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Case 1: Stinging Shingles
(Posted on 1 September 2008)
Mr. Chan, 52, found a rash on the left side of his waist. He initially took it as skin allergy and paid no heed. Later, the rash spread, blisters developed and the stinging pain worsened. It was finally diagnosed as shingles by the doctor.
Source: Quality HealthCare Medical Services
- What is shingles? The elderly says that if it runs round the body, the patient will be killed by strangulation. Is that true?
- What are the symptoms of shingles? How can doctors distinguish between common rash and shingles?
- Why do people get shingles? Is it infectious?
- Who are the high-risk groups for shingles? It has been said that the infant would have shingles if the mother eats snake during pregnancy. Is that true?
- Case 2: How is shingles treated?
- How long would shingles last? When should I go to the doctor?
- How is shingles treated? How can patients facilitate recovery?
- Is shingles preventable? What can we do in daily life?
- Drug treatment for Alopecia
- Vaccines against bacterial meningitis
What is shingles? The elderly says that if it runs round the body, the patient will be killed by strangulation. Is that true?
Shingles, formally known as herpes zoster, is an infectious skin disease caused by varicella zoster virus. Rash and blisters would appear on the skin along a nerve of the patient, in the shape of a snake.
That shingles running round the body can be fatal is just a myth without any scientific ground. Albeit shaped like a snake, shingles is a viral infection incapable of strangulation. Symptoms may emerge in any area, but normally restricted to one side of the body. Skin nerves in the waist, chest and back are the most commonly infected, while the hands, legs and face may also be affected. Severe herpes zoster infection or delayed medical attention may lead to viral proliferation and widespread symptoms.
What are the symptoms of shingles? How can doctors distinguish between common rash and shingles?
Early symptoms are non-specific; there is usually nerve pain or numbness under the skin in a certain area accompanied by flu-like symptoms like headache, fever or abdominal pain for 1-2 weeks. Rash and blisters would appear, with itching, stinging and burning sensation around the infected area. Delayed medical attention would see the pain aggravate and the rash spread, which may lead to skin inflammation, ulceration and complications like nerve pain. Therefore, you should seek medical assistance as soon as possible in case of suspicious symptoms.
The main difference between common rash and shingles is that rash causes itching while shingles causes stinging. Shingles usually involves infection of a single nerve, and hence herpes zoster only appears on one side of the body. The blisters would dry and crust over around 10 days. Both common rash and shingles may recur, but the former would not lead to postherpetic neuralgia (nerve pain) like the latter.
The doctor may make diagnosis according to clinical symptoms and the patient's medical history. Skin tissue may also be taken for confirmatory testing.
Why do people get shingles? Is it infectious?
Shingles is closely linked to chickenpox, which is caused by varicella zoster virus. Once the chickenpox infection has resolved, the virus will become latent inside nerve cells and reactivate in the form of herpes zoster during times of weakened health. According to foreign research, 3 out of 1,000 individuals would develop shingles. Every person previously infected with chickenpox is at risk, and the risk increases with age and impaired immunity.
Be cautious when you take care of chickenpox or shingles patients as varicella zoster virus is contagious. Never touch the blisters on the patients as they carry virus.
Many parents bring their children to chickenpox vaccination these days, which cannot provide 100% prevention but can alleviate the symptoms. So, even with chickenpox vaccination, an infection is still possible to allow virus to stay dormant in the body.
Who are the high-risk groups for shingles? It has been said that the infant would have shingles if the mother eats snake during pregnancy. Is that true?
Every person previously infected with chickenpox may develop shingles. Those aged above 50, cancer or AIDS patients are more vulnerable, principally due to advanced age, weakened health and compromised immunity. Hong Kong people, with heavy workload, insufficient sleep and high-pressure lifestyle, tend to have poorer resistance against viral diseases. As a result, shingles is rather common in Hong Kong.
Shingles is not related to diet. Whether the mother eats snake during pregnancy has nothing to do with shingles for the infant. Shingles is a skin disease caused by viral infection, thus snake is absolutely irrelevant. However, if the mother contracts chickenpox during pregnancy, the virus would pass onto the infant in its latent state and very likely lead to shingles by the age of 2. Therefore, pregnant women must stay away from chickenpox or shingles patients to protect the baby.
