Summary about Disease
Herpes zoster, commonly known as shingles, is a painful skin rash caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, the virus remains dormant in nerve tissue near the brain and spinal cord. Years later, the virus can reactivate as shingles. Shingles typically appears as a single stripe of blisters that wraps around either the left or right side of the torso.
Symptoms
Pain, burning, numbness, or tingling
Sensitivity to touch
A red rash that begins a few days after the pain
Fluid-filled blisters that break open and crust over
Itching
Fever
Headache
Fatigue
Causes
Shingles is caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox. The exact reason for reactivation is unknown, but it is thought to be related to a decline in immunity. Risk factors include:
Older age (especially over 50)
Weakened immune system (due to illness, medications, or stress)
Having had chickenpox
Medicine Used
Antiviral Medications: Acyclovir, valacyclovir, and famciclovir. These medications can shorten the duration and severity of the illness and reduce the risk of postherpetic neuralgia. They are most effective when started within 72 hours of the rash appearing.
Pain relievers: Over-the-counter pain relievers (acetaminophen, ibuprofen) can help with mild pain. Stronger pain medications (opioids) may be needed for severe pain.
Topical Treatments: Calamine lotion or cool compresses can help relieve itching. Capsaicin cream (after blisters have healed) can sometimes reduce postherpetic neuralgia pain.
Corticosteroids: Occasionally, corticosteroids (like prednisone) may be prescribed to reduce inflammation, but their use is controversial and not always recommended.
Is Communicable
Shingles itself is not contagious. However, a person with shingles can spread the varicella-zoster virus (VZV) to someone who has never had chickenpox or has not been vaccinated against chickenpox. In such cases, the exposed person will develop chickenpox, not shingles. The virus is spread through direct contact with the fluid from the shingles blisters. A person with shingles is contagious until the blisters have scabbed over.
Precautions
Keep the rash covered.
Avoid touching or scratching the rash.
Wash your hands frequently.
Avoid contact with pregnant women who have never had chickenpox or the chickenpox vaccine, premature or low birth weight infants, and people with weakened immune systems.
Consider the shingles vaccine (Shingrix) if you are over 50, even if you have had shingles before.
How long does an outbreak last?
A shingles outbreak typically lasts for 2 to 6 weeks.
How is it diagnosed?
Shingles is usually diagnosed based on a physical exam and a review of your medical history. The characteristic rash and pain pattern are often sufficient for diagnosis. In some cases, a doctor may take a skin scraping or fluid sample from a blister to confirm the diagnosis with a laboratory test.
Timeline of Symptoms
Prodromal phase (1-5 days before rash): Pain, burning, tingling, or numbness in the affected area.
Active phase (rash develops): Redness, followed by fluid-filled blisters that appear in a band-like pattern. Blisters rupture, crust over, and eventually scab. This phase lasts about 2-4 weeks.
Postherpetic neuralgia (PHN): Chronic nerve pain that can last for months or even years after the rash has healed. This is a potential complication.
Important Considerations
Eye Involvement: Shingles can affect the eye (herpes zoster ophthalmicus), which can lead to serious complications such as vision loss. Seek immediate medical attention if you have shingles near your eye.
Postherpetic Neuralgia (PHN): This is the most common complication of shingles, causing persistent pain in the area where the rash occurred. Treatment for PHN may include topical creams, pain medications, and nerve blocks.
Vaccination: The Shingrix vaccine is highly effective in preventing shingles and PHN. It is recommended for adults aged 50 and older, even if they have had shingles before.
Prompt Treatment: Starting antiviral medication within 72 hours of the rash appearing is crucial to reduce the severity and duration of the illness and lower the risk of complications.