Shingles, also known as herpes zoster, is a viral infection that causes a painful rash. It is caused by the varicella-zoster virus (VZV), the same virus responsible for chickenpox. Laboratory tests can confirm the presence of the varicella-zoster virus in the fluid from the shingles blisters
What does shingles look like?
Shingles usually appears as a stripe of blisters on the left or right side of the body, around the rib cage or waist. It can also appear on one side of the face, around one eye, or on the neck. The rash often looks like a “belt” or “half belt,” which is sometimes called a “shingles band” or “shingles girdle.” Doctors call this pattern dermatomal because the rash appears in an area of skin supplied by a single spinal nerve, known as a dermatome. The rash usually starts as red patches and develops into fluid-filled blisters.
Localized pain is often the first symptom of shingles and can occur even before the rash appears. This pain may be severe and is often described as burning, throbbing, or stabbing.
A few days after the onset of pain, a rash appears as a band or strip of blisters that wraps around one side of the torso, although it can appear on the face, neck, or other areas. The rash typically scabs over in 7 to 10 days and clears up within 2 to 4 weeks.
The rash is often painfully itchy. But to compound the person’s misery, the skin in the affected area may become extremely sensitive, making even light touch painful.
Some individuals may experience fever, chills, fatigue, and headache. In rare cases, if shingles affects the nerves in the face, it can lead to complications such as eye inflammation, vision problems, or hearing loss.
Postherpetic neuralgia (PHN) is the most common complication of shingles. It occurs when the nerve pain associated with shingles persists for months or even years after the rash has healed. The pain can be debilitating and is more common in older adults.
How do people get it?
Initially, chickenpox is transmitted from person to person by directly touching the blisters, saliva, or mucus of an infected person. The virus can also be transmitted through the air by coughing and sneezing. After the person recovers from chickenpox, VZV remains dormant in the nerve tissues near the spinal cord and brain. At some point later in life, they become re-activated, travel along a nerve to the skin and cause a painful rash.
Who is most at risk?
While the exact reasons for the reactivation of the virus are not fully understood, several factors increase the risk of shingles.
It’s generally associated with older adults and those with weakened immune systems. This includes people with conditions like HIV/AIDS, those undergoing cancer treatments like chemotherapy, or individuals on immunosuppressive drugs following organ transplants.
Physical trauma or emotional stress can trigger the reactivation of the virus, possibly due to their impact on the immune system.
Long-term use of steroids and other medications that suppress the immune system can increase the risk of shingles.
Since shingles is caused by the same virus as chickenpox, only individuals who have had chickenpox or received the chickenpox vaccine can develop shingles. The chickenpox vaccine can reduce the risk, but it doesn’t eliminate it entirely.
How is shingles treated?
While there is no cure for shingles, several treatments can help manage the symptoms and speed up recovery.
Antiviral drugs such as acyclovir, valacyclovir, and famciclovir can reduce the severity and duration of shingles if taken within 72 hours of the appearance of the rash. Over-the-counter pain relievers like acetaminophen or ibuprofen can help alleviate pain. In severe cases, prescription pain medications, numbing agents, or corticosteroids may be necessary.
Topical treatments including calamine lotion, cool compresses, and oatmeal baths can provide relief from itching and discomfort.
To manage chronic pain from postherpetic neuralgia (PHN), antidepressants, anticonvulsants, or nerve blocks may be prescribed.
What happens if someone doesn’t get their shingles treated?
Shingles can lead to several complications, some of which can be severe. They include postherpetic neuralgia (PHN) as well as painful eye infections and vision loss, called ophthalmic shingles. In rare cases, shingles can cause inflammation of the brain (encephalitis), facial paralysis, or problems with hearing or balance.
If the blisters from the shingles rash are not properly cared for, they can become infected with bacteria, leading to skin infections.
What should people know about the shingles vaccine?
Vaccination is the most effective way to prevent shingles and its complications. Two vaccines are available: Zostavax and Shingrix. Shingrix, a newer vaccine, is preferred due to its higher efficacy. It is recommended for adults over the age of fifty, even for those who have previously had shingles or received the Zostavax vaccine.
Early diagnosis and treatment are important for managing symptoms and preventing complications. Vaccination offers an effective means of prevention, reducing the risk of developing shingles and its associated pain.