"A pain so severe that even a brush of clothing can make you cry out"... The 72-hour golden window for shingles [Woo Soo-han's Skin Note]

[Financial News] If one side of your body suddenly feels prickly or burning, or if even a brush of clothing causes unusual pain, it is easy to mistake it for simple muscle pain. In particular, when the pain starts around the lower back, flank, or chest, many people assume they have pulled a muscle or strained themselves. But if, a few days later, clusters of red rashes and small blisters appear in the painful area, you should suspect shingles.

Shingles is caused by the varicella-zoster virus, which also causes chickenpox in childhood. Even after chickenpox clears, the virus does not disappear completely from the body. It lies dormant in the nerve ganglia and can reactivate years later. The virus causes inflammation along the nerves and leads to rashes and blisters on the skin. The risk of shingles increases as immunity to the virus declines with age, and it can also be higher in people with weakened immune function.
One of the hallmarks of shingles is that pain or abnormal sensations can appear before the skin rash does. Usually, two to four days before the rash appears, the affected area may feel prickly or burning, or there may be stabbing pain or an electric-shock-like sensation. That is why shingles is often difficult to recognize at first. If it develops on the chest or flank, it may be mistaken for muscle pain or intercostal neuralgia. If it appears in the abdomen, it may even be confused with an internal organ problem.
As time passes, the classic signs of shingles emerge as small blisters form in clusters over red patches. Because the rash usually appears along one nerve distribution or adjacent nerve distributions, it often shows up as a band on one side of the body. It rarely spreads symmetrically across the midline to the other side. So if unexplained pain or sensory changes appear first on one side of the body, followed by a red rash or blisters in the same area, it is best to seek medical care as soon as possible.

It is easy to think of shingles simply as a disease that causes blisters on the skin, but the main source of pain is actually the nerves rather than the skin itself. As the dormant virus reactivates and causes inflammation along sensory nerves, it can trigger burning pain, stabbing pain, or an electric-shock-like sensation. In severe cases, even a light touch from clothing or bedding can cause pain, a condition known as allodynia.
Even after the skin blisters and wounds heal, damaged nerves can continue to send pain signals. This is called postherpetic neuralgia (PHN). PHN is one of the complications of shingles that requires special attention. Even after the skin lesions improve within a few weeks, burning or stabbing pain may persist for months or longer. The risk of this nerve pain increases with age.
The foundation of shingles treatment is antiviral medication. Antiviral drugs such as acyclovir, valacyclovir, and famciclovir are used to suppress viral replication. Antiviral treatment is generally most effective when started within 72 hours after the skin rash appears. The earlier treatment begins, the more it can help reduce new skin lesions and acute symptoms, and speed recovery.
That said, patients should not give up on treatment simply because 72 hours have passed since the rash appeared. Antiviral therapy may still be needed later if new blisters continue to form, if shingles develops around the eyes, or if neurological complications are suspected.
So rather than deciding that treatment is useless once 72 hours have passed, patients should consult a doctor to determine whether treatment is still needed. Painkillers may be used depending on the severity of the pain, and if neuropathic pain is severe or PHN persists, medications such as gabapentin or pregabalin, or other treatments for nerve pain, may be required.

/Chief Director, Woo Soo-han The Hill Dermatology Clinic, Mapo Gongdeok Branch
[email protected] Kim Hyun-sun Reporter