Maldar: Understanding Pain of Herpes Zoster

Over the last few months, numerous patients have consulted me regarding skin lesions that were diagnosed as herpes zoster, a condition popularly known as 'Maldar' in Kashmir. There's been a notable prevalence of misconceptions about this skin disease among both patients and their attendants. To address this, it's crucial to gain a clear understanding of herpes zoster.

What is a Herpes Zoster?
Herpes zoster or shingles is a viral infection that causes a painful rash, which can appear anywhere on the body but often wraps around either the left or right side of the torso. It's caused by the varicella-zoster virus, the same virus that causes chickenpox. After you've had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, it can reactivate as shingles.

How Does it Occur or Reactivate?
The exact reason why the virus reactivates isn't entirely clear. It's thought to be linked to lowered immunity to infections as you grow older. Shingles is more common in people over the age of 50 and in those with weakened immune systems.

Risk Factors
 Age: Risk increases with age, particularly after 50.
 Chickenpox History: Past infection raises the risk.
 Weakened Immune System: Conditions like cancer, HIV or medications weaken immunity.
 Stress: Prolonged stress can make one more susceptible.
 Chronic Illnesses: Conditions like diabetes elevate risk.
 Family History: Having close relatives with shingles raises risk.
 Pregnancy: Pregnancy can temporarily weaken the immune system.
 Vaccination Status: Not vaccinated against chickenpox or shingles raises risk.

Symptoms
Shingles symptoms usually affect only a small section of one side of your body. These symptoms may include:
 Pain, burning, numbness, or tingling.
 A red rash that begins a few days after the pain.
 Fluid-filled blisters that break open and crust over.
 Itching.
 Some people also experience fever, headache, fatigue, and sensitivity to light.

Stages of Reactivation of virus
Prodromal stage: This is the time from Pain to Rash and it takes 1 to 5 days from the onset of pain or tingling to the appearance of the rash.
Rash Development: After prodromal symptoms, a red rash appears, evolving into fluid-filled blisters that crust over within 2 to 4 weeks.
Postherpetic Neuralgia (PHN): Postherpetic neuralgia (PHN) can last for months to years after the shingles rash has healed. The severity and duration of PHN can be influenced by factors such as age, overall health, the severity of the shingles infection, and the presence of other medical conditions.

Treatment
While there's no cure for shingles, prompt treatment with prescription antiviral drugs can speed healing and reduce the risk of complications. These medications are most effective if taken as soon as possible after the rash appears. Pain relief can also be managed with:

 Cool baths or compresses.
 Calamine lotion.
 Pain relievers.

We have traditional treatments for Herpes Zoster (Maldaar), called Maetravun. Many people advocate for this traditional approach, citing numerous anecdotes of individuals experiencing improvement after undergoing the treatment. Importantly, this traditional remedy is non-invasive.

Prevention
The best way to prevent shingles is to get vaccinated. There are vaccines available that can significantly reduce the risk of getting shingles. It's recommended for adults over 50 and for those with certain medical conditions.

Myth vs. Truth about shingles
Age Limit:
Myth: Only elderly get shingles.
Truth: Anyone who's had chickenpox can get shingles, regardless of age.
Contagiousness:
Myth: Shingles is highly contagious.
Truth: Shingles can't be passed from person to person, but the virus can cause chickenpox in someone who hasn't been infected before.
Chickenpox Requirement:
Myth: You can't get shingles if you've never had chickenpox.
Truth: Anyone who's had the chickenpox vaccine or chickenpox can develop shingles.
One-time Occurrence:
Myth: Shingles only happens once.
Truth: It's possible to get shingles more than once, especially in individuals with weakened immune systems.
Severity:
Myth: Shingles is just a rash and not serious.
Truth: Shingles can lead to serious complications like postherpetic neuralgia and vision loss.
Treatment:
Myth: Antibiotics can treat shingles.
Truth: Antiviral medications, not antibiotics, are used to treat shingles.
Vaccination:
Myth: Shingles vaccines are unnecessary.
Truth: The shingles vaccine significantly reduces the risk of developing shingles and its complications.