Shingles: Symptoms and Treatment

Shingles: Symptoms and Treatment

Shingles, also known as herpes zoster, is a viral infection that causes a painful, blistering rash. It’s caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox. After you’ve had chickenpox, the virus lies dormant (inactive) in your nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles.

Shingles is not life-threatening, but it can be very painful. Vaccines can help reduce the risk of shingles, and early treatment can help shorten a shingles outbreak and lessen the chance of complications. The most common complication is postherpetic neuralgia (PHN), which causes severe nerve pain that can last for months or even years after the rash has healed.

Shingles: Symptoms and Treatment

Causes of Shingles (Herpes Zoster)

Shingles is caused by the varicella-zoster virus (VZV). You can only develop shingles if you’ve had chickenpox (varicella) in the past.

Mechanism

• Chickenpox (Primary Infection): The first time you’re infected with VZV, you develop chickenpox.
• Dormancy: After the chickenpox infection resolves, the virus remains dormant in nerve cells (specifically, in the dorsal root ganglia near the spinal cord and in cranial nerve ganglia).
• Reactivation: Years or decades later, the virus can reactivate and travel along nerve fibers to the skin, causing shingles.

Risk Factors for Reactivation

• Age: The risk of shingles increases with age, especially after age 50.
• Weakened Immune System: Conditions that weaken the immune system, such as HIV/AIDS, cancer, and certain medications (e.g., steroids, chemotherapy), can increase the risk of shingles.
• Stress: Physical or emotional stress may play a role in reactivating the virus, although the exact mechanism is not fully understood.
• Certain Medical Treatments: Such as radiation therapy or organ transplantation.

It’s not entirely clear why the virus reactivates in some people and not others.

Symptoms of Shingles (Herpes Zoster)

The symptoms of shingles usually affect only a small section on one side of your body. The most common location is a band around one side of the torso (like a “shingle” or belt), but it can occur on the face, neck, or other parts of the body.

Common Symptoms

• Pain: Often the first symptom. The pain can be severe and is often described as burning, shooting, stabbing, or throbbing.
• Sensitivity to Touch: The affected area may be extremely sensitive to even light touch.
• Itching:
• Numbness or Tingling:
• Rash: A red rash that begins a few days after the pain. The rash typically develops in a single stripe or band on one side of the body.
• Fluid-Filled Blisters: The rash develops into fluid-filled blisters that break open and crust over.
• Fever:
• Headache:
• Fatigue:

Stages of the Shingles Rash

1. Prodromal Stage: Pain, itching, tingling, or numbness in the affected area *before* the rash appears (can last for several days).
2. Active Stage: Red rash appears, followed by fluid-filled blisters. This stage is contagious.
3. Crusting Stage: The blisters break open, ooze, and then crust over.
4. Healing Stage: The scabs fall off, and the skin gradually heals. This can take 2-4 weeks.

Complications

• Postherpetic Neuralgia (PHN): The most common complication. Persistent nerve pain in the area where the shingles rash occurred, lasting for months or even years after the rash has healed. The pain can be severe and debilitating.
• Bacterial Skin Infection: If the blisters are scratched, they can become infected with bacteria.
• Eye Problems (Herpes Zoster Ophthalmicus): If shingles affects the nerves around the eye, it can cause inflammation, pain, and vision problems, including blindness. *This is a medical emergency.*
• Ramsay Hunt Syndrome: If shingles affects the facial nerve near one of your ears. It can cause facial paralysis and hearing loss.
• Neurological Problems: Rarely, shingles can cause inflammation of the brain (encephalitis), spinal cord (myelitis), or other nerves.
• Disseminated Zoster: In people with weakened immune systems, the shingles rash can spread to other parts of the body.

Diagnosing Shingles (Herpes Zoster)

Shingles is usually diagnosed based on the characteristic rash and symptoms. However, a doctor may perform the following tests to confirm the diagnosis:

Diagnostic Tests

• Medical History and Physical Examination: The doctor will ask about your symptoms, medical history (including whether you’ve had chickenpox), and examine the rash.
• Viral Culture: A sample of fluid from a blister can be sent to a lab to test for the varicella-zoster virus.
• PCR (Polymerase Chain Reaction) Test: A more sensitive test that can detect the DNA of the varicella-zoster virus in a sample of fluid from a blister, skin scraping, or blood.
• Tzanck Smear: A sample of cells from a blister is examined under a microscope. This test can help distinguish shingles from other blistering conditions, but it’s not as specific as a viral culture or PCR test.
• Blood Tests: Blood tests are not usually needed to diagnose shingles, but they may be done to check for antibodies to the varicella-zoster virus or to assess the immune system.

