Saturday, February 22, 2014

All The Shingle Ladies

All the shingle ladies
All the shingle ladies
All the shingle ladies
Now put your hands up!

Okay, ang korni ng introduction. And no! I don't have shingles. Naisip ko lang sumulat about it.

Recently, I was asked to check on one of my blood brothers if the rashes he had was that of shingles. And when I saw him and his rashes limited to that one area of his chest and back in a stripe/linear fashion, I immediately confirmed my diagnosis. It is, without a doubt, shingles.

We all probably have been infected by chickenpox/varicella/bulutong during our childhood years. We had fever, body malaise, and the characteristic rash of chickenpox, fluid-filled vesicles, (hence the term bulutong tubig) often figuratively described as a dewdrop on a rose petal. These vesicular lesions start to appear from the head, down to the trunk and the extremities until the lesions heal into scabs while some more lesions develop so that the skin lesions are of different stages.

And just when we thought we are healed after all the lesions disappear, the varicella-zoster virus (VZV) slyly hides at some place where it won't be noticed by the guards of our body. It finds comfort and seeks refuge at the sensory part of just one specific nerve root.

Skin distribution (dermatome) of each spinal nerve.

With fit bodyguards (immune system) patrolling our body, the virus can't go anywhere but stay inside the nerve root. Until the opportune time when our guards are down (stressed states, immunocompromised states) that it goes outside and cause re-infection. But this time, the VZV infects only the part supplied by the specific sensory nerve root where it lived.

Say for example, the virus resided at the T4 nerve root. When it re-awakens, it infects the skin supplied by T4 which is somewhere around the nipple area. (Kindly refer to the figure above.)

Hence, the herpes zoster/shingles (or bulutong ahas as commonly called by our elders, pahaba kasi na nakapaikot sa harap at likod ng katawan).

Same characteristic lesions develop, those dewdrop on a rose petal skin lesions. It is very painful, as it infects the sensory part of the nerve root. It is usually unilateral (one-sided, either the left or the right). And the skin lesions are localized to a specific area usually in a linear fashion because the virus only infects one nerve root supplying only that specific area in our body.

Characteristic sexy body of... I mean, characteristic skin lesions of shingles.

Mutants who haven't had chickenpox or haven't been immunized by the varicella vaccine may develop chickenpox after being exposed to individuals with chickenpox or shingles. They don't get shingles right away.

Moreover, mutants who have had history of chickenpox or have been immunized by the varicella vaccine are not prone to develop shingles after being exposed to individuals with chickenpox or shingles. They get shingles because of their immunocompromised state, and not because they become exposed.

It is treatable. A 10-14 days treatment regimen of acyclovir plus simple analgesics or pregabalin for the neuropathic pain will do. Though some people develop postherpetic neuralgia, the persistence of pain even after the lesions have all been gone.

Sana, I was able to make a simple explanation about shingles. Hindi sana sumakit ulo niyo or mas naguluhan sa mga pinagsasabi ko. Hahaha!

As of writing, I haven't heard from that blood brother who got shingles. I hope he's complying well with the medications I have prescribed for him. May the efforts of the other blood brothers who have helped him in his current battle won't go to waste. I'm praying for his speedy recovery too.



  1. So much dermatomes! No wonder Si gets crazy when studying medical related stuffffiess

    1. hirap no.. hahaha! pero yun mga distinct landmarks lang naman kelangan aralin sa dermatomes.. :)

    2. it's not as hard as it seems :)