Shingles is a skin rash caused by the same virus that causes chickenpox. The virus responsible for these conditions is called the Varicella zoster virus (VZV). After an individual has chickenpox, this virus lives in the nervous system and is never fully cleared from the body. Under certain circumstances, such as emotional stress, immune deficiency (from AIDS or chemotherapy), or with cancer, the virus reactivates causing shingles. In most cases, however, a cause for the reactivation of the virus is never found. 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. It has been estimated that up to 500,000 cases of shingles occur each year in the U.S.
The herpes virus that causes shingles and chickenpox is not the same as the herpes virus that causes genital herpes (which can be sexually transmitted) and herpes mouth sores. Shingles is medically termed Herpes zoster.
What are symptoms of shingles? How long does shingles last?
Before a rash is visible, the patient may notice several days to a week of burning pain and sensitive skin. Before the rash is visible, it may be difficult to determine the cause of the often severe pain. Shingles start 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 comes out of the spinal cord (called a dermatomal pattern). The entire path of the nerve may be involved or there may be areas with blisters and areas without blisters. Generally, only one nerve level is involved. In a rare case, more than one nerve will be involved. Eventually, the blisters pop, and the area starts to ooze. The affected areas will then crust over and heal. The whole process 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.
Is shingles contagious?
Yes, shingles is contagious. Shingles can be spread from an affected person to 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 that have not previously had chickenpox, as long as there are new blisters forming and old blisters healing. Once all of the blisters are crusted over, the virus can no longer be spread.
What are the complications of shingles?
Generally, shingles heal 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. You might notice red streaks forming around the wound. If you notice any of these symptoms, contact your health-care professional. Antibiotics can be used to treat these complications.
A more worrisome complication occurs when shingles affect the face, specifically the forehead and nose. In these cases, it is possible, although not likely, that shingles can affect the eye, leading to loss of vision. If you have shingles on your forehead or nose, your eyes should be evaluated by a health-care professional.
Can shingles be prevented with a 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 60 and over who have had chickenpox. The 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, see below) by at least two-thirds. Studies are ongoing to evaluate the effectiveness of the vaccine over a longer term.
People with weakened immune systems due to immune suppressing medications, cancer treatment, HIV disease, or organ transplants should not receive the vaccine because it contains live, weakened viral particles.
Since vaccination against VZV is now recommended for children, the incidence of chickenpox has been reduced, which is expected to reduce the incidence of shingles in adults as these children age.
What is Postherpetic neuralgia and what can be done for it?
Postherpetic neuralgia is localized pain in the area of involvement of shingles that persists beyond one month.
The most common complication of shingles is postherpetic neuralgia. This occurs when the 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 and occurs primarily in people over the age of 50. There is some evidence that treating shingles with steroids and antiviral agents can reduce the duration and occurrence of postherpetic neuralgia. However, the decrease is minimal.
The pain of postherpetic neuralgia can be reduced by a number of medications. Tricyclic antidepressant medications (amitriptyline [Elavil] and others), as well as anti-seizure medications (gabapentin [Neurontin], carbamazepine [Tegretol], pregabalin [Lyrica]), have been used to relieve the pain associated with herpetic neuralgia. Capsaicin cream (Zostrix), a derivative of hot chili peppers, can be used topically on the area after all the blisters have healed, to reduce the pain. Lidocaine pain patches (Lidoderm) applied directly to the skin can also be helpful in relieving nerve pains by numbing the nerves with local lidocaine anesthetic. These options should be discussed with your health-care practitioner.
Shingles At A Glance:
- Shingles is caused by the same virus that causes chickenpox and can be spread to people who have not had chickenpox.
- Shingles, also known as Herpes zoster, is not related to the sexually transmitted herpes virus disease called herpes genitalis.
- Shingles may cause pain that can continue after the rash disappears.
- Steroids and antiviral drugs can help prevent long-term pain after shingles if they are started within the first two days of the appearance of the rash.
- A vaccine is available for people over 60 years of age to reduce the incidence and severity of shingles.
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