快樂小藥師 Im pharmacist nichts glücklich

If you've ever had the chickenpox --

and almost all adults have -- there's a good chance the virus is still at large in your body. The varicella zoster virus can lie dormant for decades without causing any symptoms. In some people, the virus wakes up and travels along nerve fibers to the skin. The result is a distinctive, painful rash called shingles.

如果你得過水痘，那你的身體裡面就有可能潛在著varicella zoster virus數十年之久，病毒會順著你的神經纖維一直皮膚，所以才成為帶狀。

What Does the Shingles Rash Look Like? 帶狀皰疹看起來像什麼樣子？
The shingles rash can be a distinctive cluster of fluid-filled blisters -- often in a band around one side of the waist. This explains the term "shingles," which comes from the Latin word for belt. The next most common location is on one side of the forehead or around one eye. But shingles blisters can occur anywhere on the body.

通常帶狀紅疹會伴隨著水泡，然後比較常在腰部發生，有些人會在前額或是眼睛周圍，不過水泡有可能在全身任何位置出現

Shingles Symptoms: Before the Rash 發作之前的症狀
The first symptoms of shingles appear one to five days before the rash.

通常在發作前1-5天就會有一些警告的訊息

These early warning signs are usually felt in the location where the rash will develop:

1. Itching養
2. Tingling麻
3. Burning灼熱
4. Pain痛

Other Symptoms of Shingles 其他症狀
While the localized pain and rash are the tell-tale signs of shingles, other symptoms may include:

1. Fever發燒
2. Chills寒顫
3. Headache頭痛
4. Upset stomach反胃

Shingles or Something Else?

跟其他的有什麼差別呢？

Small blisters that appear only on the lips or around the mouth may be cold sores, sometimes called fever blisters. They're not shingles, but are instead caused by the herpes simplex virus. Itchy blisters that appear after hiking, gardening, or spending time outdoors could be a reaction to poison ivy, oak, or sumac. If you aren't sure what's causing your rash, see your health care provider.

小水泡如果是發生在口唇周圍的可能不是帶狀皰疹是單純皰疹，如果在爬山健行之後發生的有可能是一些植物造成的，像是毒紫藤、鹽膚木。如果你不確定是因為什麼引起的，那就看醫生吧。

What Causes Shingles?

是什麼造成帶狀皰疹呢？

The varicella zoster virus is the culprit behind both chickenpox and shingles. The first time someone is exposed to the virus, it causes the widespread, itchy sores known as chickenpox. The virus never goes away. Instead, it settles in nerve cells and may reactivate years later, causing shingles.  It's also called herpes zoster, but it's not related to the virus that causes genital herpes.

varicella zoster virus就是引起水痘還有帶狀皰疹的元兇，第一次接觸的時候會造成廣範圍的癢瘡，就是你熟悉的水痘了，之後病毒會在神經細胞中停留數年，過了很久以後發作，稱為帶狀皰疹，但是是跟生殖器皰疹不一樣的。

Diagnosing Shingles

診斷方式

A doctor can usually diagnose shingles just by looking at the rash. If you have shingles symptoms, see your health care provider even if you think you've never had chickenpox. Many childhood cases of chickenpox are mild enough to go unnoticed, but the virus can still linger and reactivate.  To prevent complications, it's important to start treatment as soon as shingles appears.

醫生基本上可以從外觀上面看出來是不是帶狀皰疹，但是即使你小時候沒有得過水痘，建議你還是找醫生求診，不要自己判斷，因為有些小時候得到水痘時很輕微甚至是不記得了，但是病毒卻依然存在你的體內，為了避免併發症，在他開始發作的時候就快點就醫是最好的。 

How Long Does Shingles Last?

會持續多久呢？

Shingles blisters usually scab over in 7-10 days and disappear completely in two to four  weeks. In most healthy people, the blisters leave no scars, and the pain and itching go away after a few weeks or months. But people with weakened immune systems may develop shingles blisters that do not heal in a timely manner.

水泡大約是7-10天，之後2-4週就會完全消失了，對於多數健康的人來說，水痘不太會留下疤痕而疼痛還有騷癢感也會在數週或是幾個月後消失，但是免疫力比較差的人就會維持很久了。

Who's at Risk for Shingles?

有什麼風險呢？

Anyone who has ever had chickenpox can get shingles, but the risk increases with age. People older than age 60 are 10 times more likely to get shingles than children under age 10. Other factors that increase your risk include:

任何得過水痘的人都有機會帶狀皰疹發作，而且風險性會隨著年齡增加，60歲以上的人發作率是10歲以下小孩的10倍。其他危險因子如下：

• Some cancer medicines化療藥物
• Steroid medicines類固醇
• Long-term stress or trauma長期壓力或是創傷
• A weak immune system from illnesses such as cancer or HIV免疫不好或是有癌症與HIV感染

A quarter of adults will develop shingles at some point, and most are otherwise healthy.大約1/4的人會演變成帶狀皰疹，其餘的人是健康的

Is Shingles Contagious?

帶狀皰疹有傳染性嗎？

Yes, but not in the way you may think.  Your shingles rash will not trigger an outbreak of shingles in another person, but it can sometimes cause chickenpox in a child.  People who've never had chickenpox, or the vaccine to prevent it, can pick up the virus by direct contact with the open sores of shingles. So keep a shingles rash covered and avoid contact with infants, as well as pregnant women who have never had chickenpox or the varicella vaccine.

