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Shingles and vitamin D

Summary: Vitamin D/UV probably treats shingles

  • Shingles worse with low vitamin D, low UV, high latitude, and winter
  • Treating shingles with Vitamin D or UV lowers the pain
  • Treating shingles with Vitamin D almost eliminates risk of recurrence
  • Vitamin D has even been patented to help with shingles
       A patent is always a good sign that it probably works

Shingles incidence is slowly increasing CDC
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Chickenpox appears to be clearly associated with low vitamin D
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Hypothesis- Shingles associated with low vitamin D – Oct 2015

Vitamin D is closely linked to the clinical courses of herpes zoster: From pathogenesis to complications
Medical Hypothesis, Volume 85, Issue 4, Pages 452–457, October 2015
Chia-Ter Chao, Chih-Kang Chiang, Jenq-Wen Huangcorrespondenceemail, Kuan-Yu Hung

Vitamin D is renowned for its pleiotropic effects, including but not limited to bone integrity, and it has assumed an important role in the current research era. As vitamin D receptors are present in a variety of human tissues, particularly immune cells, the immunomodulatory potential of vitamin D cannot be overemphasized. Herpes zoster, which presents as grouped cutaneous vesicles over dermatomes or visceral/central nervous system infection in its severe form, has a higher incidence in immune-suppressed patients.
Considering the importance of vitamin D in host immunity, we hypothesize that vitamin D acts as an effect-modifier for the entire herpes zoster spectrum with regard to

  • disease susceptibility,
  • manifestation,
  • efficacy of pharmacologic management, and
  • emergent complications during treatment.

Moreover, the possibility exists that vitamin D might affect the course of postherpetic neuralgia. In line with this theory, we comprehensively searched the existing herpes zoster literature and provided important insight into the relationship between the disease courses of herpes zoster and vitamin D.

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The Varicella-Zoster Virus and Multiple Sclerosis

Journal of Clinical Epidemiology
Volume 51, Issue 7, Pages 533-535 (July 1998)
R.T. Rossa
This article is a review of the evidence suggesting a unique relationship between the varicella-zoster virus (as a possible antigen or antigen mimic) and multiple sclerosis (MS). Both MS and varicella have increased prevalences in temperate zones and both are rare in countries closer to the equator. Migration studies suggest an infectious agent acquired prior to age 14 plays a role in the risk of subsequent MS. Hutterites, who educate their children at home, have less varicella, MS, and herpes zoster than their neighbors and have the appropriate reduced varicella-zoster seropositivity matching these clinical observations. Paradoxically, patients with MS report more herpes zoster, and at an earlier age and more often, than a group of non-MS patients.


zoster patients: With UV 58% pain free, without UV 38% pain free - 2006

Broad-band ultraviolet B phototherapy in zoster patients may reduce the incidence and severity of postherpetic neuralgia.
Photodermatol Photoimmunol Photomed. 2006 Oct;22(5):232-7.
Jalali MH, Ansarin H, Soltani-Arabshahi R.
Department of Dermatology, Hazrat-e Rasool University Hospital, Iran University of Medical Sciences, Tehran, Iran.

BACKGROUND: Postherpetic neuralgia (PHN) is one of the common complications of herpes zoster infection, particularly in the elderly. Current therapeutic measures are only partially effective in the affected patients. As inflammatory mediators released by different cells play an important role in the pathogenesis of this neuropathic pain and with regard to the immunomodulatory effects of ultraviolet B (UVB) spectrum, we presumed that UVB phototherapy might be effective in the prevention of PHN.

METHOD: This study was performed in two phases. Phase I was a prospective open controlled trial. Twenty-five patients with severe pain in the first 7 days of zoster rash were divided into two groups: the prevention group (n=12) received oral acyclovir (800 mg five times a day for 10 days) plus broad-band UVB to the affected dermatomes, starting with 20 mJ/cm(2) and gradually increasing the dose by 10 mJ/cm(2) each session to a maximum dose of 100 mJ/cm(2). Treatment sessions were repeated three times a week until pain relief or to a maximum of 15 sessions. The control group (n=13), who had disease characteristics similar to the prevention group, received only oral acyclovir with the same dose. All patients reported their severity of pain on a verbal rating scale (VRS, score 0-4) before treatment and at 1 and 3 months' follow-up. In phase II of the study, five patients with established PHN (more than 3 months after rash onset) received UVB with the above-mentioned protocol.

RESULTS: A total of 17 patients older than 40 (10 females, seven males; mean age, 65.5 years; range: 47-82 years) who had intractable pain due to zoster infection received UVB in two phases of the study. In patients who received phototherapy in the first 7 days of rash, 58.33% and 83.33% were completely pain free at 1-and 3-month follow-up, respectively. The corresponding figure in the control group was significantly lower (38.46% at 1 month and 53.85% at 3 months). The severity of pain was also lower in the phototherapy group than the control group (mean VRS 2.50 vs. 3.28 at 3 months). None of the patients who were treated more than 3 months after rash onset (established PHN) experienced significant (more than 50%) pain relief.

