Shingles: Can it spread?

Shingles and chickenpox share a similarity: they are both caused by varicella zoster virus. Shingles is also called Herpes Zoster. Can shingles spread to you? Well, it’s a bit complicated: shingles cannot spread shingles but can spread chickenpox; chickenpox can spread chickenpox but cannot spread shingles.

In other words, if you haven’t got chickenpox yet, you can get chickenpox from a person with chickenpox or shingles. If you already have chickenpox, of course you won’t get chickenpox anymore and you CAN’T get shingles from a person with shingles. If you already have both chickenpox and shingles before, then you can’t get both anymore.

Shingles only can occur in people who already have chickenpox before, where the virus remains “hiding” in the nerve. For some not so well-understood reason (usually related to poor immunity), shingles will pop up as a patch/patches or a band of blisters. It can be at any part of the body but not all over the body. It is more common in elderly >50 years old.

    Blisters in clusters

Shingles is extremely painful, and it usually last 2-4 weeks, sometimes it heals with scar. Anti-viral drugs if given early enough within 72 hours may reduce the severity and duration of shingles. Strong pain-killer is certainly required. Sometimes the pain may last for > 1 month even after the skin lesion has disappeared. This is a complication called post-herpetic neuralgia which can happen in about 10-15% of people with shingles. This troublesome condition may require more potent medicine to control the pain.

Not like chickenpox, shingles cannot spread through the air. It is transmitted through direct contact with the blister fluid. Thus, if you don’t want to get chickenpox, you not only need to avoid contact with chickenpox sufferers, but also shingles sufferers as well. Or you may consider getting a vaccine for chickenpox.

PUPPP -> PuPP-P -> PUPPY

If you are in the 3rd trimester of pregnancy and you feel very itchy all over the body and you see some rash, you may have PUPPP. PUPPP stands for Pruritic Urticarial Papules and Plaques of Pregnancy. What a long name! Luckily we can write or read as PUPPP. (Pruritus = itchy)

Though the name is long and sounds scary, PUPPP is completely a benign (not-serious) skin problem. It occurs in the third trimester (after 28 weeks) of pregnancy. It usually starts at the abdomen where there are striae (stretch marks) and spread to other areas. It seldom involves face, palms and soles.

The skin may have raised spots (papules) or patches (urticaria) of red rash. No one knows why it happens. However, what we know for sure is that it won’t affect the mother and the baby. It will resolve by itself 1-2 weeks after delivery.

    

 PUPPP: Dots and Patches of rash

The big problem is…. It’s very itchy and you can’t sleep well! For this, doctors will give you rather strong steroid cream to relieve the itchiness and redness. Use it sparingly when the itchiness is less serious. Anti-histamine and moisturizers may also be given though not as effective. Soaking in warm water may help some.

Nevertheless, not all itchy rashes in pregnancy are PUPPP. It can be allergy, eczema, infection etc.

Stye vs Chalazion

Both are swelling of the eyelids, can be upper or lower eyelids.

Stye is an infection, usually caused by bacteria in the glands of the eyelids. Chalazion is a swelling caused by blockage at the gland’s opening, thus it is not an infection. They can arise when the eye hygiene is poor, with frequent rubbing the eyes with dirty hand, contact lenses and eye makeup etc. Stye can spread to other people while chalazion can’t.

Stye will show the signs of infection, such as marked redness, pain, swelling and sometimes pus discharge, typically with a yellow dot on red swelling. Chalazion presents as swelling and redness as well, sometimes with pain and it can grow larger than a stye. They both look similar, don’t they?

    Stye: markedly red, note a yellow dot

It is not easy to differentiate between the two. However, no matter what swelling it is, if it looks more likely to be infected, antibiotics will be given.

    Chalazion: larger but mildly red

Treatment for stye and chalazion are generally similar. Since stye is a bacterial infection, it is usually treated with antibiotic eyedrops/ointment. Both conditions can benefit from warm compresses by placing a warm and wet towel over the affected eyelid for 10-15 minutes every 4-6 hours. It is advisable not to break or pinch the swelling on your own.

