Shingles Complications In The Elderly

Shingles, or zoster, is commonly seen in people who are age 60 years old and older. The incidence rises in the elderly as age progresses. The complications of shingles are painful, incapacitating, as well as chronic, lasting for six months or more. This condition is called postherpetic neuralgia (PHN)

Shingles is caused by the varicella zoster virus, which is the same virus that causes chickenpox, found mostly in young children. Once you have had chickenpox you are immune, however, you are at higher risk for develping shingles in later years.

Other risks for zoster are:

• Weakened immune system


• Pregnancy - which weakens the immune system


• Chemotherapy treatments


• Cancer


• HIV/AIDS


• Prolonged and extreme emotional stress


• Anti-rejection drugs

A shingles virus remains latent in the dorsal nerve root after a bout with chicklenpox has come and gone. An underlying disease component related to the immune system can trigger a reaction, resulting in reactivation of the zoster virus. Should an infection begin anywhere on the face, risk of eye infection increases. This can result in temporary or permanent vision and hearing loss.

Of equal concern is bacterial infection of the open blisters, which can result in scarring of the affected area, as well as other dangerous conditions that can destroy the underlying soft tissues of the body. That is why it is important to be diligent in keeping the blisters clean.

Other complications include:

• Depression


• Pain


• Sleep deprivation


• Pneumonia


• Postherpetic neuropathy (PHN)

PHN is a very painful complication of shingles in the elderly. The older a person is the more painful PHN is. The pain can last from weeks to years and can be disabling.

Medications for shingles:

• Antivirals


• Steroids


• Antidepressants


• Anticonvulsants


• Analgesics

Corticosteroids such as Prednisone, used usually in combination with acyclovir to combat nerve inflammation.

Treatment for PHN:

• Lidocaine patch applied to the skin for pain;


• Anticonvulsants such as gabapentin (Neurontin) and carbamazepine (Tegretol)


• Tricyclic antidepressants


• Opioids such as oxycodone, morphine, and methadone


• Relaxation and biofeedback


• Imagery

Soothing lotions such as calamine are effective to relieve itching and pain. Additionally, capsaicin cream can be applied to crusted over blisters.

Eye infection due to shingles is treated with antivirals and corticosteroids. It is imperative to consult with an eye doctor if the eyes become infected with zoster.

Prevention:

Zostavax is a vaccine approved for prevention of shingles for people 60 years and older. Zostovax is a chickenpox booster recommended for the older generation that helps to prevent a VZV attack, which also acts to ward off the complications related to a zoster infection.

A shingles infection is not a walk in the park. It is painful, debilitating, and disabling. You can prevent an infection by lowering your stress, and as we have learned, shingles can be brought on when you have been stressed for a prolonged period of time. Never ending stress may also be responsible for many other illnesses such as high blood pressure and heart attack. Therefore, it is important to take measures to reduce your stress to stay well.

by Barb Hicks RN/LMT