![]()
Overview
Shingles are caused by the virus that causes chickenpox, varicella-zoster.
If you've ever had chickenpox (typically during childhood), this virus is quietly
hiding out in the roots of your nerves and can re-activate causing a painful
skin rash. This is known as shingles, herpes zoster, or "the devil's whip."
Not everyone who has had chickenpox will develop a case of shingles. Approximately
20% of North Americans develop shingles at some point in their life. Two-thirds
of people who get shingles are over the age of 60.
Causes
The latent or "quiet" infection caused by varicella-zoster can
become active again, even many years after you've had chickenpox. This can
occur when your immune system isn't working at its best. This may be due to
any of the following reasons:
- older age
- illness
- use of drugs that suppress the body's immune system (e.g., corticosteroids
for severe asthma)
- HIV infection or certain types of cancer
- radiation treatment
Shingles rarely occur in children under the age of 10. The risks of getting
it at that age increase significantly if a child has been infected with the
virus during the first year of life, or if the mother had chickenpox during
pregnancy.
Symptoms
When the virus becomes active again, you may get symptoms such as rash,
upset stomach, headache, fever, and the chills. These symptoms are often
preceded by warning signs (the prodrome) in the days before the rash appears.
The rash produces painful, fluid-filled blisters, and you'll feel tingling or
burning sensations.
When the varicella-zoster virus enters its "quiet" phase after chickenpox,
it remains dormant in certain nerves. The shingles rash will break out in the
areas of the body connected to those nerve cells. As a result, only one section
or one side of the body is often affected. Common sites for the rash include
the chest, back, buttocks, neck, and sometimes the face and scalp.
The rash itself is reddish, with many tiny, fluid-filled blisters. For
a few days, the rash spreads, although its extent varies from one person to
another. The rash commonly occurs on one side of the trunk of your body as a
band of blisters that go from the middle of your back around one side of your
chest to your breastbone. The blisters will break, dry out, and then crust over.
From before the time the rash erupts until after it's healed, you'll be
itchy - in some cases, the rash can be extremely painful. The rash usually
lasts about seven to ten days and completely disappears after one month. The
pain can last for up to three months or longer in a very small percentage of
people. While you will likely have only one bout of the disease, some people
may get it several times.
If your immune system isn't working at full capacity, your rash and symptoms
will be more severe and take longer to heal, which can lead to scarring.
The virus can also spread to other organs in your body, but this is rare for
people with healthy immune systems.
Post-herpetic neuralgia (PHN) is one of the complications of shingles.
It is characterized by severe pain along affected nerves. It can last for several
weeks, even after your blisters have cleared up. The cause of PHN is not known.
Other complications can occur if the virus spreads up the nerve that connects
to your eyes. This may result in an eye infection or eye pain triggered by exposure
to light. Your eye doctor should be consulted immediately if shingles in the
eye area is suspected. If left untreated, the virus can cause blindness. If
the virus spreads to two particular nerves in your face, then a condition called
Ramsay Hunt syndrome can develop. This can lead to temporary facial paralysis
and loss of hearing and taste.
Treatment
Anti-viral drugs work best if started within three days of developing the
shingles rash. This will minimize the extent and spread of the rash and
minimize the pain associated with it. Blisters will also crust over and heal
faster. Anti-viral drugs may also help to reduce the risk of developing chronic
pain from shingles.
Antiviral drugs currently in use today include acyclovir,* valacyclovir, and
famciclovir.
There's some evidence that starting treatment quickly can lower your risk of
developing PHN, or at least shorten the duration of symptoms if you do get it.
Talk with your pharmacist about using over-the-counter medications such as ibuprofen
for the pain associated with PHN. If your pain is very severe, your doctor can
prescribe other types of medications that work to decrease the action of pain
fibers and alter the way pain signals are interpreted by our brain. Your doctor
may also recommend an ointment containing capsaicin that can help to ease the
pain of shingles.
To relieve the itching and pain of shingles, you can try:
- applying calamine lotion to the blisters
- using cool, moist compresses
- soaking in a tub with cornstarch or oatmeal
To prevent shingles, the first step is to avoid getting chickenpox.
If you haven't had it, make sure you don't touch the blisters of people with
either chickenpox or shingles. A vaccine against the varicella-zoster virus
is now available for both children and adults. As immunization of children becomes
routine, the incidence of chickenpox will go down and fewer people will be susceptible
to developing shingles.
For most of us, vaccination comes too late, because we've had chickenpox as
part of our many childhood diseases. To prevent the virus from becoming active
again and causing shingles, the best bet is to keep your immune system healthy
- a balanced diet, regular exercise, and adequate rest can go a long way.
*All medications have both common (generic) and brand names. The brand name
is what a specific manufacturer calls the product (e.g., Tylenol®).
The common name is the medical name for the medication (e.g., acetaminophen).
A medication may have many brand names, but only one common name. This article
lists medications by their common names. For more information on brand names,
speak with your doctor or pharmacist.
Other tips:
With shingles, the rash is fairly characteristic and easy to identify.
If necessary, your doctor can have the fluid from your blisters analyzed to
see if it contains the varicella-zoster virus.
In order to reduce the chances of developing complications, it's a good idea
to see your doctor right away if you suspect you might have shingles. However,
the warning symptoms are not sufficient to diagnose shingles, since they're
similar to the symptoms of a number of other conditions.
© MediResource Inc. Terms and conditions of use: The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.