn’t go away). Some medicines that are also used to treat depression and seizures can help the nerve pain of postherpetic neuralgia. These medicines don’t work very fast. It might be several weeks before they help your pain.