CONCLUSION: UVB phototherapy in the acute stage of zoster rash might reduce the incidence and severity of PHN.
Treatment after 3 months does not seem to have a significant beneficial effect.
PMID: 16948824


Risk factors for herpes zoster reactivation in maintenance hemodialysis patients.

Eur J Intern Med. 2012 Sep 5. Chao CT, Lai CF, Huang JW.

OBJECTIVE:
Herpes zoster (HZ) reactivation is common in immunocompromised patients. Advanced renal failure is also reportedly associated with impairment of cellular immunity. There is not any study yet assessing risk factors of HZ reactivation in hemodialysis patients.

METHODS:
All patients undergoing maintenance hemodialysis for more than 3months and who developed HZ between 2000/01/01 and 2009/12/31 in a tertiary referral medical center were identified, and matched 1:1 to hemodialysis patients without HZ by age and gender.
Multivariate-adjusted conditional logistic regression model was constructed to determine possible risk factors.

RESULTS:
Out of a total of 126 maintenance hemodialysis patients (65.3% female), 63 belonged to the HZ reactivation group and 63 to the age/sex matched control patients. Conditional logistic regression model linked corticosteroid use with heightened risk (odds ratio [OR] 20.2, 95% confidence interval [CI] 3.5-125.6; p=0.002),
while iron therapy and 1?-hydroxylated vitamin D were associated with significantly lower likelihood of developing HZ (OR 0.12, 95%CI 0.0-0.6; p=0.01, and OR 0.06, 95% CI 0.0-0.4; p=0.005 respectively).

CONCLUSIONS:
Use of iron preparations and 1?-hydroxylated vitamin D is potentially associated with less risk of developing HZ reactivation in maintenance hemodialysis patients.

Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

PMID: 22958951


Herpes Zoster Is Associated with Prior Statin Use: A Population-Based Case-Control Study

Published: October 24, 2014DOI: 10.1371/journal.pone.0111268 PLOS ONE
Shiu-Dong Chung equal contributor, Ming-Chieh Tsai equal contributor,
Shih-Ping Liu, Herng-Ching Lin, Jiunn-Horng Kang mail

Background
This study investigated the association between statin use and herpes zoster (HZ) occurrence in a population-based case-control study.

Methods
Study subjects were retrieved from the Taiwan Longitudinal Health Insurance Database 2000. This study included 47,359 cases with HZ and 142,077 controls. We performed conditional logistic regression analyses to calculate the odds ratio (OR) to present the association between HZ and having previously been prescribed statin.

Results
We found that 13.0% of the sampled subjects had used statins, at 15.5% and 12.1% for cases and controls, respectively (p<0.001).
A conditional logistic regression analysis suggested that the adjusted OR of being a statin user before the index date for cases was 1.28 (95% confidence interval (CI): 1.24~1.32) compared to controls.
Subjects aged 18~44 years had the highest adjusted OR for prior statin use among cases compared to controls (OR: 1.69; 95% CI: 1.45~1.92).
Furthermore, we found that the ORs of being a regular and irregular statin user before the index date for cases were 1.32 (95% CI: 1.27~1.38) and 1.23 (95% CI: 1.181.29), respectively, compared to controls.

Conclusions
We concluded that prior statin use was associated with HZ occurrence.
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Zoster INCREASES with UV – 2002

The role of solar ultraviolet irradiation in zoster.
Epidemiol Infect. 2002 Dec;129(3):593-7.
Zak-Prelich M, Borkowski JL, Alexander F, Norval M.
Department of Dermatology, Medical University of Lodz, Lodz, Poland.
Ultraviolet radiation (UVR) suppresses many aspects of cell-mediated immunity but it is uncertain whether solar UV exposure alters resistance to human infectious diseases. Varicella-zoster virus (VZV) causes varicella (chickenpox) and can reactivate from latency to cause zoster (shingles). The monthly incidence of chickenpox and zoster in a defined Polish population over 2 years was recorded and ground level solar UV was measured daily. There was a significant seasonality of UVR. Evidence of seasonal variation was found for all zoster cases and for zoster in males, with the lowest number of cases in the winter.

The number of zoster cases with lesions occurring on exposed body sites (the face) demonstrated highly significant seasonality with a peak in July/August. Seasonal models for UVR and zoster cases showed similar temporal patterns. By contrast, for varicella, the maximum number of cases was found in March and the minimum in August/September, probably explained by the respiratory spread of VZV. It is tempting to speculate that the increase in solar UVR in the summer could induce suppression of cellular immunity, thus contributing to the corresponding rise in the incidence of zoster.
PMID: 12558343 CLICK HERE for full text
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6839 Zoster vs month.jpg admin 29 Jun, 2016 13:01 41.75 Kb 2713
6717 Zoster Oct 2015.jpg admin 01 Jun, 2016 07:17 32.47 Kb 3308
4873 Chickenpox vs month.jpg admin 13 Jan, 2015 20:10 40.39 Kb 7141
4872 Shingles Incidence increasing.jpg admin 13 Jan, 2015 20:09 47.24 Kb 7891
4522 Herpes Zoster Oct 2014.pdf PDF 2014 admin 28 Oct, 2014 03:25 175.31 Kb 885
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