Shingles

Question 1

Does the vaccine for shingles hurt?

Answer 1

If a person is over 50, they should get the vaccine. The vaccine hurts, but shingles itself is on another dimension of pain

Question 2

What is the typical presentation of shingles?

Answer 2

Painful and tingly sensation on trunk

Development of small blisters along nerve pathways (oozing/crusting can occur)

Usually affects one side of the body (not bilateral)

Occurs in 10-30% of people

Before the rash appears, pain is possible

It takes 3-4 weeks to resolve

Question 3

What pathogen causes shingles?

Answer 3

Reactivation of chicken pox (varicella) virus in nerves

Question 4

When does shingles occur?

Answer 4

Usually 50 years after chickenpox infection (can happen in younger people, but rare)

Question 5

What should pharmacists do when patients present with pain on one side of their back?

Answer 5

This is the realm of MD

Question 6

Is shingles on the face a severe condition?

Answer 6

Yes, it is a medical emergency because it could spread to the eyes

Question 7

What agents are used to treat the acute phase of shingles?

Answer 7

Antivirals within 72 hours (less effective in people younger than 50)

Analgesics (pain relief)

Cool compress/calamine (itch relief)

Question 8

How long do people need to use antivirals to prevent shingles from getting really bad?

Answer 8

7 days

Question 9

Are pharmacists prescribing a lot of antivirals for shingles?

Answer 9

No, Sask pharmacists only prescribed antivirals 65 times in 2019

Question 10

Can NSAIDs be used to help with pain in shingles?

Answer 10

We can use NSAIDs in acute shingles, but not the chronic form

Question 11

What is chronic shingles?

Answer 11

The skin has healed, but the pain remains for a longer period of time (post-herpetic neuralgia)

Question 12

What drugs are commonly used to treat pain associated with chronic shingles?

Answer 12

TCAs (amytriptyline): very common choice

Capsaicin

Question 13

What is the difference between neuropathic and somatic pain?

Answer 13

Neuropathic: The pain originates from the nerves and feels like hitting your funny bone 24/7

Somatic: The pain is from non-nervous tissue and it is like stubbing your toe (more temporary)

Question 14

Are NSAIDs effective in managing pain in chronic shingles?

Answer 14

No, they do not help manage painin chronic shingles

Question 15

What is the benefit of capsaicin?

Answer 15

It irritates the skin (counter-irritant), and it also reduces Substance P (associated with nerve pain)

Do not apply products with capsaicin on an active shingles rash (it will aggravate)

Question 16

Can someone with shingles pass it to other people?

Answer 16

Shingles itself cannot be transmitted, but chickenpox can be spread (same pathogen)

Question 17

How long does the immunity under shingles vaccines last?

Answer 17

4 years according to drug manufacturers

Question 18

What is pityriasis?

Answer 18

A spotty rash that has ambigious visual presentation, but one large rash will dominate a sea of smaller rashes

Seen in younger adults

Unknown etiology

Can go away on its own (last 6-8 weeks)

Can use anti-itch products, but no definitive therapy

Question 19

How to differentiate pityriasis vs. other skin conditions?

Answer 19

Tinea (tinea does not spread as fast)

Eczema (eczema will be in different spots, itchier and possibly blisters at start)

Psoriasis (silvery crust on lesions)

Hives (move faster, itchier, and no scaling)

Question 20

What condition is butterfly rash indicative of?

Answer 20

Lupus (more than 90% of patients have skin symptioms)