Case 2: How is shingles treated?
Mrs. Lee, 38, was diagnosed with cancer and fell victim to worsening health and mood. Several days ago, she found rash and blisters on her body with burning and stinging pain. Her family suspects of shingles and looks for treatment options.
How long would shingles last? When should I go to the doctor?
Shingles usually lasts for 7-10 days, while the blisters may take several weeks to heal, and normal skin will be restored in a month. Herpes zoster may leave scar or black spots for some patients.
Although herpes zoster usually clears on its own, viral damage to the nerve may aggravate the pain or even lead to the complication of nerve pain. Therefore, seek for medical help as soon as possible in case of any suspicious signs, especially the following:
- The rash expands in size while the pain intensifies.
- You or your family has impaired immunity or chronic disease.
- The rash is found near the eyes, as viral infection can cause blindness.
Postherpetic neuralgia may be persistent: most cases subside in 2-3 months, 10% several months and 2% more than 1 year. Early treatment not only reduces the pain, but also effectively lowers the possibility of neuralgia.
How is shingles treated? How can patients facilitate recovery?
Normally, shingles patients need to take antiviral drugs for 5 days with local application of ointment to relieve pain and discomfort, and speed up recovery. Analgesics would also be prescribed by the doctor in case of extreme pain.
Immunity is vital besides taking drugs on time. Patients should rest at home, drink more water, relax themselves and stay in positive mood. Skin care is important as well: shower daily and keep the skin clean and dry. Wash the affected area with cold water and apply the ointment after wiping. That can reduce itching and pain. Do not scratch or cover the skin with cloth/adhesive plaster, or inflammation may ensue.
Inspection and treatment by ophthalmologist is obligatory for shingles in the upper half of the face or near the eyes, to avoid any damage to the cornea and the eyesight.
Besides, patients should avoid contact with the elderly, those in poor health, chronic disease patients, pregnant women or children to prevent infection.
Is shingles preventable? What can we do in daily life?
After the initial infection, varicella zoster virus would be latent in the nerve root with the possibility to reactivate for life. To prevent shingles, the best way is obviously to avoid chickenpox. Children and those who have never had chickenpox can receive vaccination although prevention is not 100% effective. In other words, infection is still possible upon vaccination. In daily life, we should maintain personal and environmental hygiene, and wash the hands frequently. We should also refrain from contact with chickenpox patients.
Those previously infected with chickenpox should adopt a healthy lifestyle: wake up early and sleep early; do more exercise; and have a nutritious diet. All these can boost immunity and health. Stay relaxed and keep away from pressure to prevent reactivation of virus.
Drug treatment for Alopecia
Every day, roughly 100 hairs are lost from our head. The hairs fall out and will be replaced by new ones. The regular and natural loss of hairs due to normal body metabolism would not lead to "Alopecia". "Alopecia" means the excessive and abnormal loss of hairs. The most common form is "Androgenetic Alopecia", also known as "Male pattern baldness", which both males and females may suffer from. Below are the common drugs for treating "Androgenetic Alopecia":
Internal use - Finasteride
Finasteride is the only oral drug that approved by U.S Food and Drug Administration (FDA) to treat "Androgenetic Alopecia". It is a prescription-only medicine which can be used in male only. The main function of Finasteride is to lower the male hormone in the scalp. Male hormone can suppress the growth of hair follicles, hence, lowering the male hormone concentration in another words can promote the growth of hair follicles. The new hairs will usually come out after a continuous treatment for three months or more. The most common side effect of Finasteride is sexual dysfunction, e.g. loss in libido, erectile dysfunction, etc; yet these side effects will disappear upon the discontinuation of the drug.