Treatment for Shingles (Herpes Zoster)

There is no cure for shingles, but treatment can help shorten the course of the illness, reduce the severity of symptoms, and prevent complications.

Treatment Options

• Antiviral Medications: These medications can reduce the severity and duration of the shingles rash and pain, and they can also reduce the risk of postherpetic neuralgia. They are most effective when started within 72 hours of the rash appearing.
  • Acyclovir (Zovirax)
  • Valacyclovir (Valtrex)
  • Famciclovir (Famvir)
• Pain Relief:
  • Over-the-counter pain relievers: Acetaminophen (Tylenol), ibuprofen (Advil, Motrin).
  • Prescription pain relievers: Opioids (for severe pain), gabapentin, pregabalin, tricyclic antidepressants (for nerve pain).
  • Topical pain relievers: Lidocaine patches or creams, capsaicin cream.
• Corticosteroids: May be used to reduce inflammation and pain, especially in severe cases or when the eyes are involved. However, their use is controversial, and they may not prevent PHN.
• Wet Compresses: Applying cool, wet compresses to the rash can help soothe itching and pain.
• Calamine Lotion: Can help relieve itching.
• Keep the Rash Clean and Dry: To prevent bacterial infection.
• Avoid Scratching the Blisters:
• Rest:

Prevention of Shingles (Herpes Zoster)

The best way to prevent shingles is through vaccination.

Shingles Vaccines

• Shingrix (Recombinant Zoster Vaccine): The preferred shingles vaccine. It’s recommended for adults 50 and older, even if they’ve had shingles before or received the older Zostavax vaccine. Shingrix is given in two doses, 2-6 months apart. It’s highly effective at preventing shingles and PHN.
• Zostavax (Zoster Vaccine Live): An older shingles vaccine that is no longer available in the United States (as of November 2020). It was a live vaccine and less effective than Shingrix.

Who Should Get the Shingles Vaccine?

• The CDC recommends that adults 50 years and older get Shingrix, even if they’ve had shingles in the past, received Zostavax, or are unsure if they had chickenpox.
• Adults 19 years and older who have weakened immune systems because of disease or therapy should also get Shingrix.

FAQ – Frequently Asked Questions About Shingles (Herpes Zoster)

Q1. Is shingles contagious?

A1. Shingles itself is *not* contagious. However, the varicella-zoster virus (VZV) that causes shingles *is* contagious. A person with shingles can spread VZV to someone who has never had chickenpox or the chickenpox vaccine, causing them to develop *chickenpox*, not shingles. The virus is spread through direct contact with the fluid from shingles blisters. Once the blisters have crusted over, the person is no longer contagious.

Q2. Can you get shingles more than once?

A2. Yes, it’s possible to get shingles more than once, although it’s not common. The shingles vaccine significantly reduces the risk of getting shingles again.

Q3. How long does shingles last?

A3. The shingles rash typically lasts for 2-4 weeks. However, the pain can last longer, especially in people who develop postherpetic neuralgia (PHN).

Q4. What is postherpetic neuralgia (PHN)?

A4. PHN is the most common complication of shingles. It’s persistent nerve pain in the area where the shingles rash occurred, lasting for months or even years after the rash has healed. The pain can be severe and debilitating.

Q5. Can I get shingles if I’ve had the chickenpox vaccine?

A5. Yes, it’s possible to get shingles even if you’ve had the chickenpox vaccine, but it’s much less likely. The chickenpox vaccine significantly reduces the risk of getting chickenpox, and therefore also reduces the risk of developing shingles later in life. If someone who has been vaccinated against chickenpox *does* develop shingles, it is usually a milder case.

Q6: Can children get shingles?

A6: Yes, children can get shingles, but it’s much less common than in adults. Shingles in children is usually milder than in adults.

Q7. Can I be around pregnant women if I have Shingles?

A7 If you have Shingles, you should avoid contact with pregnant women who have never had chickenpox or the chickenpox vaccine, as you could transmit the virus to them, and they, in turn, could develop chickenpox. Chickenpox during pregnancy can cause complications for the unborn baby.

Conclusion: Early Treatment and Vaccination are Key

Shingles (herpes zoster) is a painful condition that can have significant complications, especially postherpetic neuralgia. Early treatment with antiviral medications can help reduce the severity and duration of the illness. Vaccination with Shingrix is highly effective at preventing shingles and PHN and is recommended for adults 50 and older. If you develop a painful, blistering rash on one side of your body, see a doctor promptly.