Doctor Q&A Youtube EczemaBlues Channel

AAD A:Z Videos with Dr Daniela Kroshinsky – Shingles

In 2013, I’ve featured American Academy of Dermatology (AAD)’s Dermatology A: Z Videos (here). Since then, AAD has added several other videos which are informative and practical. AAD’s public relations team has once again been most helpful in introducing me to the dermatologists who assisted with my questions, making it possible to bring this special AAD Dermatology A:Z video series to you!

The video covered today is “Shingles: Pain Management”. For this video, I interviewed Dr. Daniela Kroshinsky M.D., MPH, who is an Associate Professor of dermatology at Harvard Medical School in Boston and the director of pediatric dermatology and director of inpatient dermatology, education, and research at Massachusetts General Hospital.  

MarcieMom: Dr Daniela, thank you for helping out in this AAD video series. Shingles affects about 1 in 5 people and more common in people over the age of 50. However, it’s possible to get it at any age though, as my daughter with eczema and chickenpox (at age 2) had shingles at the age of 4! We’d like in this interview to learn more about managing the pain and the rash associated with shingles and pointers for an eczema child/patient with shingles.

Key points in the AAD Video

    • Anyone can get shingles if they have the chicken pox virus (varicella zoster), either from having had chicken pox or from chicken pox vaccination
    • Shingles rash – More pain experienced than chickenpox, commonly in one region of the body and usually confined to one side of the body
    • Symptoms of Shingles – Area of skin that burns, tingles, itches or sensitive; begins as red spots that turn to raised areas and blisters in the same area. This is followed by crusting.
    • 2 to 3 weeks for the blisters to heal with reducing pain
    • If pain, itch, numbness or tingling develops, it can last months to years
    • Anti-viral medication used within 72 hours of rash appearing may shorten the course of the rash and lessen the pain. After 72 hours, anti-viral medication can still lessen the pain.
    • At home – Cool the rash, apply calamine lotion, do not peel, pick at or pop the blisters, cover the rash with loose, sterile bandage and wear loose-fitting, cotton clothing
  • Shingles is contagious – can spread in the form of chicken pox to someone who has not had chicken pox or to the fetus of a pregnant person.
Questions answered by Dr Daniela Kroshinsky on Shingles : Pain Management
Questions answered by Dr Daniela Kroshinsky on Shingles : Pain Management

MarcieMom: Shingles is caused by reactivation of an infection that is dormant in a nerve and the area of skin supplied by the nerve. Dr Daniela, can you explain which nerves get infected most often and is that why most people get the shingles rash on their torso? In the video, it is mentioned that some people get it on their face – does a person’s age and immune system affect which nerves will get infected? Once infected, can it spread from one part to another of the body?

Dr Daniela: In general, shingles will arise in the area of the body that had the greatest concentration of blisters at the time of the chicken pox but it varies widely.  Most chickenpox blisters arise on the torso.  Once someone is infected, they can spread the lesions to other parts of theirs skin through contact with the blister fluid which contains active virus.  In addition, people who have compromised immune systems may experience widening of the affected area beyond the initial skin patch fed by the nerve. This is called “disseminated zoster” and requires urgent attention and treatment.

Reducing Pain in Shingles

MarcieMom: We learnt in the video that anti-viral medication can help to reduce pain and pain relief measures at home can help. Why do certain people feel more pain than others? (Age, immune system, or existing medication they are on?) Are there any measures one can take to reduce the likelihood of prolonged pain, ie months after the rash has healed (Postherpetic neuralgia or PHN)?

Dr Daniela: There are many factors that can influence people’s perception of pain, many that we are still starting to understand.  Starting antiviral medication as soon as possible is the most helpful tool to help minimize the risk of pain.  If PAIN develops, seeking medical attention as soon as possible, including with a pain specialist if needed, can help to better manage these symptoms.

Lowering Likelihood of Shingles’ Complications

Apart from postherpetic neuralgia, there are other complications such as

    1. Skin infection, from bacteria/germs
    1. Shingles at the eye can cause eye inflammation
  1. Muscle weakness (palsy) due to shingles infection of the motor nerve

MarcieMom: Of particular interest is skin infection. What are the factors that will increase the chance of skin infection and what measures should one take to reduce the chances of skin infection?