是的，有傳染性，而且還會讓小朋友得到水痘，沒有得過水痘的人可以先打疫苗來避免，因為是接觸傳染，所以請將紅疹包起來避免別人去接觸到，尤其是小孩還有孕婦。

Can Shingles Cause Chronic Pain?

帶狀皰疹會造成慢性疼痛嗎？

In some people, the pain of shingles may linger for months or even years after the rash has healed. This pain, due to damaged nerves in and beneath the skin, is known as postherpetic neuralgia. Others feel a chronic itch in the area where the rash once was. In severe cases, the pain or itching may be bad enough to cause insomnia, weight loss, or depression.

對某些人來說，就算是紅疹已經復原了，也會持續疼痛好幾個月，主要是因為已經造成了神經的傷害，有些是會在紅疹區域持續覺得搔癢，比較嚴重的患者會在患部持續疼痛與搔癢甚至會造成失眠、憂鬱還有體重減輕。

Other Complications of Shingles

其他的併發症？

If the shingles rash appears around the eye or forehead, it can cause eye infections and temporary or permanent loss of vision. If the shingles virus attacks the ear, people may develop hearing or balance problems. In rare cases, the shingles virus may attack the brain or spinal cord. These complications can usually be prevented by beginning treatment for shingles as soon as possible.

如果帶狀皰疹出現在前額或是眼周，有可能會造成視力損失或是失明，如果是在耳朵，就有可能造成平衡失調或是聽覺受損，極少數的案例是病毒攻擊腦部與脊髓。建議儘快治療以減少併發症

Treatment: Antiviral Medication

抗病毒藥物的治療

While there is no cure for shingles, antiviral medications can put the brakes on an attack. Prompt treatment can make a case of shingles shorter and milder, while cutting in half the risk of developing postherpetic neuralgia.  Doctors recommend starting prescription antiviral drugs at the first sign of a shingles rash. Options include acyclovir, valacyclovir, or famcyclovir.

目前的抗病毒藥物都可以有效的治療帶狀皰，尤其是可以減少帶狀疱疹後的神經痛(post-herpetic neuralgia)的風險，醫師建議當有初期徵兆的時候就可以開始使用acyclovir、valacyclovir與famcyclovir

Treatment: Rash Relief

減輕紅疹

Over-the-counter pain relievers and anti-itch lotions, such as calamine, can relieve the pain and itching of the shingles rash. If the pain is severe or the rash is concentrated near an eye or ear, consult your doctor right away. Additional medications, such as corticosteroids, may be prescribed to reduce inflammation.

一些非處方的乳液或是洗劑也可以減少皮膚紅疹的不適感，像是卡拉明（爐甘石洗劑）如果疼痛比較嚴重而且靠近眼耳周圍，可以請醫師開立類固醇來減少發炎症狀

Home Care for Shingles

居家照護

Colloidal or powerderized oatmeal baths are an old standby for relieving the itch of chickenpox and can help with shingles, as well. To speed up the drying out of the blisters, try placing a cool, damp washcloth on the rash (but not when wearing calamine lotion or other creams.) If your doctor gives you the green light, stay active while recovering from shingles. Gentle exercise or a favorite activity may help keep your mind off the discomfort.

有些燕麥的膠體或是粉狀洗劑對於水痘的搔癢是有幫助的，為了加速水泡的收乾，可以放一些冰涼的濕毛巾在紅疹部位（當然不是跟洗劑還有乳霜藥物一起），如果醫師使用綠光照射治療法（Low-level laser (light) therapy (LLLT)）的話，記得保持活動，運動也可以讓你減少注意到皰疹帶來的不舒服。

Shingles Vaccine

皰疹疫苗

The CDC recommends people ages 60 and older get the shingles vaccine,  Zostavax. In a large trial, this vaccine cut the risk of developing shingles in half and reduced the risk of postherpetic neuralgia by 67%. The vaccine won't treat a current outbreak of shingles, but it can prevent future attacks if you have already had shingles. The FDA has approved Zostavax for people as young as age 50, depending on a doctor's guidance.

疾管局建議60歲以上的成年人接種皰疹疫苗，因為在大型實驗中發現，疫苗可以減少約67%的皰疹後神經痛，疫苗對於已經發作的皰疹並沒有用，但是可以預防未來的發作。

FDA已經核准伏帶疹在50歲以上的使用

Who Should Not Get the Vaccine?

誰不能接種疫苗呢？

Do not get the shingles vaccine if:

• You might be pregnant 可能懷孕的人
• You have HIV/AIDS or a weak immune system 有HIV感染或是免疫功能低下的人
• You are undergoing chemotherapy or radiation 進行化療或是放射線治療的患者
• You take medications that suppress the immune system 可能會有影響免疫力藥物的患者
• You have a history of leukemia or lymphoma 白血症或是淋巴癌的患者
• You are allergic to gelatin, the antibiotic neomycin, or any ingredient in the vaccine 對於明膠，抗生素neomycin或是疫苗其他成分會過敏的患者

Chickenpox Vaccine and Shingles

水痘疫苗及帶狀皰疹

Since the late 1990s, most children in the U.S. have received the varicella vaccine to protect against chickenpox. This vaccine uses a weakened strain of the varicella zoster virus that is less likely to settle into the body for the long haul. 

儘管1990年開始很多兒童都已經有接種過水痘疫苗，但是這個疫苗的效果並沒有持續這樣的久。

最後是Zostavax仿單