Shingles

Definition

Shingles is a painful infection of the nerves and skin.

Causes

It is caused by the varicella zoster virus. This is the same virus that causes chickenpox . Shingles occurs in people who already had chickenpox. After causing the first chickenpox infection, the virus does not leave the body. It settles in nerve roots near the spinal cord. Once reactivated, the virus travels along nerve paths to the skin. There it causes pain and a rash.

Shingles Blisters

© 2008 Nucleus Medical Art, Inc.

Risk Factors

These risk factors increase your chance of developing shingles. Tell your doctor if you have any of these risk factors:

Shingles can occur in those with no known risk factor other than age.

Shingles cannot be transmitted from one person to another. But a person who has never had chickenpox and never received the varicella vaccine , could get chickenpox if he came in contact with a person who has shingles.

Symptoms

If you have any of these symptoms do not assume it is due to shingles. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

  • Rash:
    • Red, slightly raised band or patch often overlain with multiple small fluid-filled blisters
    • Develops on one side of the body or the other, but typically does not cross the midline
    • Spread to multiple parts of the body—the so-called “disseminated” zoster (in severe cases)
    • Blisters dry out and crust (within several days)
    • Affects mostly the torso and face
  • Affected eyes (in severe cases), which can seriously threaten vision
  • Pain on the skin at the site of the rash (usually severe)
  • Tingling or itchiness on the skin, which may start a few days before the rash
  • Skin in the affected area is unusually sensitive to touch
  • Fever
  • Headache
  • Tiredness

The rash disappears within three weeks. The pain may continue months or years after the rash has healed. This is called postherpetic neuralgia (PHN). PHN pain is difficult to treat. It can also be very severe.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. He can diagnose the rash by its appearance. He may draw fluids from the blisters for testing. But this is rare.

Treatment

Shingles cannot be cured. Treatment is focused on:

  • Easing symptoms
  • Speeding recovery
  • Preventing PHN

Itch and Pain Relief

Itching may be relieved by:

  • Calamine lotion
  • Wet compresses
  • Frequent oatmeal baths

Over-the-counter pain relievers:

  • Oral medications like acetaminophen (Tylenol) , ibuprofen (Advil) , and naproxen (Aleve)
  • Capsaicin , a substance from hot peppers (topical)

Your doctor may prescribe drugs to relieve pain that doesn't respond to over-the-counter remedies.

Antiviral Drugs

Certain antiviral medications may control shingles by changing how the virus reproduces in nerve cells. They include:

  • Acyclovir (Zovirax)
  • Famciclovir (Famvir)
  • Valacyclovir (Valtrex)

Antiviral therapy may shorten a shingles episode. But you must start it within 48-72 hours after symptoms first develop. These medications can reduce the severity and duration of PHN. They are for patients with the highest risk for this condition (ie, over 55).

Steroids

Your doctor may also prescribe a short course of oral steroid medication (eg, prednisone ) if your immune system is functioning normally.

Postherpetic Neuralgia

Taking antiviral medications before PHN develops is the most effective way to reduce its severity.

A variety of other treatments are available:

  • Capsaicin
  • Tricyclic antidepressants (may also treat shingles)
    • An SSRI (selective serotonin reuptake inhibitor) may also be prescribed.
  • Lidoderm patch—a transdermal form of lidocaine (local anesthetic)
  • Gabapentin —an anti-seizure medication (also treats PHN)
  • Transcutaneous electrical nerve stimulation (TENS)—a device that generates low-level pulses of electrical current on the skin's surface
  • Nerve blocks—injections near nerves to provide temporary pain relief (used as a last resort)

Prevention

There is no proven way to prevent shingles. Stress and fatigue may contribute to an outbreak. Future cases of shingles should decrease as more children are vaccinated.

The US Food and Drug Administration approved a vaccine (Zostavax) for people over 60 who have had chickenpox. The vaccine decreases the likelihood of getting shingles and the severity if shingles does occur.

RESOURCES:

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov/

VZV Research Foundation (for research on Varicella Zoster)
http://www.vzvfoundation.org/

CANADIAN RESOURCES:

Canadian Family Physician
http://www.cfpc.ca/cfp/

Public Health Agency of Canada
http://www.phac-aspc.gc.ca/

References:

Beers MH. The Merck Manual of Geriatrics (on-line edition). Whitehouse Station, NJ: Merck and Co.; 2000. Available at: http://www.merck.com/mkgr/mmg/home.jsp . Accessed June 22, 2008.

Shingles: an unwelcome encore. FDA Consumer Magazine . 2001 May-June. US Food and Drug Administration website. Available at: http://www.fda.gov/FDAC/features/2001/301_pox.html . Accessed June 22, 2008.

Stankus SJ, Dlugopolski M, Packer D. Management of herpes zoster and postherpetic neuralgia. Am Fam Physician . 2000 Apr 15.



Last reviewed November 2007 by Ross Zeltser, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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