Stye usually can heal in a week. Whereas for chalazion, it grows and heals slowly and sometimes it can last more than a month. If it can’t heal or get worse, minor surgery can be done to drain the swelling.

Thus,

Stye = infected eyelid swelling

Chalazion = non-infected eyelid swelling

However, it is a challenge to tell whether it is infected or not…

Ovarian Cysts: When to worry

With the increasing use of the ultrasound scan for screening purpose, more cases of ovarian cyst have been diagnosed than ever. Should you be worried if you have one, or two?

In more than 95% of time, ovarian cysts, which are just sacs filled with fluid, are harmless or not cancerous. It usually produces no symptoms, but may cause pain at the lower abdomen if the cyst burst, bleed or twist.

Normal ovaries are filled with many small cysts (usually <2.5cm – physiological cysts). During menstrual cycle, when an egg gradually mature in a cyst, the cyst will increase in size to become a follicle. When the egg is released, the follicle will turn into corpus luteum, which will then shrink in size gradually. However, sometimes this whole process does not occur in a perfect way. When the egg fail to get out from the follicle, follicular cyst will form. The size of follicular cyst is >2.5cm and sometimes can even reach 20cm. In other scenario, when the egg is released but the corpus luteum fail to shrink, a corpus luteum cyst will form. These 2 types of ovarian cysts are called functional cysts as they are part of the normal process of menstruation. They are generally harmless and will shrink in size after a few menstrual cycles.

Other non-functional but benign ovarian cysts include dermoid cyst, endometrioid cyst and cystadenoma. Dermoid cyst, or cystic teratoma is a benign tumour which contains various types of body tissues inside such as hair, bone, skin etc. This may sound scary but it is not cancer. Endometrioid cyst forms when menses blood flow backwards to the ovaries and collect there. It is also called a “chocolate cyst” because the cyst is filled with chocolate-like blood. Cystadenoma does not form from an ovarian follicles but from other part of the ovary. It is also benign though can be very large.

    Dermoid cyst with hair inside

    Chocolate cyst

To make it less complicated, ovarian cyst can be divided as follows:

• Benign (>95%)
  • Functional (follicular cyst, corpus luteum cyst)
  • Non-functional (dermoid cyst, endometrioid cyst, cystadenoma, PCOS)
• Malignant (cancerous)

From ultrasound, we can know the "growth" in the ovary is either cyst or solid. Solid growth is not good news. If it is a cyst, it can be a simple or a complex cyst. Simple cyst means that the cyst appears all black in an ultrasound image. It will be a complex cyst if there are white lines/dots inside. Simple cyst, like what it sounds, is usually functional cyst and harmless. Complex cyst can be either cancer or non-cancer and require closer monitoring or further test. Dermoid & chocolate cysts usually appear as complex cysts.

    Simple ovarian cyst: usually harmless irrespective of size

Any ovarian cyst <2.5cm is normal (physiological). Cysts between 2.5-5cm are most likely functional cysts. Just repeat the ultrasound scan in 3 months time to see how it changes. Functional cysts will usually shrink in size or disappear in less than 3 menstrual cycles. However, if the size increases to >5cm, it may be non-functional cysts, which are still benign but need follow up scan. For ovarian cysts >10cm, intervention or surgery may be considered. Sometimes CT scan may be needed to further evaluate a complex cyst. The presence of endometrioid cyst even of any sizes may be harder to manage as it is usually associated with severe menses pain and infertility.

Ovarian cyst can occur in all ages. It is common in child-bearing age as the ovaries are forming follicles and corpus luteum in every menstrual cycle. However, if it is found in post-menopausal women, more attention need to be given as the risk of cancer increases since there will be no more functional cyst there.

Nevertheless, benign cysts can get bleeding, ruptured, twisted or infected. If you are worry or unsure, please consult a gynaecologist.