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Patches of shingles appeared on hand and thoracic spine. No relief from antiviral medicine. Remedy?

DOCTOR OF THE MONTH - Mar 2013
Mar 2013
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Practicing since : 1998
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I have a large patch of shingles about the size of my hand directly on my thoracic spine, then a thinner band about 3 inches wide that continues around my trunk and across my right breast. I started anti-viral medication at day 2 of rash, and have been taking gabepentin for pain which is only minimally effective. I also have pain in my right arm from the shoulder to my hand, pain in my right scalp, pain on the right side of my face, and pain in my abdomen. There is no rash in these areas, but they are very sensitive to touch. My rash is still active, this is the 5th day since it appeared, and their has been no reduction in pain, which is more severe at night, starting about 5pm. Is this typical? I had to go to an urgent care clinic and they have not offered any additional help when I have called.
Posted Sat, 23 Mar 2013 in Infections
 
 
Answered by Dr. Aarti Abraham 48 minutes later
Hello
Thanks for your query.
Shingles is caused by reactivation of chickenpox virus.. Early symptoms include headache, sensitivity to light, and flu-like symptoms without a fever. You may then feel itching, tingling, or pain where a band, strip, or small area of rash may appear several days or weeks later. A rash can appear anywhere on the body but will be on only one side of the body, the left or right. The rash will first form blisters, then scab over, and finally clear up over a few weeks.

The rash caused by shingles is more painful than itchy, because the virus travels up the nerve roots, leading to extreme pain at times. This is why the rash can wrap around either the left or right side of your body, usually from the middle of your back toward your chest, along the area of nerve distribution. The pain is referred to areas supplied by the nerve, hence it can refer to your face, scalp, hand etc.

Shingles develops in stages:

Prodromal stage (before the rash appears)
Pain, burning, tickling, tingling, and/or numbness occurs in the area around the affected nerves several days or weeks before a rash appears.
Flu-like symptoms may develop just before or along with the start of the rash.
Swelling and tenderness of the lymph nodes may occur.
Active stage (rash and blisters appear)
A band, strip, or small area of rash appears. It can appear anywhere on the body but will be on only one side of the body, the left or right. Blisters will form.

Pain, described as "piercing needles in the skin," may occur along with the skin rash.
Blisters may break open, ooze, and crust over in about 5 days. The rash heals in about 2 to 4 weeks, although some scars may remain.

Postherpetic neuralgia (PHN) is the most common complication of shingles. It lasts for at least 30 days and may continue for months or years. Symptoms are:
Aching, burning, stabbing pain in the area of the earlier shingles rash.
Persistent pain that may linger for years.
Extreme sensitivity to touch.

Hence, having pain and rash on the 5th day is quite typical. Gabapentin is one of the most effective medications for the pain which you describe. You can try Zostrix cream, and also other higher order prescription painkillers. You should consult your primary care physician if the pain is unbearable.

Take care, and feel free to ask for further clarifications.
Above answer was peer-reviewed by
 
Follow-up: Patches of shingles appeared on hand and thoracic spine. No relief from antiviral medicine. Remedy? 7 hours later
Dr. XXXXXXX
Thank you for your prompt response. Its seems like I am already having symptoms of PHN such as allodynia, or can allodynia occur while shingles is in the active stage? Should I go to a family practitioner or a neurologist?
 
 
Answered by Dr. Aarti Abraham 52 minutes later
Hi
Thanks for the appreciation.
Allodynia most definitely occur during the active phase of shingles, however, it is defined as PHN If it persists beyond the active phase of rash.
I think you should consult a Neurologist, as you already faced certain apathy at the urgent pain clinic.
Take care, and get well.
Above answer was peer-reviewed by
 
Follow-up: Patches of shingles appeared on hand and thoracic spine. No relief from antiviral medicine. Remedy? 1 hour later
Thank you again! XXXXXXX XXXXXXX
 
 
Answered by Dr. Aarti Abraham 3 hours later
Anytime, XXXXXXX !
Its a pleasure interacting with you.
Feel free to leave a review, and consult me directly whenever you wish to.
Be well.
Above answer was peer-reviewed by
 
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