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I NEED HELP ON SHINGLES PAIN

Celebrity chef Jean-Christophe Novelli has suffered from irritating shingles

Tuesday July 15,2008

By Dr Rosemary Leonard

Q Three years ago I had an attack of shingles, which in turn left me with postherpetic neuralgia in my right arm.

My doctor put me on carbamazepine tablets, which didn’t do much for the pain and gave me nightmares, so I gave them up. Do you know how I can ease the pain?

A Shingles is caused by the same herpes zoster virus that causes chickenpox. After an attack of chickenpox, the virus responsible lies dormant in nerve roots next to the spinal cord. Then sometime later – often 10
or 20 years – it re-activates and travels along one nerve to the skin, causing inflammation and the classic blistering rash of shingles. The reason is unclear, but it may be triggered by a period of stress or illness.

General “ageing” of the immune system is thought to be the reason why shingles is more common in elderly people.
Because shingles is caused by nerve inflammation it can be very painful, although usually the pain eases as the rash heals. Sometimes however, the pain – known as postherpetic neuralgia – persists. Up to a quarter of those affected over 60 have pain that lasts a month or more.

It is caused by ongoing inflammation in the nerves that carry messages about sensation (such as touch, heat, cold or pain) that can lead to a nasty, burning sensation – neuropathic pain.

Many find that wearing loose clothing that doesn’t scratch (so avoid wool) can be helpful.

Drugs that dampen down the transmission of the pain messages along the nerve fibres, such as amitriptyline (developed to treat depression) are better than paracetamol, which just takes the edge off the pain.

Drugs developed to treat epilepsy, such as carbemazepine and gabapentin, can also be effective.

These take at least two weeks to have any effect and side-effects vary, so if one does not suit you, it is worth trying another. Capsaicin cream, which contains an extract from chilli peppers, applied to the skin, may also help. It is available on prescription from your GP. Most cases clear within a year.

QMy father, who is 79, has a very dry scalp condition that I am told is known as cradle cap. The skin becomes flaky like large pieces of dandruff. Can you recommend any possible treatment?

* If you have a health question for Dr Rosemary, write to her at The Northern & Shell Building, 10 Lower Thames Street, London EC3R 6EN, or e-mail health@express.co.uk. Dr Rosemary’s reply will appear in this column.