What is Shingles?
Shingles is an extraordinarily painful condition that involves inflammation of sensory nerves. It causes numbness, itching, or pain followed by the appearance of clusters of little blisters in a strip pattern on one side of the body. The pain can persist for weeks, months, or years after the rash heals and is then known as postherpetic neuralgia. The term is derived from the Latin cingulum, meaning girdle -- the idea being that shingles often girdles part of the body.
What Causes Shingles?
Shingles, also known as herpes zoster, is caused by the same virus that causes chickenpox (varicella-zoster virus or VZV) and belongs to the herpes family of viruses. After an individual has chickenpox, this virus lives dormant in the nervous system and is never fully cleared from the body. In some people, it remains dormant forever. In others, the virus "wakes up" when disease, stress, or aging weakens the immune system, resulting in shingles. In most cases of shingles, however, a cause for the reactivation of the virus is never found. If the virus becomes active again, it can only cause shingles, not chickenpox.
What Does the Shingles Rash Look Like?
The shingles rash is made up of painful skin blisters that erupt on only one side of your face or body along the distribution of nerves on the skin. Typically, this occurs along your chest, abdomen, back, or face, but it may also affect your neck, limbs, or lower back.
Who Is at Risk for Shingles?
Anyone who has ever had chickenpox is at risk for the development of shingles, although it occurs most commonly in people over the age of 60. Weakened immune systems, emotional stress, immune deficiency (from AIDS or chemotherapy), or cancer can cause the virus to reactivate. It has been estimated that up to 1,000,000 cases of shingles occur each year in the U.S.
Shingles Symptoms: Before the Rash
Even when there is no rash, the pain of shingles may be apparent. Before a rash is visible, the patient may notice several days to a week of burning pain and sensitive skin. When the characteristic rash is not yet apparent, it may be difficult to determine the cause of the often severe pain. The sensation can be itching, tingling, burning, constant aching, or a deep, shooting pain. Other nonspecific symptoms that can occur at the same time are fever, chills, headache, or upset stomach.
Shingles Symptoms: The Rash
Shingles rash starts as small blisters on a red base, with new blisters continuing to form for three to five days. The blisters follow the path of individual nerves that come out of the spinal cord in a specific "ray-like" distribution (called a dermatomal pattern) and appear in a band-like pattern on an area of skin.
Shingles Symptoms: After the Rash
As with the blisters of chickenpox, eventually, the blisters in shingles pop, and the area starts to ooze. The affected areas will then crust over and heal. Before the blisters are crusted over, the virus can be spread to anyone who does not have immunity to chickenpox through vaccination or previous infection. The rash disappears as the scabs fall off, and scarring may result.
How Long Does Shingles Last?
The duration of a shingles outbreak may take three to four weeks from start to finish. On occasion, the pain will be present but the blisters may never appear. This can be a very confusing cause of local pain. Some patients develop postherpetic neuralgia (PHN), in which the localized pain remains even after the rash is gone.
What Is Postherpetic Neuralgia (PHN)?
The most common complication of shingles is postherpetic neuralgia. This occurs when the nerve pain associated with shingles persists beyond one month, even after the rash is gone. It is a result of irritation of the nerves of sensation by the virus. The pain can be severe and debilitating. As many as 15% of people with shingles develop postherpetic neuralgia; most of these cases occur in people over 50 years of age. There is evidence that treating shingles with antiviral agents can reduce the duration and occurrence of postherpetic neuralgia.
Is Shingles Contagious?
Shingles is contagious and can be spread from an affected person to babies, children, or adults who have not had chickenpox. But instead of developing shingles, these people develop chickenpox. Once they have had chickenpox, people cannot catch shingles (or contract the virus) from someone else. Once infected, however, people have the potential to develop shingles later in life.
Shingles is contagious to people who have not previously had chickenpox, as long as there are new blisters forming and old blisters healing. Similar to chickenpox, the time prior to healing or crusting of the blisters is the contagious stage of shingles. Once all of the blisters are crusted over, the virus can no longer be spread and the contagious period is over.
What Are Complications From Shingles?
Generally, shingles heals well and problems are few. However, on occasion, the blisters can become infected with bacteria, causing cellulitis, a bacterial infection of the skin. If this occurs, the area will become reddened, warm, firm, and tender. A more worrisome complication is when shingles affects the face (forehead and nose), which may spread to the eye and lead to loss of vision.
How Is Shingles Diagnosed?
