Shingles or herpes zoster is a localized, painful, blistering rash caused by the varicella virus, which is the same virus that causes chicken pox. It occurs only in people who have had chickenpox in the past and represents a reactivation of the dormant varicella virus. Shingles is not a new infection, it is rather a second outbreak of the chicken pox virus. Shingles is primarily a disease of the elderly, but it can occasionally affect young individuals also. It affects both sexes and all races with equal frequency and occurs sporadically throughout the year.
What are the causes of shingles?
The varicella zoster which belongs to the herpes family causes shingles. The virus after causing chicken pox in childhood, remains dormant or quiet in the nerve cells near the spine. A weakening of certain cells of the immune system reawakens the varicella virus causing shingles. The immune system is also weakened by certain diseases like cancer and HIV and by certain medications like chemotherapy, corticosteroids and drugs to prevent rejection of organ transplants. Once active, the virus travel along the nerve paths to the skin, leaving a path of destruction along the nerves in which they travel. The result is the pain and rash of shingles.
What are the symptoms associated with shingles?
First sign of shingles is a tingling feeling or itchiness of the skin, which occurs several days before the rash appears.
Stabbing pain accompanying the rash occurs in some people in the beginning, while in others it may occur only after the rash begins.
The rash begins as a band of red spots, which turn into blisters that burst and crust over, usually within a week or two.
The rash may occur in any part of the body, but they will affect only one side of the body and will never cross the midline. This is because they come out on the area of skin which is supplied by one particular nerve.
The rash appears as a band on one side of the chest or abdomen, or down an arm or leg. The most common sites of shingles are on one side of the chest (front or back, like half of a belt) and on one side of the forehead and scalp.
The pain accompanying the rash usually settles as quickly as the rash, but in some cases it may continue for many months or even years. This condition is called Post Herpetic Neuralgia (PHN).
How is shingles diagnosed?
The location and pattern of the rash is the most important sign that confirms the diagnosis. However, a sample of the fluid from the blisters, or of the blood can confirm the diagnosis further, beyond which, no other tests would be needed.
How is shingles treated?
The main treatment goals of shingles is to reduce the pain associated with the rash and to hasten the healing of the blisters, thus preventing the spread of the disease. The early treatment of the infection would reduce the chances of developing Post Herpetic Neuralgia.
The primary treatment for shingles is antiviral medication like acyclovir (Zovirax), famciclovir (Famvir), or valacyclovir (Valtrex), since the infection is caused by a virus. A new skin patch containing a 5% lidocaine solution is the only prescription specifically for the treatment of the pain associated with PHN. Opioid pain relievers, low doses of tricyclic antidepressants, and corticosteroids may be given to relieve the pain associated with shingles (PHN). However, patients with severe PHN may be ordered a nerve block through transcutaneous electrical nerve stimulation (TENS), which involves sending electrical impulses to the affected nerves to block the pain sensation.
A person affected with herpes zoster in the forehead area would need an emergency consultation from an ophthalmologist as the infection can, at times, cause severe eye problems. In the event of ophthalmic herpes (when the eye is infected with the herpes virus), the treatment would usually involve anti-viral eye drops accompanied by oral drugs.
Frequently asked questions about Shingles :
Which doctor should I consult with, if I have shingles?
You can consult a dermatologist.
Can anyone get shingles?
No. Not everyone will get shingles. Only those who have had chicken pox in childhood can get shingles as adults.
Is shingles contagious?
Shingles is not contagious and cannot spread from one person to another. However, contact with a person affected with shingles can cause chicken pox in someone who has never had it before.
Can shingles cause other infections related to viruses of the herpes family?
No. Shingles cannot cause other herpes related infections, because the varicella zoster virus can cause only chicken pox and shingles. The virus does not cause genital herpes or cold sores.
How long does the infection last?
The rash associated with shingles can last up to 2 weeks, while the pain may occur even before the rash starts and could last up to a month, or longer in some cases (PHN).
Why does the virus get reactivated after a dormant period?
The varicella zoster virus is reactivated due to the weakening of the immune system with aging or diseases like AIDS or Cancer.
Can shingles recur in a person affected with the infection once?
Most people are affected with the infection only once, but those with weakened immune systems may have repeated encounters with the disease.
Glossary
Antidepressants : Any type of medications used to counter depression.
Antiviral : An agent that is effective against viruses.
Blister : A collection of serous, bloody or watery fluid under the skin.
Chemotherapy : Treatment by chemical substances having a specific effect on the microorganisms causing disease without injuring the patient.
Corticosteroid : A steroidal compound found in urine which has biological properties resembling those of adrenal cortical extract.
Herpes : Skin disease marked by clusters of small vesicles.
HIV : Human Immunodeficiency Virus; the virus that is responsible for causing AIDS.
Immune system : A system of the body through which it fights the effects of deleterious agents like pathogenic microorganisms and protects itself from diseases.
Neuralgia : Pain in a nerve.
Opioid : Any man-made drug that exhibits properties of opium and is given to treat pain.
Rash : A temporary eruption on the skin.
Tens : Transcutaneous Electrical Nerve Stimulation—A type of treatment in which electrodes are attached to the skin and low amounts of electricity is sent to the affected nerves to block the pain sensation.
Tricyclic antidepressants : A type of medication given to ease Post Herpetic Neuralgia (PHN). Brand names of some commonly used tricyclic antidepressants are Elavil, Pamelor, and Norpramin.
Varicella Zoster : A type of virus which causes chicken pox and shingles. It belongs to the herpes family.
Virus : One of a heterogenous group of infectious agents, smaller than ordinary bacteria and requiring susceptible host cells for multiplication and activity.
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