HEALTH WATCH

Waimarino Bulletin, Volume 6, Issue 271, 24 January 1989, Page 16

HEALTH WATCH

Chances are you cannot remember that itchy rash called chickenpox you contracted when young but few will ever forget the time it re-erupts as shingles.

The virus is aptly nicknamed "Hell's Beit of Roses", a translation from its Norwegian name. It causes a nasty bright red rash, which eventually blisters and can, if untreated, fester and lead to ulceration and long term scarring. It also deals out often intolerable pain which can continue for up to a year after the initial attack. In 1989, some 12,000 New Zealanders will probably suffer from the disease. There is a strong chance you will experience it some time in your life if, as is very likely, you have already gone through its juvenile stage, chickenpox. Flew escape virus Shingles appears in approximately three people per thousand each year. Three quarters of cases are in the 45 and over age group,

and it is estimated that the majority of those who live to the ripe old age of 85 will by then have suffered a shingles attack at some stage in their lives. Very few will have a second attack. The blistering and pain that result can be alleviated and sufferers are advised to see a doctor or skin disease specialist as soon as the symptoms appear. Auckland specialist Dr Peter Gould says the first thing people will notice is an aching muscular pain, easily mistaken for a pulled muscle. After two or three days, red blotches will appear and within another twelve hours they will develop blisters filled with a clear fluid. "If they have a severe attack, these blisters can ulcerate or bleed. Occasionally they can have secondary bacte-

rial infection," said Dr Gould. Long term pain The rash will take six weeks to clear up, often leaving small marks, but the pain, called post-herpetic neuralgia, can stay around for many months or years and can be extremely severe. Shingles often appears in so-called immunocompromised patients such as leukaemia sufferers and others whose immune systems are suppressed by chemotherapy or radiotherapy. It is one of the host of opportunistic infections which can lead to the death of an AIDS sufferer. Shingles and chickenpox are caused by the same virus - varicella zoster, a member of the herpes family which also includes herpes simplex, the cause of cold sores and genital herpes. Just as cold sores can spread from adult to child by kissing and touching, the shingles and chickenpox virus is also highly contagious, particularly when the blisters are drying up and shedding scabs. Dr Phil Morton, a scientific advisor with Wellcome New Zealand, part of a worldwide company involved in viral rescarch, says the virus migrates from the nerve endings in the skin to the nerve ganglion, or base, where it will lodge for the rest of a patient's life. Stress triggers attack After a childhood episode of chickenpox, the virus can remain dormant for years until some emotional or physical stress triggers off a shingles attack. In a New Zealand study, it was often seen to reappear in the area of an old scar, or after some traumatic event such as the death of a close relative. Even the emotional stress of moving house has been known to set off an attack. Unlike cold sores however, milder stress conditions such as overexposure to sunlight and wind do seem to be less likely to cause a recurrence of the zoster virus. Once reactivated, the virus migrates back to the nerve endings in the skin, replicates and spreads usually in a

distinct area relative to the sensory nerve it has been occupying. It may be localised to one side of the face, sometimes involving the eye, or it may spread in a "girdle" around one side of the trunk (hence the "belt of roses"). The body's natural antibodies will move in to contain the virus and eventually the virus will return to the nerve ganglion. But this may take up to a week, during which time the rash has progressed unchecked and the patient has undergone so much pain that they often cannot tolerate the touch of clothing. In most cases

the pain will gradually disappear but the patient may experience continued tingling (pins and needles), itching or numbness in the area caused by damage to the nerve ends. Half of all sufferers can continue to experience these symptoms for up to six months after the event, while 10 per cent can still be suffering some pain six months later. Pain and other symptoms have been treated with steroids and analgesics in the past while new medications are being developed for use with shingles which ensure the disease need no longer be the infernal complaint it once was.