More Info on Shingles from ICD10 and CDC: History, Code, Guidelines

Shingles is a disease of the nervous system. It is caused by the varicella-zoster virus, the same virus responsible for chicken pox. This means that anyone who has ever had chicken pox can get shingles. 1 in 3 persons will get shingles in their lifetimes. Although anyone can get the disease, people over age 50 are more predisposed due to having weaker immune systems.

Common signs and symptoms of shingles are painful rash, blisters, itchiness and flu-like symptoms. When present, the rash appears on localized areas and only on one side of the body. It also forms a band-like appearance. Cases of disseminated shingles are rare but not unheard of.

There are a number of important things to know about shingles. In this article, we look at the history, recommendations and guidelines provided by the CDC and ICD 10 for shingles.

Shingles ICD 10 code

ICD 10 is the code set for diagnosis coding. It is the standard used by healthcare settings. Shingles ICD 10 code also applies to herpes zoster, which is another name for shingles.

The disease is described as a common disorder that involves the skin and nervous system. It is caused by varicella-zoster virus which has reactivated after remaining in latency within nerve fibers that branch from the spinal cord. The virus can remain in latency for years or decades after initial chicken pox infection. The disease presents with clusters of blisters along affected dermatomes and neuralgic pain. Sometimes, adjacent dermatomes are also involved. This can be seen in some shingles on buttocks pictures.

You cannot get shingles from an infected person. Neuralgic pain caused by shingles can be described as burning, itching, shooting and tingling. It develops before rash and blisters appear. While the rash disappears in about 2 weeks, pain can persist for months or years.  No medication is available that can be used to cure shingles. However, treatments are available which help fight herpes zoster virus and also prevent lingering pain. People above age 60 can use shingles vaccine to prevent outbreaks or reduce severity of outbreaks.

Shingles on head how long does it last? Unless complications of shingles are involved, outbreaks last for 2-4 weeks regardless of location.

History of shingles ICD 10

Basically, history of shingles ICD 10 describes the relationship between chicken pox and shingles as well as how shingles shows up later in life. Varicella-zoster virus is abbreviated as VZV. Chicken pox therefore can be referred to as primary VZV infection.

How does shingles start? A shingles outbreak traces its roots to a chicken pox infection which probably occurred during childhood years. Many people who had chicken pox when growing up don’t remember. Chicken pox is an airborne disease. It is passed to other people by sneezing or coughing. More than 80% of people who get exposed to varicella-zoster virus for the first time develop chicken pox. Signs and symptoms include malaise, fever and disseminated rash. After exposure, the virus remains in incubation for 10-21 days. Patients are most contagious several days before the rash appears.

After recovery from chicken pox, VZV infection persists throughout the patient’s lifetime. It however largely remains in latency, producing only a couple of viral proteins, not enough to cause infection. The virus hides in the dorsal root ganglia.

Shingles shows up when VZV reactivates. This is usually caused by weakened immunity. Since our bodies become resistant to chicken pox after the initial infection, signs are localized along the dermatome served by affected nerve. This is why cases such as shingles on both ankles are not common. The nerves that get affected by herpes zoster branch from the spinal cord in pairs. Shingles occurs along the skin served by these nerves. You can browse through pictures of shingles rash under breast to get the idea.

What is the incubation period for shingles? Since shingles is not the primary infection, it is hard to state its incubation period. Basically, rash and blisters appear 1-5 days after first symptoms.

CDC guidelines for shingles

CDC outlines several isolation guidelines for management of herpes zoster patients. Control measures for the disease depend on two main factors. The first factor is immunity status. Patients can either be immunocompetent or immunocompromised.  The other factor is whether shingles rash is widespread or localized. In most cases, signs of shingles occur on small areas of the body, specifically ones supplied by a particular sensory nerve. Patients with serious immune issues can have widespread shingles rash.

For immunocompetent patients with a localized rash, affected areas with lesions should be completely covered. Standard precautions should also apply. In case the rash is widespread, both contact and airborne precautions should be followed. Standard precautions should also apply.

For immunocompromised patients with a localized rash, airborne, standard and contact precautions should be followed. Once disseminated signs are over, standard precautions are to apply until the lesions have completely crusted over. If the rash is widespread or disseminated, the same above mentioned precautions should apply until lesions have fully scabbed over.

CDC guidelines for shingles treatment identify antiviral medications, particularly acyclovir, valacyclovir and famciclovir as the available medicines to treat shingles as well as reduce severity and shorten recovery time. Other treatment options include pain relievers and home treatments such as cool compress, colloidal oatmeal baths and calamine lotion. These are aimed at relieving itching rather than curing shingles. Essential oils for shingles can also provide some relief from itching and nerve pain. In fact, essential oils may restore skin integrity and thus help prevent scarring.

CDC recommendation for shingles vaccine

Once a person has been exposed to VZV, not much can be done to flush the virus out of the system. Prevention can however be done with shingles vaccine.

CDC recommendations for shingles vaccine majors on two vaccines. These are Zostavax and Shingrix.

Zostavax

Zostavax was approved by the FDA in 2006. It prevents shingles with about 50% effectiveness and post-herpetic neuralgia with about 65%. The vaccine is given in a single shot by a doctor or a pharmacist.

People above age 60 are the best candidates for the vaccine. This is regardless of whether they recall ever having a primary VZV infection or not.

People who have a history of allergic reactions to gelatin, neomycin or any other ingredient of Zostavax should not take the vaccine. Patients are urged to inform their doctors of any history of allergies to medications. Since Zostavax is a live vaccine, its use is not recommended for people with serious immune issues such as caused by HIV and leukemia or cancer treatments and any other treatment that may weaken the immune system. The vaccine should also not be given during pregnancy. Women who are planning to become pregnant should inform their doctors before receiving the vaccine.

Zostavax is well tolerated and safe. Potential side effects include soreness, redness, itching and swelling on site of injection. Mild headache may also occur.

Shingrix

Shingrix is recommended for people above age 50. It is given in two shots 2-6 months apart. The shots can be given by a doctor or a pharmacist. The vaccine was approved by the FDA in 2017. It is the recommended vaccine for shingles. Shingrix prevents both shingles and post-herpetic neuralgia with up to 90% effectiveness.

People who have been given Zostavax in the past can still be given Shingrix. This also goes for those who have been diagnosed with shingles or chicken pox in the past. If you have recurring or internal shingles, Shingrix can help prevent the flare ups. Internal shingles occurs when a rash doesn’t materialize. See shingles in mouth and throat pictures for illustrations.

Shingrix is well tolerated and safe. Since is a nonliving vaccine, it can be given to people with serious immune problems. People who are allergic to any component of the vaccine should not take it. If you have never gotten chicken pox, the better approach is to be given a chicken pox vaccine rather than Shingrix. Pregnant women and those planning to become pregnant should inform their doctors before taking the vaccine. Potential side effects include swelling and soreness at the site of injection.

Note that vaccines are not given during an ongoing outbreak. In that case, antiviral medications and pain relievers are the better choice. Antiviral drugs work best when started within 72 hours of first signs of shingles. Otherwise, they are of little or no help. Ensure to check with your doctor if you think you may have shingles.

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