Forum: Early diagnosis and treatment key to controlling shingles

I refer to the article

“What is shingles and how is it prevented?”

(Oct 2).

There are three other important features of shingles, or herpes zoster infection, that people should be aware of.

First, diagnosis is often made late. This is because the first presentation of shingles is usually severe pain on a particular part of the body, supplied by the affected nerves. Depending on the location of the affected nerves, the pain can be in the chest which mimics cardiac pain, or in the abdomen which mimics acute abdominal pain.

I have come across patients presenting with severe right lower abdominal pain which appeared like acute appendicitis. Laboratory tests and scans showed normal findings and shingles was diagnosed only when blisters emerged over the affected area.

Diagnosis will be easier if patients consult the same doctor, rather than doctor-hop, as the same doctor is likely to appreciate the change in symptoms and signs.

Second, early administration of antiviral therapy is effective in controlling the infection and preventing complications such as post-herpes nerve pain and paralysis. Delayed initiation of antiviral drugs may lead to more complications.

Patients with suspected shingles should consult a doctor early and start antiviral treatment once diagnosis is confirmed. While complementary treatment such as acupuncture may help control the pain and help hasten recovery from the paralysis, it is not a substitute to antiviral therapy.

Finally, shingles usually occurs in older people or those with a weakened immune system. Post-organ transplant patients, or patients on chemotherapy, are particularly prone. Young people with shingles should be evaluated for any immunosuppressive states such as diabetes mellitus.

Early recognition of symptoms of pain with blisters, prompt medical consultation and early initiation of antiviral therapy are key to reducing the severity of shingles complications.

Desmond Wai (Dr)