Is someone with eczema skin that is already colonized with staphylococcus aureus bacteria more likely to suffer from skin infection? If yes, is it advisable to clean the shingles rash with chlorhexidine?

Dr Daniela: Picking or touching the lesions can introduce bacteria that could create bacterial infection of the shingles. Keeping the lesions clean and covered helps to minimize this.  With eczema in general, keeping eczema controlled and minimizing wounds helps to prevent secondary infection.  It is not necessary to clean shingles with a medicated soap.  Chlorhexidine can be irritating and can dry out skin, further exacerbating eczema and as such I would not recommend it be used for shingles.  Keeping the lesions covered and clean with gentle care is usually sufficient.

Managing Shingles for those with Active Eczema

For some eczema children and adults, they may be on various courses of corticosteroids or immunosuppressant, such as prednisolone, mycophenolate mofetil and cyclosporine. Will taking such medication increases the risk of getting shingles? 

Is it possible that shingle rash will appear over a patch of skin with eczema flare-up? If so, what topical medication should be applied? (still ok to apply topical corticosteroid over the eczema if shingles appear on the same patch?)

Dr Daniela: Immune-lowering medications can make it more likely that someone will have their shingles spread more widely so it is important to watch shingles as it develops to assess whether the eruption is spreading more widely, warranting more aggressive treatment. Once antiviral treatment has been started, topical steroids can be used cautiously to the eczema around the shingles lesions but it is important not to rub the viral lesions as it is possible to spread the viral particles and extend the infection.  Anti-itch medications like antihistamines can be very helpful to control the symptoms of itch that can accompany eczema.

Thank you Dr Daniela for helping us to understand how to manage shingles and offering clarity for those suffering with eczema who also get shingles.

Support Group

Shingles for Eczema Child

Shingles in a child with eczema
Shingles in a child with eczema

Sometime end of last year, my daughter with eczema had a case of Shingles! We didn’t think it was shingles as it is not very common that young children (age 4) get shingles. But she did – as she also had chickenpox before at about age 2. (She also likely had many times of Hand Foot Mouth Disease!)

Before we cover the basics of shingles, just want to share our experience of a 4 year old eczema child getting shingles.

First 2-3 days: She got itchier than normally, and small red bumps started appearing around her torso. We didn’t know it’s shingles, how would we when it is not very different from eczema flare-up?

Next 2 days: More pronounced bumps and blisters on one side of her torso and she complained about some of the bumps being painful. We brought her to a general practitioner who then diagnosed it as shingles and gave her medication cream to apply.

Next 2-3 days: The blisters/ rashes subsided, and she’s as good as she normally is!

On hindsight, there are certain symptoms to look out for:

  1. The rashes being painful.
  2. The rashes being only on one half of her torso.
  3. The rashes looking a little different from her normal eczema rash (but really, it’s quite hard to tell in the first 2-3 days).

What we did:

Apart from the medication cream that the doctor prescribed, we did the usual and continued with moisturizing and shower. There’s no apparent change in her diet or sleep pattern. She got it after a few of her classmates were ill, so I’m not sure if a reduced immunity assisted in the onset of shingles. Now let’s find out more about it!

What is Shingles?

Shingles is an infection caused by the chicken pox virus (varicella zoster), and only people who had chickenpox can get shingles. This is because the virus still remained dormant in the body and later reactivated and become shingles.

Obviously, don’t go to school or crowded place (7 days). Someone who had not have chickenpox may get chickenpox after contact with one with shingles.

Who can get Shingles?

Generally, people over 50 with weaker immune system are at higher risk of shingles, if they had chickenpox before. But as we know, children as young as 4 year old can get shingles!

What are the Symptoms?

Various signs are pain, tingling, burning sensation on one side of body, mostly on the torso. This can be accompanied by fever, chills and headache. Blisters will develop in the next few days, get crusted and pain may linger after the blisters are healed.

How to treat Shingles?

No treatment needed, but the pain can be soothed by pain relievers or cold compress. Anti-viral medication or cream may be prescribed.

How to prevent Shingles?

Chicken pox vaccine can be considered for those who have not had chicken pox. Keeping immune system strong helps, i.e adequate sleep (something which an eczema child lacks of!), lower stress level and healthy lifestyle.

Share your experience in the comments too, it can help other parents going through the same!