The clinical appearance of shingles, with characteristic painful blisters localized to the region of a specific nerve, is usually sufficient to establish the diagnosis. No diagnostic tests are usually required. However, particularly in people with impaired immune function, shingles may sometimes not display the characteristic clinical pattern. In these cases, samples from the affected area may be tested in a laboratory, either by culturing the tissue for growth of the virus or by identifying the genetic material of the virus.
What Is the Treatment for Shingles?
There is no cure for shingles. You can take steps to shorten the duration of a shingles outbreak, but in the end, the virus must often simply run its course. People who have shingles symptoms should see their doctor as soon as possible, because antiviral medication is effective only if given early. Individuals with facial, nose, or eye symptoms should seek medical care immediately. Early medical attention may also prevent or reduce the scarring that shingles can cause. We'll take a look at both conventional medicine and home self-care remedies on the following slides.
Shingles Treatment - Medications
There are several effective treatments for shingles. Drugs that fight viruses (antivirals), such as acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir), can reduce the severity and duration of the rash if started early (within 72 hours of the appearance of the rash). In addition to antiviral medications, pain medications may be needed for symptom control. Both nonsteroidal anti-inflammatory medications and narcotic pain-control medications may be used for pain management in shingles. Postherpetic neuralgia (PHN) may require additional medications such as opioids (for example, oxycodone, morphine) to control pain.
Sometimes topical corticosteroids are used to decrease inflammation and pain, but they should be used only under the supervision of a health care professional since in some patients, corticosteroids may make the condition worse.
Shingles Treatment -- Home Self-Care
Bathing is permitted, and the affected area can be cleansed with soap and water. Cool compresses and anti-itching lotions such as calamine lotion may also provide relief. An aluminum acetate solution (Burow's or Domeboro solution, available at your pharmacy) can be used to help dry up the blisters and oozing. Application of petroleum jelly can also aid in healing. Over-the-counter (OTC) antihistamines (Benadryl) and pain medicines can also help ease recovery.
Wear loose clothing to avoid extra pain from clothing rubbing against the rash. Avoid close skin-to-skin contact with others who have not had chickenpox, are ill, or who have a weakened immune system.
Is There a Shingles Vaccine?
In May 2006, the U.S. Food and Drug Administration (FDA) approved the first vaccine for adult shingles. The vaccine known as Zostavax is approved for use in adults ages 50 and over who have had chickenpox. The U.S. Centers for Disease Control and Prevention recommends the vaccine for people 60 years of age and over who have had chickenpox. It is a onetime injection (shot) that does not need to be repeated. The shingles vaccine contains a booster dose of the chickenpox vaccine usually given to children. Tests over an initial four-year period showed that the vaccine significantly reduced the incidence of shingles in these older adults. The single-dose vaccine was shown to be more than 60% effective in reducing shingles symptoms, and it reduced the incidence of postherpetic neuralgia (PHN) by at least two-thirds. Studies are ongoing to evaluate the effectiveness of the vaccine over a longer term. Even if you have had shingles, you can still have the vaccine to help prevent future outbreaks.
Who Should Not Receive the Shingles Vaccine?
There are certain contraindications to receiving the shingles vaccine. The shingles vaccine should not be administered to pregnant women. It is recommended that a woman wait three months before trying to become pregnant after she has received the shingles vaccine. People with weakened immune systems due to immune-suppressing medications, cancer treatment, HIV disease, or organ transplants should not receive the shingles vaccine because it contains live, weakened viral particles. There is not enough information available from researchers to decide at this point whether Zostavax may be beneficial in people younger than 60 years of age. Pregnant women should not receive the shingles vaccine.
Are There Side Effects to the Shingles Vaccine?
The shingles vaccine has not been shown to cause any serious side effects or health consequences. Minor side effects include redness, soreness, swelling, or itching at the shot site, and headache. It is safe for those who have received the shingles vaccine to be around babies or those with weakened immune systems. It has not been demonstrated that a person can develop chickenpox from getting the shingles vaccine, although some people who receive the vaccine may develop a mild chickenpox-like rash near the injection site. This rash should be kept covered and will disappear on its own.
Is Shingles Dangerous in Pregnant Women?
Pregnant women are susceptible to shingles, but fortunately, shingles in pregnancy is very rare. The antiviral medications described above are considered safe to use in pregnant women, as are most pain-relieving drugs. In the later stages of pregnancy, women should not take nonsteroidal anti-inflammatory medications such as ibuprofen (Advil) or naproxen (Aleve). However, acetaminophen (Tylenol) is considered safe even in the late stages of pregnancy. Having chickenpox during pregnancy has the potential to cause birth defects, depending upon when in the pregnancy the infection occurs. The risk of birth defects is believed to be lower with shingles than with primary chickenpox infection.
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