Herpes Zoster, commonly called Shingles, is characterized by a painful rash with blisters. It is caused by the dormant varicella zoster, also known as chickenpox, becoming active again, often years following the initial incidence of the infection. The dormant virus becomes active when the patient’s immune system declines due to illness, immunosuppression or aging, stress or malnutrition. This is also why cancer patients have a risk of getting herpes zoster due to the emotional stress/strain placed on the person, the effects of the cancer on the body’s immune system or the effects of treatments that cancer patients receive that compromise immunity.

The painful rash is associated with an involved nerve root and its associated cranial or spinal nerve dermatome that occurs 3-5 days after transmission of the virus. It will usually only be present on one side of the body because it typically will not cross midline. However, it can affect both sides of the body at different levels. Patients will typically experience pain and itching before the skin lesions are noticed.

Half of the people affected are over the age of 60, but people of any age can develop herpes zoster (shingles) if they have previously contracted the varicella-zoster (chicken pox) virus. However, there is another setting in which shingles is known to emerge in people of all ages – that of a weakened immune system. And therefore having cancer and/or undergoing treatments associated with this, puts you at risk of developing condition. 

At first, there is only pain, tingling, or burning before a rash appears. The pain that the patient may experience can be constant or intermittent and will vary from light burning to a deep visceral sensation. This is generally on one side of the body. The rash appears as red areas, then blisters that break and form crusts. This rash usually lasts two to three weeks and often affects an area from the spine to the chest or abdomen. It could also affect the ears, face, or eyes. Other associated symptoms that may or may not be present include flu-like symptoms such as fever, chills, headache, joint pain, and swollen glands.

Postherpetic neuralgia, which is pain lasting longer than 90 days following the initial herpes zoster rash, was found in 24% of patients in a quality of life study by Drolet et al. Acute pain and postherpetic neuralgia were most commonly associated with anxiety, depression, difficulty sleeping, and decreased ability to participate in activities of daily living. Early interventions like Physiotherapy can help decrease the risk of developing postherpetic neuralgia.

Antiviral medications are commonly prescribed to treat shingles to shorten the duration and ease the severity of the outbreak. Analgesics may also be prescribed to help with the pain related to shingles.
Physical Therapy Management (current best evidence)Physiotherapy is effective in treating the pain as well as the blisters and rash associated with shingles. Laser therapy has been found to be effective in drying up the blisters and rash assisting in shortening the healing time and reducing risk of chronic nerve pain. 

TENS may be used to treat acute pain and reduce the healing time of the rash associated with herpes zoster. It can be used safely with medical treatment or as the only treatment. A recent study in 2012 found that TENS may be as effective as traditional pharmacological therapies, and it may help reduce or prevent the risk of developing longer lasting/chronic nerve pain. TENS therapy generally involves placing two electrodes on the dermatome affected by herpes zoster for 30 minutes five times per weeks for a period of time up to three weeks.

If the facial nerve is affected by herpes zoster and peripheral facial palsy results, facial exercises have been found to be effective. These exercises include exercises to stimulate functional movement in the face, achieve symmetry, to improve motor control, reduce, improve perception of movement, and promote emotional expression. Mirror therapy, mime therapy, facial muscular re-education, and Kabat’s exercises were found to be effective means of facial rehabilitation techniques.

At Celeste Prinsloo Physiotherapy we effectively treat Shingles on a regular basis. Give us a call today if you or someone you know are battling with this condition.