[Health in the 100-Year Life Era] Conquering Shingles

Not long ago, while having lunch with a professor at the hospital, we started talking about all the various experiences we had with herpes zoster. The professor said, "Back in my day~ it was so tough that even during our young 20s as residents, there wasn’t a single person who didn’t get herpes zoster (Herpes zoster, 대상포진) at least once." Another professor, who was an avid skier, shared that during his first year as a resident, he pulled an all-nighter on a night shift in winter and, wanting to ski badly, went skiing in the morning without sleeping, only to suffer from herpes zoster on his back and struggle for a while. Herpes zoster can occur in young and healthy people when their immunity drops due to extreme fatigue or stress, and even elderly people can develop it despite having received the herpes zoster vaccine. Although it is a very common disease that can be quickly diagnosed and treated at nearby primary or secondary hospitals, many patients suffer for hours in front of university hospital emergency rooms due to lack of awareness. I hope this article will be helpful to those patients.

Herpes zoster is a viral disease accompanied by severe pain along with blisters or rashes on the skin. Generally, pain starts first in a specific area on one side of the body, and skin lesions appear a few days later. When a patient visits the emergency room with pain on one side of the torso, there are initially no skin lesions, so it is easy to mistake it for simple muscle pain or another condition. When a patient presents with sharp, stabbing, or burning pain in one area of the body, emergency medicine doctors consider the possibility of herpes zoster as long as basic tests show no particular problems, and they make sure to explain this to patients before discharge. The painful skin area will develop a rash a few days later, followed by blisters that fill with pus like acne and then scab over. If herpes zoster occurs near the eyes or face, it can affect the eyes or facial nerves, causing vision impairment or facial paralysis. If it spreads to the ears or scalp, it can cause not only facial paralysis but also meningitis, so in such cases, prompt medical attention is necessary.

The skin lesions caused by herpes zoster have a characteristic shape and distribution, so they can be identified just by looking at the clustered blisters or pustules arranged in a band-like pattern. If necessary, the lesions can be scraped to detect the virus. Once herpes zoster is confirmed, antiviral treatment is started immediately; taking medication within 3 to 5 days of blister onset usually leads to complete recovery. If blisters have not appeared, preventive antiviral medication is not necessary. Since herpes zoster is usually accompanied by pain, painkillers are prescribed together, and topical medications may be used to prevent secondary infections. In some cases, even after the rash disappears, severe pain persists, progressing to postherpetic neuralgia. In such cases, strong painkillers or other procedures such as nerve blocks may be required.

The herpes zoster vaccine does not completely prevent herpes zoster, but vaccination reduces the severity of symptoms if one contracts the disease and lowers the risk of complications such as postherpetic neuralgia. Therefore, adults aged 60 and older should consult with their doctor and receive the appropriate vaccine.

Park Chaeryeong, Department of Emergency Medicine, Severance Hospital