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The Informed Parent


by Louis P. Theriot, M.D., F.A.A.P.
Published on Nov. 01, 1997

Dear Dr. Theriot,

The little neighbor girl is 5 years old, and her mother told me that she came down with the shingles. I always thought that only older people got shingles. What is shingles, and how does a person get them?

Shingles, or Herpes zoster, is a reactivation of the virus that causes chickenpox. In other words, after a case of chickenpox, the virus (varicella zoster virus) may lay dormant in the nerve root even though the person has fully recovered from the chickenpox. Then at some later time, if reactivated, it manifests itself as a skin eruption that courses along the area of skin served by that particular nerve...shingles.

Unlike chickenpox, shingles occurs throughout the entire year and doesn't have a seasonal peak incidence. No one knows exactly what triggers the reactivation of the virus causing shingles. It is relatively uncommon in children under 10 years of age, after which its incidence increases steadily with each succeeding decade. The severity of the disease also increases with age. Second attacks of shingles occur in less than 1% of patients.

The initial symptoms of shingles may include pain, itching or even numbness along a strip of skin served by the affected nerve (dermatome). This can occur even before the rash appears. Then there is an outbreak of a red patchy rash that may appear in clusters. Within 12-24 hours the rash forms blisters or vesicles that have yellowish fluid in them. Within a week, the blisters begin to dry and crust. The rash tends to clear within 7-14 days.

The rash is almost always confined to one side of the body, and it rarely crosses the midline. It usually occurs along the trunk and is often painful and tender especially while the rash is spreading. In uncomplicated cases, the rash resolves on its own leaving varying degrees of superficial scarring or patches of increased, or decreased pigmentation (much like chickenpox). It can be much more serious if shingles affects the nerves serving the face. Fortunately, this is very uncommon in healthy children.

The treatment of shingles is directed at alleviating the pain or itching, and preventing secondary infection. Over the counter pain medicine should suffice, although some cases require codeine for the pain. Anti-histamines are effective for the itching, and one should be sure to trim the fingernails to minimize scratching. As is the case in chickenpox, avoid any product that contains aspirin because of the association with Reye syndrome.

Chickenpox is a highly contagious respiratory virus that is spread by coughing and sneezing etc. Shingles, on the other hand, is spread by direct contact with the skin lesions. So if the lesions are appropriately covered, there should be no risk to others.

In healthy children with normal immune function there is no need for specific anti-viral therapy because shingles is usually mild with swift recovery and virtually no residual effects. If you have any further questions about shingles, please discuss them with your doctor.

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