Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention

Definition

Shingles is a painful infection of the nerves and skin.

Causes

It is caused by the varicella zoster virus. This is the same virus that causes chickenpox. Shingles occurs in people who already have had chickenpox. After causing the first chickenpox infection, the virus is not totally eliminated from the body. Some of the remaining virus settles in nerve roots near the spinal cord. Once reactivated, the virus travels along nerve paths to the skin. There it causes pain and a rash.

Shingles Blisters

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Risk Factors

These risk factors increase your chance of developing shingles. Tell your doctor if you have any of these risk factors:

  • Age: 50 or older (Women are somewhat more susceptible.)
  • Compromised immune system:
  • Excessive fatigue
  • Physical or psychological stress
  • Radiation therapy

Shingles can occur in those with no known risk factor other than age.

Shingles is not usually transmitted from one person to another. But, a person who has never had chickenpox and never received the varicella vaccine is likely to get chickenpox if he came in prolonged contact with a person who has shingles. Covering shingles sores with a bandage reduces the risk of transmitting shingles to others.

Symptoms

If you have any of these symptoms do not assume it is due to shingles. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

  • Rash:
    • Red, slightly raised band or patch often overlain with multiple small fluid-filled blisters
    • Develops on one side of the body or the other, but typically does not cross the midline
    • Spread to multiple parts of the body—the so-called “disseminated” zoster (in severe cases)
    • Blisters dry out and crust (within several days)
    • Affects mostly the torso and face
  • Affected eyes (in severe cases), which can seriously threaten vision
  • Pain on the skin at the site of the rash (usually severe)
  • Tingling or itchiness on the skin, which may start a few days before the rash
  • Skin in the affected area is unusually sensitive to touch
  • Fever
  • Headache
  • Tiredness

The rash disappears within three weeks. The pain may continue months or years after the rash has healed. This is called postherpetic neuralgia (PHN). PHN pain is difficult to treat. It can also be very severe.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor can diagnose the rash by its appearance. Fluids may be drawn from the blisters for testing but this is rare.

Treatment

Shingles cannot be cured. Treatment is focused on:

  • Easing symptoms
  • Speeding recovery
  • Preventing PHN

Itch and Pain Relief

Itching may be relieved by:

  • Calamine lotion
  • Wet compresses
  • Frequent oatmeal baths

Over-the-counter pain relievers:

  • Oral medications like acetaminophen (Tylenol) , ibuprofen (Advil) , and naproxen (Aleve)
  • Capsaicin , a substance from hot peppers (topical)

Your doctor may prescribe drugs to relieve pain that doesn't respond to over-the-counter remedies.

Antiviral Drugs

Certain antiviral medications may control shingles by changing how the virus reproduces in nerve cells. They include:

  • Acyclovir (Zovirax)
  • Famciclovir (Famvir)
  • Valacyclovir (Valtrex)

Antiviral therapy may shorten a shingles episode. But you must start it within 48-72 hours after symptoms first develop.

Steroids

Your doctor may prescribe a short course of oral steroid medication (eg, prednisone ) if your immune system is functioning normally.

Postherpetic Neuralgia

Being vaccinated to prevent shingles is the only effective way to reduce the risk and severity of PHN.

A variety of other treatments are available in the event PHN does occur:

  • Tricyclic antidepressants
  • Gabapentin —an anti-seizure medication (also treats PHN)
  • Pregabalin —approved for PHN
  • Pain medications including long-acting opiates (narcotics) and Tramadol
  • Capsaicin cream
  • Lidoderm patch—a transdermal form of lidocaine (local anesthetic)
  • Nerve blocks—injections near nerves to provide temporary pain relief
  • Transcutaneous electrical nerve stimulation (TENS)—a device that generates low-level pulses of electrical current on the skin's surface
  • SSRI (selective serotonin reuptake inhibitor)

Prevention

The herpes zoster vaccine (Zostavax) is recommended for people aged 60 years and older. The vaccine decreases the likelihood of getting shingles and significantly reduces the severity of PHN if shingles does occur. The vaccine is most effective in persons 60-69 years of age, and it reduces the likelihood of getting shingles by about half.

If you do have shingles, take these steps to prevent giving chickenpox to others:

  • Keep all blisters covered with a bandage until they are dry and crusted over.
  • If you are a healthcare worker, do not return to work until the blisters are dry and crusted over.
  • Avoid contact with people who are at risk to getting severe varicella, such as:
    • Pregnant women
    • Premature infants
    • People who have a compromised immune system (eg, cancer, HIV)