HEALTH MATTERS: Adults 60 and older should ask for shingles vaccineQ. I am in my mid-fifties. On my last visit with my physician, I was asked a question I had never been asked before: Did you have chickenpox as a child? I answered yes, which prompted me to ask why. The nurse said that adults who have had chickenpox as a child are susceptible to shingles as an adult. Chickenpox can be prevented by vaccination, and there is a vaccine to prevent shingles. My doctor did not prescribe the vaccine against shingles for me. Should I request to have the vaccine?
By: Dr. Joshua Wynne , Grand Forks Herald
Q. I am in my mid-fifties. On my last visit with my physician, I was asked a question I had never been asked before: Did you have chickenpox as a child? I answered yes, which prompted me to ask why. The nurse said that adults who have had chickenpox as a child are susceptible to shingles as an adult. Chickenpox can be prevented by vaccination, and there is a vaccine to prevent shingles. My doctor did not prescribe the vaccine against shingles for me. Should I request to have the vaccine?
A. The answer is “maybe.” The same virus that causes chickenpox also causes shingles. It turns out that while having chickenpox (or being vaccinated against chickenpox) as a child helps prevent a second infection of chickenpox, it is not protective against an infection of shingles.
Shingles is caused by reactivation of dormant chickenpox viruses that have hidden in the nerve tissue near the spinal cord. So if a person has chickenpox as a child, some of the virus may lie in waiting in the nervous tissue for decades, only to reappear in later life. Why only some people who had chickenpox get shingles is unknown; some people who develop shingles, however, have problems with their immune systems (although most do not).
People with shingles are contagious and can spread the virus to people who were never vaccinated nor had chickenpox; however, people infected through contact with someone with shingles will develop chickenpox, not shingles (at least at first).
The risk of shingles goes up with age. Thus, the recommendation is for adults who are 60 years and older to get the vaccine to prevent reactivation of the virus. Since you are in your mid-fifties, you certainly should consider asking for the vaccine, and definitely when you turn 60.
Q. I developed a rash on my upper body that consists of tan patches. My doctor said that it is tinea versicolor. What is this, and how is it treated?
A. Tinea versicolor is a common fungal infection of the skin, often seen in young people in particular, and often in the hot weather. Back when I was in the U.S. Army years ago, I’d see this rash all the time. It is not contagious, and typically is not associated with any serious underlying condition.
The fungus that causes the rash is found on the skin of many people; why only some get the rash while most are unaffected is not known. The patches are usually limited to the upper torso, and appear tan. If one gets a suntan, the patches tan less than the surrounding skin, so they may appear lighter colored. We can usually make the correct diagnosis by just looking at the rash, as did your doctor. However, the diagnosis can be confirmed, if necessary, by looking at scrapings from the skin rash under the microscope.
The condition is treated with anti-fungal medication that is applied to the skin or taken orally. One treatment that I used on patients when I was in the Army was a daily application of Selsun Blue. Because recurrences of the rash are common, preventive showering with the Selsun Blue may help prevent recurrences.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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