Makeup Down Under

Question:

A co-worker of mine who thought she had painful poison ivy called in sick today, because her doctor diagnosed shingles. I heard there is a new shingles vaccine. I am 35 years old and not pregnant. Should I be concerned that I will catch shingles from her, and should I get the shingles vaccine?

Answer:

There are a lot of pieces to this problem. Shingles, also called herpes zoster, is a nerve and skin infection caused by the same virus that causes chickenpox. Shingles is a re-activation of the chickenpox virus that remained in the nerve root from a person’s initial chickenpox infection years ago.

The virus activation and infection is restricted to that single nerve root, which supplies only one side of the body. That accounts for the pattern of the rash, which always follows the nerve around that side of the body, stopping at the body’s midline. The nerve involvement explains the pain associated with shingles.

The skin rash begins as red patches along the nerve path and soon becomes blisters. They heal in 2-8 weeks without treatment. However, treatment with oral anti-viral medication (acyclovir, famvir, or valtrix) shortens the attack and reduces the symptoms.

Shingles is only contagious through direct skin-to-person contact with someone who has never had chickenpox. Small children and infants, as well as patients with decreased resistance (cancer patients, patients with AIDS, patients on chemotherapy, etc.), are at greater risk to catch chickenpox from someone with shingles. It is advisable to cover the area where the shingles are evident if out in public to avoid skin contact with another individual.

Bottom line, shingles is not very contagious; and unless you are susceptible, have never had chickenpox or had direct contact with the co-worker’s skin lesions, you have no significant risk. There is a vaccine available for shingles that is recommended for patients over 60 who have not had shingles. The reason for the age recommendation is that the severity of shingles seems to increase with age. The vaccine has limited protection in some patients, but would hopefully decrease the severity of the shingles in those patients.

Younger patients have less severe cases of shingles and respond well to the oral shingles medication. The earlier a person makes the correct diagnosis and begins treatment, the less severe the shingles should be. With your young age of 35, I would not recommend that you get the shingles vaccine.

Question:

I am 34 years old with two small children, a husband, and hands that are red, scaly, and cracked. My hands are at a point where even water causes a burning sensation, and moisturizers do not help. I am desperate for some type of relief. Why is this happening to me? I have friends with similar life situations, and their hands are fine!

Answer:

You have a common skin problem called Hand Eczema (Hand Dermatitis). It is usually chronic with remissions and recurrences and is characterized by a red, scaly, itchy rash on the palms, back of the hands, and the fingers. Hand Eczema usually results from a combination of irritants and, at times, allergic substances that come in contact with the skin. Everyone routinely touches soaps, detergents, raw foods, fruits, and home cleaning agents around the house, as well as the chemicals, inks, adhesives, solvents, and other products in the work place.

As you can see, our hands take a beating; but not everyone gets Hand Eczema. Many people have “tough” skin, and their exposure time to irritants is minimized. Unfortunately, many people have “sensitive” skin, and contact with irritating agents is abusive. We can’t make one’s skin tougher, but there are ways to protect the skin and to treat Hand Eczema. Physical protection when possible is essential. Wear gloves (latex, vinyl, or plastic) to avoid contact with detergents, scouring powders, solvents, bleach, raw foods, fresh lemons, fresh fruits, onions, etc. It is important to have more than one set of gloves and to avoid the hands sweating inside the gloves. Use gloves that are lined or use thin, cotton liner gloves to wear underneath the heavier, protective gloves. Abuse your gloves, not your hands!

The most important part of treatment is protection and prevention. However, when Hand Eczema appears, apply a cortisone cream (over-the-counter hydrocortisone cream, 1 percent) several times a day. Apply a small amount of medicine to the rash, and massage it in well. If the skin is still dry, you may apply plain white petrolatum (Vaseline) or other non-medicated hand cream. When your rash is better, you can use the medicine less often.

You should apply a hand cream several times a day to prevent dry skin on the hands. Pamper your hands for several months after healing. It takes 2-3 months for the skin to totally recover. Hand Eczema is chronic and stubborn, and not treating the symptoms creates frequent recurrences. Pamper your hands with protection and immediate treatment with recurrences. If your Hand Eczema does not respond to these recommendations, evaluation by a dermatologist and prescription medications are recommended.