External use - Minoxidil
Minoxidil is a vasodilator, which enhances the blood circulation in scalp and thus stimulating the growth of hair follicles. It can be used in both males and females. Minoxidil is available as the lotion form with a simple way of application. Just apply the lotion to the dry and clean scalp 2 times in a day, and then gently massage the scalp. Patients can buy the Minoxidil lotion in the dispensary under the pharmacists' supervision. An improvement of the alopecia condition is usually seen after 2 months of treatment. Minoxidil is relatively safer than Finasteride, and not much side effects are seen with Minoxidil. However, some patients may have allergic response towards it. If the patients come across any reddening and swelling, burning sensation; or any other allergic reactions after use, you should immediately stop using and inform the medical professionals.
Finasteride and Minoxidil can improve "Androgenetic Alopecia" efficiently, however, after a few months of drug discontinuation, patients' condition would return to the untreated state. Therefore, the existing medications can only ameliorate the condition, but not cure the alopecia in itself.
Source: Hong Kong and Drug Education Resources Centre, The Society of Hospital Pharmacists of Hong Kong
Vaccines against bacterial meningitis
Presently three types of vaccine are available in Hong Kong targeting the most common microbial etiologies of bacterial meningitis: S. pneumoniae, N. meningitidis, H. influenzae.
Pneumococcal Vaccines
In the prevention of pneumococcal meningitis (meningitis caused by S. pneumonia), pneumococcal vaccines are available as 23-valent polysaccharide vaccine and the newer 7-valent conjugate vaccine containing serotypes 4, 6B, 9V, 14, 18C, 19F and 23F conjugated to a nontoxic mutant diphtheria toxin. Since the 23-valent polysaccharide vaccine is not immunogenic for children under 2 years of age, it is recommended for all persons over 65 years of age and older children at least 2 years of age with high risk for invasive pneumococcal infection such as in those with chronic diseases. The newer 7-valent conjugate vaccine is widely used, and is usually given from 2 months of age at approximately 2-months intervals for 3 consecutive doses followed by a fourth dose at 12-15 months of age. Although the incidence rate of invasive pneumococcal diseases in Hong Kong was low, whether the inclusion of vaccines against invasive pneumococcal diseases in the Childhood Immunisation Programme (CIP) in Hong Kong is still uncertain while their cost effectiveness are being reviewed by the Scientific Committee of the Department of Health (DH).
Haemophilus Influenzae Serotype b (Hib) Vaccine
The H. influenzae serotype b (Hib) is a common causative bacteria of respiratory infections in children. The introduction of conjugated Hib vaccines during the 1990's has led to a marked decrease in invasive Hib infections in early childhood. Vaccination against Hib is not routinely recommended by the Department of Health in Hong Kong but is part of routine recommended childhood immunizations in other countries such as Australia, Canada and the United States. The Hib vaccine is composed of the capsular polyssacharide of Hib conjugated to a carrier protein like tetanus. New combined vaccines, which contain conjugated Hib vaccine, DTaP, injectable polio viral vaccine (IPV), and hepatitis b vaccine (HBV) are available to decrease the number of injections.
Meningococcal Vaccines
Presently there are two preparations of meningococcal vaccines against N. meningitidis available in Hong Kong - the bivalent (serogroups A & C) and the quadrivalent (serogroups A, C, Y & W135). These two vaccines are indicated for children more than 18 months (bivalent) or 2 years old (quadrivalent) and adults. The vaccines usually provide effective protection at 10 days following injection and each vaccine will offer up to 3 years of immunity. In Hong Kong, the incidence of meningococcal infections is low (6 notifiable cases of meningococcal infections in 2006) and about half of the meningococcal infections were caused by N. meningitidis serogroup B. The quadrivalent meningococcal vaccine does not confer protection against meningococcal infections caused by serogroup B. Furthermore, the duration of protection offered by the vaccine is short, and it is relatively ineffective in children under 2 years of age. Therefore, there is insufficient justification to include the quadrivalent meningococcal vaccine in the CIP in Hong Kong. However, the meningococcal vaccine is recommended for high-risk patients such as immunocompromised patients; patients with anatomic or functional asplenia; military recruits; persons traveling to an area in which group A epidemics occur (e.g., sub-Saharan Africa during the dry season); expects to have prolonged contact with local persons; and persons traveling to the countries with type C meningococcal outbreaks.
Source: Hong Kong and Drug Education Resources Centre, The Society of Hospital Pharmacists of Hong Kong
