Pharmacist diary: Shingles

A day working in a pharmacy can definitely be described as varied and when you are a locum it comes with other challenges; new systems, staff and patients. 

There are days as a pharmacist when I seem to only get asked about rashes. But when your passion is dermatology, it definitely makes the day more interesting!

One particular day I helped diagnose, gave advice and treatments to patients with shingles, eczema, insect bites, sweat rash, viral rashes, warts and that was all before lunchtime! Sometimes, I can offer an OTC treatment but often I have to refer as our offering for skin conditions are limited. For example, the lady with shingles. She had presented to her GP several days earlier with lower back pain and generally feeling unwell. She had been given an anti-inflammatory gel to rub on the area. This was fine until the rash appeared. 

On examination, I could see a typical shingles rash; red, blotchy with blisters appearing on the left side of her body mainly on her back and upper torso. I had to refer her back to her GP, as I can't prescribe the anti-viral treatment she needed and advised oral pain-relief and rest in the meantime. Getting treatment can reduce pain and length of time having symptoms. Whilst the rash tends to clear in a few weeks, some patients can experience often severe, ongoing pain (known as post-herpetic neuralgia) for several months after the infection.

Shingles is caused by reactivation of the varicella-zoster virus (VZV), the same virus which causes chickenpox. When infected initially, the patient will have chickenpox. The virus then lies inactive, often for decades, and if triggered again, the patient will have shingles (herpes zoster). Herpes zoster often affects people with weak immunity, for example, when they are run down after a previous illness.

The lady's main concern was about the virus being contagious as she attends a retirement group regularly. A person with shingles will not cause someone to have shingles, however, someone who has never encountered the VZV previously and comes into contact with someone with shingles, can develop chickenpox. It is important therefore to avoid contact with vulnerable groups such as pregnant women, newborns and those with weakened immune systems.

Photo source Dermnet NZ

The downside of locum life is that I don't often get to see these patients again, missing out on knowing if the treatment or advice was suffice or referral was necessary. But you just do what you can with the resources available and hope you have provided the best advice at the time.

Michelle 

Skin Health Pharmacist

Tonic Skincare