Introduction

What is shingles?

Shingles is caused by a virus known as Varicella-zoster. In fact, this is the same virus that causes chickenpox. The Varicella-zoster virus can be found around Europe, however, it is most likely to occur in this region around winter and spring. If you live in tropical areas, you are more likely to become infected at older ages, when unfortunately you are at risk to more serious symptoms.¹

What is the difference between chickenpox and shingles?

When you catch the Varicella-zoster virus for the first time, it is likely due it spreading by an infected person coughing, sneezing or coming into direct contact when suffering with the viral rash. It is more uncommon, but not unheard of that infection can be caused from parts of the rash becoming airborne.²

You may be seeing a lot about chickenpox when researching shingles, but they are almost the same. The only difference is that the first infection, one you often catch as a child, is called chickenpox. Shingles means you have been infected for the second time which happens mostly in adulthood.³ This is because the virus lays dormant meaning it is not active and so you will not suffer from an infection. 

Sometimes even decades later, this dormant virus can become active which will cause you to suffer from symptoms. Your antibodies are what trigger an immune response which is the cause to your symptoms. Antibodies will therefore detect the shingles virus, but only when it is not dormant.³

Are you Likely to Get Shingles?

There are a variety of risk factors that make you more susceptible to shingles which are as follows:⁴

• Age – As you get older, your body becomes less reactive to viruses and so your immune system is not as effective
• Immunocompromised – Any other condition you are suffering with that suppresses the immune system. This includes conditions that directly affect the immune system like HIV and lymphoproliferative malignancies, or medications you are taking such as corticosteroids and chemotherapy.
• Female from birth – you have a greater chance of being infected compared to male from birth
• Psychological stress – there are multiple causes of stress. The major associated causes to consider are all forms of abuse, increased dependency, lack of social support and being unable to work
• Ethnicity – a combination of studies showed that black people are at around half the risk of being affected by shingles compared to white people
• Current conditions - There are diseases and disorders which increase your risk including:
  • Respiratory disease
  • Cardiovascular
  • Chronic kidney disease
  • Depression
  • Psoriasis
  • Rheumatoid arthritis
  • Type 1 diabetes
  • Neurological disorders
  • Inflammatory Bowel Disease

What Does Shingles Look Like?

Shingles will appear as a rash that occurs anywhere on the body but mostly on one side of the body either on the torso or on the face. Blisters will later form which leak infectious fluid, that later become dry and scabby.⁴ Very rare cases can cause a painful area of the skin but with no rash.

When the virus is dormant, it lives within the nerves around your spine and within the brain. This is what gives shingles the distinct rash. The blistering will only occur on the skin where the nerves run and so it will not appear like chickenpox, which is all over your body.⁴

Nerve Problems Caused by Shingles

Why Should We Care About the Nerve Issues?

As mentioned, the virus infects the nerves around our spine and brain. Blistering of the skin and pain are not the only symptoms we want you to be concerned about as the nervous system is a deeply important function of our body. Damaging your nerve function will likely cause prolonged chronic pain where there will be difficulty regarding your quality of life and comfort.⁵

Long-Lasting Nerve Pain (Postherpetic Neuralgia)

A combination of studies showed that postherpetic neuralgia develops in roughly 13% of patients who are older than 50 years old. This dramatically increases to 60% at 60 years old and rises to 75% from the age of 70 years old.⁶ It is important to portray here that postherpetic neuralgia will likely develop sooner rather than later (within a month of developing shingles).⁷

Postherpetic neuralgia will cause heightened pain responses from damaged nerves within the infected area⁷ and this pain is described as burning. You will experience great discomfort with this burning pain, and it can be brought on by touching the rash. Be mindful of heat and cold temperatures as this can also trigger excruciating pain.⁸

Shingles Near the Eye (Herpes Zoster Ophthalmicus)

As previously mentioned, the shingles virus lays in a dormant phase within nerves of the brain or the spine. The shingles virus can become inactive within a brain nerve called the trigeminal nerve ganglion. This nerve branches off into 3 paths, and one leads to the eye. If the shingles virus activates within this nerve and travels towards the eye, it can cause Herpes zoster ophthalmicus.

Herpes zoster ophthalmicus will present as a blistering rash around your eye which will often burn and give you great discomfort. The rash will blister and a couple weeks later it will dry and scab over. Here it can be very itchy and may cause some difficulty for you to move your eye. This rash will appear like the common shingles rash, which is often in one area.³

You are urged to seek medical attention to manage the symptoms presented to prevent further infection within the eye itself. If left untreated, the following complication may develop which propose the risk of blindness if untreated:⁹

• Keratitis
• Glaucoma
• Cataract
• Chronic uveitis
• Corneal scarring
• Corneal neovascularisation
• Episcleritis
• Retinitis

Facial Nerve Issues (Ramsay Hunt Syndrome)

Rather than the shingles virus spreading to your eye like it does in Herpes zoster ophthalmicus, Ramsay hunt syndrome is where the shingles virus has infected a different nerve pathway in your brain which leads to the ear. Other than the common shingles rash flaring up on and around the ear, you will experience a sudden onset of facial drooping, usually the side that the infection is on. 

This condition is mostly age related with the risk being for those of you who are 50 years or older. Despite this, Ramsay hunt syndrome is fortunately very rare. Since this affects nerves around the ear, you may also be exposed to discomforts such as vertigo and tinnitus.¹⁰

Serious Brain Infections (Encephalitis)

Encephalitis is a very serious infection where your brain becomes inflamed. Symptoms can strike very suddenly and there will be distinct changes in your awareness. Frightening signs of encephalitis often start with:

• Fever
• Severe headache
• Confusion

With that said, severity of symptoms is quick to develop into seizures where encephalitis can even cause death. This is why it is critical for you to get a diagnosis and a treatment plan in place quickly.¹¹

Less Common Neurological Disorders Caused by Shingles

There are a few very uncommon disorders caused from a shingles infection which are associated with an infection that does not present as a rash, like in most cases:⁷

• Cranial neuropathies
• Myelitis
• Polyneuritis
• Aseptic meningitis

Managing Your Shingles

The essential management that you need to take immediately is seeking medical specialists to help you diagnose and treat shingles, and any other possible complication that has developed because of it.

In terms of managing the pain of the rash, painkillers like paracetamol and anti-inflammatories like ibuprofen will usually be sufficient to take away the discomfort.¹²

Summary

So, it turns out that shingles is an infection of the nervous system that is caused by the same virus that initially caused you to have chickenpox. This may occur decades after you experienced chickenpox, most likely as a child. Shingles presents as a blistering rash which eventually dries and scabs over within a couple of weeks. This rash will only occur where the infected nerves run under the skin.

The key message to take from this article is just how critical it is to quickly manage and treat the early signs of shingles before more serious complications develop. If neurological complications develop like postherpetic neuralgia, herpes zoster opthalmicus, Ramsey Hunt syndrome and encephalitis, the tough journey of treatment will not just stop at medication to clear the infection. Potential complications are very serious here where you may suffer from seizures, brain swelling and long-term neurological challenges which will not only impact your own quality of life but will exert a huge demand and resilience on loved ones around you whilst you require care.