Answers To The 24 Most Commonly Asked Questions
About The National Shingles Foundation,
Shingles, Post-Herpetic Neuralgia (PHN) and Chickenpox

(1) What is the National Shingles Foundation?
The National Shingles Foundation is the worlds only nonprofit organization
solely dedicated to the fight against the varicella-zoster virus
(VZV) and VZV infections (chickenpox, shingles and post-herpetic
neuralgia) through research and education.
(2) Can the Foundation help me determine whether or not I
have a VZV infection and advise me on treatments?
The National Shingles Foundation is not licensed to practice medicine
and, therefore, cannot make any diagnosis, prescribe medication
or make physician referrals. No information contained on this website
is medical advice or a substitute for the advice of a physician.
If you have any of the conditions or symptoms described on this
website, you should consult a physician as soon as possible.
(3) Does the Foundation have a list of physicians who specialize
in VZV infections?
Since it is not licensed to practice medicine, the National Shingles Foundation does not have a list of VZV specialists nor can it make
any referrals to physicians, pain clinics or patient support groups.

Shingles
Post-Herpetic Neuralgia (PHN)
PHN Pain Teatments
Chickenpox

Shingles
(4) What is shingles and how is it caused?
Shingles is an often-painful outbreak of rash or blisters on the
skin. It is caused by a reactivation of the varicella-zoster virus,
the same virus that causes chickenpox.
(5) What causes the varicella-zoster virus to reactivate?
Scientists do not know exactly what triggers a reemergence of the
varicella-zoster
virus. However, scientists do know that it more commonly occurs
in people over age 50, and in those who have a weakened immune system
brought on by an illness such as cancer and certain medical treatments
such as chemotherapy.
(6) Who can get shingles?
Anyone who has had chickenpox can get shingles, although it is most
common in individuals over the age of 50. Individuals who have conditions,
or are undergoing medical treatments, that weaken their immune systems
are also more likely to develop shingles. These include: HIV infection;
chemotherapy or radiation therapy; corticosteroids; transplant operations
and possibly stress. National Shingles Foundation estimates that
nearly one million individuals develop shingles in the U.S. each
year.
(7) What are the signs and symptoms of shingles?
The early signs of a shingles outbreak are so vague, they can easily
be mistaken
for another illness. They include: burning or shooting pain, numbness,
tingling or
itching in an isolated region on one side of the body or face. Mild
flu-like symptoms, such as headache, fever, chills and nausea, may
also be present. Lesions (the rash) appear on the skin from one
to 14 days later, usually in a band on one side of the body, or
clustered on one side of the face (where there previously was pain).
In two to four days, these lesions become fluid-filled blisters.
In two to four weeks, they slowly crust, scab and heal. Once the
blisters heal, one may continue to have pain for a month or longer.
The skin may also become discolored where the rash once was.
(8) Can shingles occur without a rash?
Yes, but this is rare. It is called zoster sine herpete. The shingles
rash may also go unnoticed. Shingles typically starts out without
the rash. The patient may
experience burning or shooting pain, numbness, tingling, itching,
headache, fever,
chills and nausea. While the rash almost always follows, it may
be disregarded or
mistaken for something else.
(9) How is shingles treated?
One of three oral, antiviral medications is usually prescribed for
shingles: acyclovir, famciclovir and valaciclovir. Early treatment
with one of these drugsideally within 72 hours of the appearance
of the rashcan lessen the duration of shingles and lower the
risk for post-herpetic neuralgia (PHN).
(10) Can a person get shingles twice? If so, does it appear
in the same place twice?
Yes, a person can get shingles twice it recurs in an estimated
one to five
percent of patients and it can reappear many years after
the initial episode of shingles.
If shingles strikes
a second time, it will usually not appear in the same location.
Most people who seem to experience multiple episodes of shingles
are probably having recurrent infection with a related herpes simplex
virus and not true shingles.
(11) Can a person who has never had chickenpox develop shingles?
No. To get shingles, one must already have had a case of chickenpox
and therefore harbor the varicella-zoster virus in the nervous system.
However, the case of
His or her chickenpox may have been very mild and unrecognized.
(12) Is shingles contagious?
Shingles cannot be caught from a shingles sufferer. Nor can a person
catch shingles if exposed to someone with chickenpox. However, a
person who has never had chickenpox can come down with chickenpox
if he or she is exposed to the shingles rash.
(13) What should I do if I suspect I have shingles?
See a doctor (e.g., general practitioner, family physician, internist,
dermatologist or neurologist) immediately if you are experiencing
any of the symptoms of shingles or if there is any unexplained rash
or pain in any part of your body. Shingles treatment is most effective
if administered by a doctor within 24 to 72 hours of the appearance
of the rash. If a doctor cannot determine the cause of a shingles-like
condition, the patient can suggest that it could be shingles. If
a rash is present, the doctor can conduct a test to determine whether
it is shingles.
Post-Herpetic Neuralgia
(14) What is PHN and how is it caused?
