Recurring shingles rarely occurs, except in people with compromised immune systems, according to University of Alabama Medical School professor Richard J. Whitely, M.D. Immune system compromise can result from diseases such as AIDS or drugs used to treat other health problems, such as cancer or autoimmune disease. Although shingles usually produces mild, self-limited disease in healthy people, in people with compromised immune systems, shingles can produce severe disease with symptoms that never seem to heal.
Pain
During the first episode of shingles, pain precedes the onset of other symptoms by two or three days, says Whitely. However, according to the National Institute of Neurological Disorders and Stroke, 50 percent of people who develop shingles also develop a chronic pain syndrome known as post-herpetic neuralgia. Therefore, for patients with recurring shingles, pain loses its predictive value. In addition, patients with recurring shingles almost inevitably develop post-herpetic neuralgia and their pain may be severe because of repeated, inflammation-induced injury to the nerve. Narcotics, local anesthetics and other prescription medications that modulate pain signals may be required to provide relief.
Skin Rash
In healthy people, shingles produces a mild-to-moderate blistering skin rash confined to the distribution of a single nerve. Lesions usually form for three to five days and heal completely in seven to 10 days. According to Whitely, people with recurring shingles develop larger, more numerous blisters that are usually distributed over the territories of several nerves, rather than just one. In 40 percent of patients, the skin rash affects the entire body, says Whitely. New lesions continue to form for over a week and healing may not begin for three weeks. Antiviral drugs such as acyclovir can reduce the severity and duration of skin rashes due to recurring shingles. Antibiotics are required to treat secondary bacterial infections.
Meningitis and Encephalitis
Patients with recurring shingles are more likely to develop infections of the spinal cord and brain, called meningitis and encephalitis, respectively. Meningitis manifests with sudden onset of high fever, stiff neck and headache. People with encephalitis often exhibit seizures, mental stupor and coma, states NINDS. Both cause nausea and vomiting, confusion, disorientation, sleepiness, and sensitivity to light. Some people with recurring shingles also develop blindness. Prompt treatment with antiviral drugs is essential for recovery of vision. Most patients also require steroids to quell inflammation.
References
- "Harrison's Principles of Internal Medicine, 23rd Edition"; A.S. Fauci et al.; 2008
- National Institute of Neurological Disorders and Stroke: Shingles
- National Institute of Neurological Disorders and Stroke: Shingles Information Page
- National Institute of Neurological Disorders and Stroke: Meningitis and Encephalitis Fact Sheet
