Shingles: a belt of roses from Hell.

Shingles: a belt of roses from HellThe Norwegians have an admirable name for zoster (which like shingles means belt)-"a belt of roses from Hell"-while the Danes call it "hell-fire."The pain is such that few other conditions will drive so many patients to despair.Much unnecessary mystique still surrounds the disease, even among doctors.Yet, although we do not know everything about this common ailment, much is certain.Zoster is the reactivation of the latent varicella-zoster virus, usually in the sensory nerve cells but sometimes in motor cells, in a patient who has had chickenpox at some time.Chickenpox may be contracted from a patient with zoster,1-3 but, contrary to common belief, there is no evidence that zoster may be contracted as a reinfection with a virus from a patient with chickenpox or zoster.It afflicts about 20% of adults at some time, but seldom more than once; and it occurs sporadically, and independently of epidemics of chichenpox.4 5 Records covering over a quarter of a century show a fairly constant incidence of 3-4 per thousand of the practice list per annum.4Zoster may occur at any age but increases in frequency and severity with age, being 15 times more common in the eighth than the first decade.Although pain is the outstanding feature, it may be absent, and is usually mild in the young; most old people have it, however-possibly for months or years.It may precede the eruption in sensory zoster by three weeks, but sometimes vesicles appear after only a day's warning.Very occasionally no blisters appear, in which case zoster can be diagnosed only ifthe doctor thinks about the possibility.Neutralising antibody to varicella-zoster virus is absent or present in a low titre at the onset of zoster,6 but both complement-fixing and neutralising antibody appears more quickly than in chickenpox.Sensory zoster may occur in any dermatome.Trauma of the affected part has been suggested as a common cause of reactivation of the latent virus.7The virus has been detected in the skin and nerves in active zoster.8Ophthalmic zoster, with the nasociliary branch affected, may produce troublesome eye symptoms, and zoster of the lower sacral segments may affect the bladder and rectum, giving rise to retention of urine and severe constipation.910