PHN (post-herpetic neuralgia) is the name given to the pain that
lingers for months or even years after the shingles rash has healed.
PHN results from injury to the nervous system caused by the varicella-zoster
virus during the shingles infection. The pain of PHN may be sharp,
burning, throbbing or stabbing.
(15) What are the signs and symptoms of PHN?
If an individual, whose shingles rash has healed, experiences significant
pain in the area where the shingles rash occurred, or beyond that
area, it could be PHN. In addition, if touching the skin causes
pain, the patient may be experiencing allodynia, a frequent symptom
of PHN. Allodynia is a condition in which the skin is unusually
sensitive to normally painless stimuli, such as the touch of clothing
or a gust of wind.
(16) How long does PHN last? Will it ever go away?
The duration of PHN varies widely. In some patients, it can last
for months or even years. However, for many patients, the pain will
lessen over time. Furthermore, there are a growing number of pain
relief options for PHN that are proving to be effective for many
patients.
(17) What type of physician should be consulted to treat PHN?
If one suspects PHN, a physician should be seen as soon as possible.
The physician may make a referral to a pain specialist, neurologist
or anesthesiologist who has experience in working with PHN patients.
(18) Can PHN be cured?
Currently, PHN cannot be cured. The relief of the pain it causes
is the focus of treatment. However, the effectiveness of treatment
for PHN varies widely among patients.
(19) Can PHN be prevented?
Currently, PHN cannot be prevented in all patients. However, prompt
medical treatment for shingles can lessen the duration of shingles
and lower the risk for PHN. Specifically, the effectiveness of antiviral
medication (acyclovir, famciclovir or valaciclovir) is well established
if it is taken within 72 hours after the appearance of the shingles
rash.
There is a major study
underway The Shingles Prevention Study whose aim is
to determine if vaccination can decrease the incidence and/or severity
of shingles and its complications in older adults. The study is
also trying to determine if vaccination can protect against PHN.
The outcome of this study will help scientists determine whether
PHN prevention is a valid strategy using this vaccine.
PHN Pain Treatments
(20) How is PHN treated?
The following is a brief summary of PHN treatments and their relative
effectiveness as assessed in a paper published in the May 2000 edition
of the journal Drugs, entitled, "Treatment of Postherpetic
Neuralgia: An Update."1 In this article, authors Ghassan E.
Kanazi, M.D., Robert W. Johnson, MB, BS, FRCA, and Robert H. Dworkin,
Ph.D., reviewed the findings of recent studies.
Each pain relief medication or procedure assessed is referenced.
Reference is also made to studies conducted on other medications
that fall under the same classes of drugs, but that were unable
to be included in this text due to space limitations. All study
references are provided so that physicians can learn more about
each treatment, including potential side effects.
Ones physician, who is most familiar with an individuals
case of PHN, will be able to determine which of these or other treatments
can best relieve an individuals PHN-related pain. Please
note that the opinions expressed are those of the articles
authors and not the National Shingles Foundation, which is not licensed
to practice medicine.
I. Pharmacological Approaches
(A) Topical Agents
Topical agents include the lidocaine patch
(Lidoderm), a patch containing a solution of lidocaine, which
is the same medication used by dentists. The lidocaine patch was
approved by the FDA in 1999 to treat PHN.
In their article in the journal Drugs, Drs. Kanazi, Johnson
and Dworkin cite studies that found "a majority of patients
treated with the
patch
reported moderate or greater pain
relief." 1,2,3,4
Capsaicin cream is sold as a pain reliever for arthritis
and PHN. Drs. Kanazi, Johnson and Dworkin stated, in their article,
that capsaicin cream "continues to play a minor role in the
treatment of patients with PHN. Compliance
is low because of
the intense burning after application, which may, however, lessen
with time." 1 These authors also reported a recent review concluded
there is no evidence of significant improvement following capsaicin
treatment. 1,5
Chickenpox
(21) What is chickenpox?
Chickenpox is a very contagious disease primarily affecting children.
It is caused by the varicella-zoster virus (VZV).
(22) Can chickenpox be prevented?
Yes. In March 1995, the U.S. Food and Drug Administration (FDA)
approved the countrys first chickenpox vaccine.
(23) Why should chickenpox be prevented?
Chickenpox is not simply a mild childhood illness, but, rather,
a potentially serious infection. While its most common complications
are bacterial skin infections, other complications include inflammation
of the brain (encephalitis) or pneumonia, although these are rare
in otherwise healthy people. According to the Centers for Disease
Control and Prevention (CDC), each year, in the U.S. alone, chickenpox
complications result in the estimated hospitalization of 11,000
individualsthe majority of whom were otherwise healthyand
105 deathsthe majority of whom are children.
(24) Is the chickenpox vaccine safe and effective?
Experience and research to date have shown the vaccine to be safe
and effective. A five-year, active surveillance study of varicella
incidence and hospitalization conducted between 1995 and 1999 at
three sites by the CDC reported an 80 percent reduction in varicella
incidence, with the greatest decline among children one-to-four
years of age.