Shingles, also called herpes zoster, occurs when a previous infection with the herpes zoster virus (the previous infection being a case of chickenpox, caused by varicella-zoster or VZV) reactivates. The resulting infection causes a painful, localized rash, usually with blisters on top of reddish skin. Herpes zoster viruses are not the same viruses that cause genital herpes.
After an individual recovers from chickenpox, the virus remains dormant in the body, usually at the roots of nerves that control sensation. In about 20 percent of the previously infected population, the virus will reactivate, years or even decades after the childhood (or adult) chickenpox infection clears up. What causes this reactivation in some, but not others, remains unknown.
Once the reactivation occurs, the virus travels along the sensory nerves to the skin, causing the shingles disease and rash. The majority of people who develop shingles are older than 60 years of age, but it does occur in younger people and even in children.
What Are the Risk Factors?
Anyone who has had the chickenpox infection or who has received the chickenpox vaccine (with live, attenuated virus) may carry the herpes zoster virus that causes shingles.
People older than 50, those with cancer, HIV/AIDS or organ transplant patients are at higher risk for getting shingles, as are those who have a decreased ability to fight off infection because of chronic stress or immune deficiency. Chronic fatigue can play a role in the reactivation of the herpes zoster virus.
What Are the Signs and Symptoms of Shingles?
The symptoms of shingles occur in three stages, the prodromal stage, which occurs before the onset of the disease’s characteristic rash; the active stage, during which the rash appears and is present; and the postherpetic neuralgia, or chronic pain stage.
Prodromal Stage
● The first symptom of shingles typically is extreme sensitivity to pain in a broad band across one side of the body, along the dermatomes or where the nerves from the spine function. This can be accompanied by an itching, tingling, burning, aching or shooting, “lightning-bolt” pain. These symptoms may occur in the face or near the eyes -- which is a sign to seek immediate medical attention.
● Flu-like symptoms, including fever, chills, headache and itching are common.
● Stomach ache and diarrhea may accompany the onset of other flu-like symptoms.
● Swelling and tenderness of the lymph nodes may develop.
● Fatigue, body aches or headaches may develop in the early stages of the disease.
● A general feeling of malaise often accompanies the early pain and itching associated with the disease.
Active Stage
● One to three days after the pain starts, a rash with raised, red bumps and blisters erupts on the skin in the same distribution as the pain. These blisters become filled with pus, then form scabs about 10-12 days after onset. In some cases, the pain may be present without the rash or blisters.
● A rash may occur on the forehead, cheek, nose and around one eye (called herpes zoster opthalmicus). If this condition develops, it requires immediate medical attention because it may threaten your sight if not treated promptly.
● Pain, described by some as “piercing needles in the skin” typically accompanies the skin rash.
Postherpetic Neuralgia
Postherpetic neuralgia (PHN) is the most common complication from shingles. This condition develops in approximately 15 percent of patients who develop shingles, most often occurring in patients older than 50. The most common symptoms associated with postherpetic neuralgia are:
● Aching, burning, stabbing pain in the area where the shingles rash previously occurred.
● Persistent pain that lasts for at least 30 days but may linger for years.
● Extreme sensitivity to touch.
What Should I Do?
Contact your doctor right away if you suspect that you’re developing shingles and seek immediate medical attention if you develop a rash or pain near one of your eyes, as well as if you are in any one of the following situations that may put you or a loved one at risk for complications:
● You are 70 or older because advanced age is directly linked to your likelihood of developing complications from shingles.
● You or someone in your household has a compromised immune system, because of cancer, medications or chronic illness.
● The rash is widespread or extremely painful.
How Is It Treated?
There is no cure for shingles, but if you contact your doctor promptly to begin treatment with prescription antiviral drugs, you can speed your healing time and reduce the risk of developing complications. Because the condition is often incredibly painful, your doctor may prescribe oral, injected or topical painkillers.
At home, you can take cool baths or apply cold, wet compresses to the blisters on the skin to relieve itching and pain. Minimize daily stress, which may help ease symptoms and speed recovery time. Calamine lotion and colloidal oatmeal baths also have been shown to ease the itching associated with the shingles rash.
Shingles typically will last two to six weeks before clearing up completely. Most people will only get shingles once in their lifetime, but it is possible to get it two or more times -- so just because you’ve had it before doesn’t mean that you won’t have it again.
While shingles cannot be passed from one person to another, direct contact with fluid from shingles blisters passed on to someone who has never had chickenpox may transmit the VZV virus to that person, causing him or her to break out in chickenpox. So if you have shingles, you should steer clear of young infants and those who have not yet contracted the virus or been vaccinated. And while shingles is rare in pregnant women (and the disease will not harm the fetus), a pregnant woman who contracts the disease should seek medical attention to avoid complications.