Shingles in Pregnancy in S3 dermatone

[dot1]

Hello Dr. Karon-Flores:

I was wondering if you've encountered patients in your practise before who had this occur?  As you would know, the S3 dermatone innervates the back of buttocks and extends down and around into the vulvar/labia/vaginal area and in my case seems to be in rectal area too (so I wonder if s4, or s5 is affected also? ....although the rash is not in that dermatone)  I'm 35 weeks pg, am on day 6 of treatment with valacyclovir to try to clear this up prior to birth (it was started within 48 hours of rash onset).  It's really painful (hurts to pee, sit, poo and I can't imagine having sex) and I'm nervous about the potential for post herpetic neuralgia (PHN).  I am going to see an anaesthesiologist in a pain clinic in a few days (as apparently there is some clinical studies that show nerve blocks initiated early greatly reduce the risk of PHN).  

Have you encountered patients with shingles in this dermatone before?  If so, how long did it take for the pain to subside?  Did any go on to develop PHN?  The literature is unfortunately, so scant when it comes to sacral dermatone shingles and pregnancy.  I'm so worried that with the trauma/swelling from childbirth that my outcome might not be so great...

Also, are there any naturopathic treatments for shingles that have been validated by studies, that reduce the serverity and reduce chance of PHN?  Obviously you cannot give specific advice here; however any links to information/research would be greatly appreciated!  I am following a good diet, trying to get adequate rest, taking prenatals, floradix, cal-mag-D so I'm not sure what else I can do.  (Our only naturopathic physician here is away on holidays for at least the next couple of weeks, and always has a wait list, so it's no use trying to contact her).

Thanks!!!!!

[drjkf]

Shingles is a very individual illness, and while your presentation is not what I most often encounter, it is one I have seen before.  PHN is an unwelcome after effect in less than 5% of patients who experience shingles.  It is treatable, and in my opinion may be preventable with early intervention.  You asked about studies to support natural treatments of shingles / PHN, and from my survey it looks like the studies almost exclusively focus on Chinese Medicine.  I would suggest you seek out the services of a Chinese Medicine practitioner who has experience treating pregnant women.  Acupuncture and wet cupping may greatly increase your comfort and decrease chances of PHN.  In addition, if you have access to a homeopathic physician, I have found a properly chosen remedy can be near miraculous in helping recovery from shingles. 

If you haven't seen the Chinese Medicine studies, here are some of them:

http://www.ncbi.nlm.nih.gov/pubmed/21639941

http://www.ncbi.nlm.nih.gov/pubmed/21280462

http://www.ncbi.nlm.nih.gov/pubmed/17397428

http://www.ncbi.nlm.nih.gov/pubmed/16813460

Take good care!

[dot1]

Thank you so much for responding and for those links.  I will try to find someone who practices TCM/acupuncture.

I'm interested in the 5% statistic of PHN.  Is that from your experience in your practice, or is there a study on a specific age group with certain characteristics?  I've read that as many as 50% (elderly) population are affected by PHN, but I've never been able to find any numbers that specifically addresses patients who would fit my demographic....especially pregnant ones pushing 40 who are about to give birth, add trauma to an already traumatized anatomical area, and undergo another significant hormonal shift!  I hope I would be in that 95%....but given those other factors I am concerned about potential for permanent nerve alteration (hence I might be trying a nerve block later today with an anaesthesiologist who runs a pain clinic)...and I certainly couldn't function with this pain ongoing.

Thanks again!