Shingles In Children

Overview

Shingles, also known as zoster or herpes zoster, is a painful skin rash that develops in the nerves below the skin.¹ The varicella-zoster virus (VZV) causes chickenpox. Someone who has already had chickenpox can still get shingles later in life because the virus remains (i.e., dormant) in their nervous system before it flares up again.¹ However, in most people, the virus does not return.

Anyone can get shingles. However, it is more common amongst the middle-aged (>50 years old) and typically less common in children.¹ It is also uncommon for someone to develop shingles more than once.

Causes of shingles in children

Shingles are caused by varicella-zoster virus (VZV), which also causes contagious chickenpox. The VZV  dormant in the nerve tissues of the body. After chickenpox,  the virus reactivates later in life, causing shingles.²

If someone has had chickenpox or is vaccinated, they have a lower risk of catching shingles from another person.⁵ However, if someone has never had chickenpox or the vaccine, they can catch chickenpox from someone who has shingles.⁵

Shingles are contagious until scabs form and cover the blisters.⁵

Signs and symptoms of shingles in children

The main symptoms of shingles include itching and tingling in the area where the rash will appear. It starts as small pimples that transform into pus-filled blisters and follow a band or belt of skin, typically the nerve path the virus is present in beneath the skin.¹ The blisters erupt and scab over in about a week and tend to fall off about a fortnight to a month later.¹

The rash commonly occurs on one side of the body.

Shingles can develop on the face, arms, legs, torso or buttocks.⁴

Shingles are typically uncommon in children. However, a child is more at risk for shingles if any of the following are true:

• The child developed chickenpox before the age of 1⁴
• The mother had chickenpox in the late stage of pregnancy⁴
• The child is immunocompromised (i.e., weak-immune system) from a specific health condition or treatment, like cancer therapy.⁴

Other symptoms may include fever with chills, headache and nausea.⁴

Complications of shingles in children

Most cases of shingles heal on their own without medical intervention. However, in rare cases, shingles can cause the following complications:

Post-herpetic neuralgia (PHN):

The nerves in the skin send abnormal signals to the brain, resulting in ongoing pain. PHN is the most common complication of shingles.¹

Vision problems

The shingles rash can occur around the eyes or forehead, usually on one side only. It manifests in a sizable minority ( 10-20%) of individuals with shingles.³ When the shingles rash affects the eyes, it is called herpes zoster ophthalmicus.³

Skin infections

A shingles rash can become infected with bacteria, leading to impetigo or cellulitis.¹

Diagnosis of shingles in children

The preliminary diagnosis of shingles in children involves a physical examination where a doctor looks for the rash.¹ In some cases, additional tests may be required, such as gently scraping a tiny section of the pimples to send it to a laboratory and identify the VZV in the skin sample.⁴

Treatment of shingles in children

The treatment for shingles includes an antiviral medication that works by preventing the growth of the virus in the body, thereby stopping its ability to multiply and spread.¹ Pain control medicine helps to manage the pain accompanied by shingles and to ease inflammation such as redness or swelling. These usually come in over-the-counter (or prescription) creams or skin patches.¹

The most common antivirals for shingles are acyclovir (Zovirax) or valacyclovir (Valtrex).¹ These medications heal the skin rash, control pain and help prevent the virus from replicating.

Medications do not eliminate the virus but limit the chances of complications, such as lingering pain, and help speed up the healing process.¹ Vaccination against chickenpox reduces the chances of developing shingles.¹

The shingles vaccine is designed for adults since they are at increased risk of getting shingles, and the disease is uncommon in children.¹ If a child gets shingles, they would not be as seriously affected as adults.

The shingles vaccine called Zostavax is available for adults over 60.⁵

Management of shingles

There are several methods to alleviate the itchiness or pain accompanied by shingles:

• Use moist compresses (e.g., folded washcloth) with cool water⁵
• Apply pain-relief cream on the itchy areas (seek the guidance of a healthcare provider)⁵
• Keep fingernails clean and trimmed⁵
• Avoid scratching the itchy areas⁵

FAQs

What immunisations do I need to prevent shingles?

Two doses of the chickenpox vaccine are for all children.⁵ Immunisations need to be kept up-to-date.

• 1st dose: administered between 12-15 months of age⁵
• 2nd dose: administered before the child enters nursery (between 4-6 years of age)⁵

Teenagers (>13 years old) who did not get immunised may get 2 doses at least 28 days apart.⁵

When should I call the child’s healthcare provider?

You should call a healthcare provider if symptoms do not improve or additional symptoms are visible.⁴

Can a child go to school with shingles?

Someone with shingles should stay off school or work if the rash is open and releases fluid. When the rash is out, they may return to their daily obligations.

What can shingles be mistaken for?

Conditions such as cellulitis, herpes simplex and contact dermatitis (amongst others) may cause symptoms that resemble a shingles rash. Chickenpox can also be mistaken for shingles since both conditions are due to the same varicella-zoster virus (VZV).

Where is the most painful place to get shingles?

The location of the shingles rash can significantly impact the level of discomfort. The common areas where shingles can occur include the torso, face, neck and shoulders.

Can a child get shingles without having chickenpox?

Someone can not get shingles if they have never had chickenpox. However, some individuals may have been exposed to chickenpox without realising it. This exposure can make someone particularly susceptible to shingles.

Summary

Shingles are painful skin rashes caused by the varicella-zoster virus (VZV), a contagious chickenpox disease. The virus resides in the nerves beneath the skin. It remains dormant before becoming active,  causing small painful blisters to erupt in a band across the skin. Someone who has had chickenpox or has received the vaccine has a lower chance of getting shingles than someone who has never had chickenpox or the vaccine can catch chickenpox from a person infected with chickenpox. 

The symptoms of shingles are tingling and itching, accompanied by a fever and headache. Children with weakened immune systems have a higher risk of getting shingles, and a woman who develops shingles late in pregnancy can pass the disease to her child in early childhood due to exposure to the virus through maternal infection. Shingles usually heal on their own without treatment. Complications can occur in ongoing pain, known as post-herpetic neuralgia (PHN), and skin infections like cellulitis.

Physical examination confirms shingles. Additionally, a biopsy confirms for VZV. Treatment of shingles currently includes antiviral medications such as acyclovir or valacyclovir, or topical creams to help ease pain due to itching. The antiviral medicines are commonly administered to adults (>50 years old) since they are more likely to get shingles than children.