What Is Shingles

Shingles is a common infection of the nerves. It is a disease that is caused by reactivation of the virus called  varicella zoster following a previous chickenpox infection.¹

Overview

Shingles which can also be referred to as  herpes zoster is an excruciatingly painful rash that develops on one side of the face or body. The rash consists of blisters that typically scab over in 7 to 10 days. The whole episode usually lasts 2–4 weeks.^{1 2} Shingles is caused by the varicella-zoster virus, which also causes chickenpox.³

It's estimated that around one in every four people will have at least one episode of shingles during their life.³ It is more common in people with weakened immune systems and in people over the age of 50.⁵ Shingles is rarely life-threatening, however, complications resulting from shingles might be fatal in adults over the age of 70.³ 

Shingles cause a painful rash or small blisters to arise on the affected area of the skin. It can appear anywhere on the body, but it normally appears on only one side of the face or body. Burning or shooting pain and tingling or itching are early signs of the infection. Even after the rash is gone, the pain can continue for months, even years.⁵

Shingles and chickenpox are both caused by varicella-zoster virus, which belongs to a group of viruses called herpes. However, shingles and chickenpox are not the same illness. Chickenpox is mild as compared to shingles and it mainly affects children. After a person recovers from chickenpox, the virus remains dormant in the body’s central nervous system. However, under the right circumstances, the herpes zoster virus can reactivate and cause shingles to travel down the nerve fibres.⁷

Shingles symptoms start with skin sensitivity, tingling, itching, and/or pain followed by a rash that looks like small, red spots that turn into blisters.⁵ The virus travels in specific nerves, so you will often see shingles occur in a band on one side of your body or face. This band corresponds to the area where the nerve transmits signals. The shingles rash stays somewhat localized to an area. It doesn’t spread over your whole body.⁶ Treatment that is started as soon as possible helps reduce the severity of the disease.⁵ 

While shingles don’t recur in most people, they can come back a second and, rarely, a third time. One study found that within seven years, the odds of a recurrence may be almost 5 percent, which is about the same as the odds of getting shingles the first time. Recurrence most often occurs in people with weakened immune systems. 

Complications of shingles can arise, and these are more likely in the elderly or in those who have a weakened immune system.³ Some of the main complications associated with shingles are:

1. Postherpetic neuralgia

Postherpetic neuralgia is the most common complication of shingles. Estimates suggest that one in five people over 50 could develop postherpetic neuralgia as the result of shingles.⁷ Postherpetic neuralgia can cause severe nerve pain (neuralgia) and intense itching that persists after the rash and any other symptoms of shingles have gone. Symptoms of postherpetic neuralgia can be treated with a number of different pain-killing medicines.

Types of pain experienced by people with postherpetic neuralgia include:

• constant or intermittent burning, aching, throbbing, stabbing, or shooting pain
• allodynia – feeling pain from things that are not supposed such as changes in temperature or the wind
• hyperalgesia – increased sensitivity to pain

1. Eye problems

Another complication of shingles can arise when one of your eyes is affected (ophthalmic shingles).There is a risk you could develop further problems in the affected eye.⁷  The complications include ulceration (sores) which is a permanent scarring of the surface of your eye (cornea), inflammation of the eye and optic nerve and glaucoma which is when pressure builds up inside the eye.  If these complications are not treated promptly, there is a risk that ophthalmic shingles could cause a degree of permanent vision loss.⁷ 

2. Ramsay Hunt syndrome

It is a complication that comes about when shingles affect certain nerves in your head. Ramsay Hunt syndrome can cause earache, hearing loss, dizziness, vertigo, a sensation that you or the environment around you is spinning, loss of taste, paralysis and tinnitus, thehearing of sounds coming from inside your body rather than outside source.³

Ramsay Hunt syndrome is usually treated with antiviral medication, corticosteroids and painkillers.⁷ 

3. Other complications

A number of other possible problems can also sometimes develop as a result of shingles. These include rash becoming infected with bacteria,  white patches or scarring in the area of the rash, pneumonia,  liver (hepatitis), brain (encephalitis), spinal cord (transverse myelitis) and meningitis.³

Causes of shingles

Shingles occur as a result of chickenpox virus reactivation. While the causes of reactivation are unclear, it is believed to happen when the immune system is immunosuppressed. Advanced age, other diseases such as human immunodeficiency virus (HIV) or AIDS, cancer, and cancer treatments such as chemotherapy and radiation therapy are risk factors for shingles.⁷ This is so because they lower a person’s resistance to disease. Other risk factors include stress or trauma; medications (especially immunosuppressive drugs) used to treat patients after an organ transplant; and children who had chickenpox in infancy or whose mothers had chickenpox late in pregnancy.⁷

Signs and symptoms of shingles

Painful rash and itchy blisters  are the most defining characteristic of shingles, however, they are not the most troubling complications.  Most commonly, the rash occurs in a single stripe around either the left or the right side of the body or face. In rare cases, usually in immunosuppressed individuals, the rash may be more widespread on the body and look similar to a chickenpox rash.²

Pain lasting after the rash is known as postherpetic neuralgia (PHN), which is often described as burning, stabbing, throbbing and or shooting pain is the most troubling. Pain during, and prior to, the rash is also a common symptom. In addition to pain, other symptoms include long-term nerve pain, fever, headache, chills, upset stomach, muscle weakness, skin infection, scarring and decreased or loss of vision or hearing.⁷

Furthermore, shingles can lead to corneal scarring and blindness if it affects the eyes.⁷

Management and treatment for shingles

There is no cure for shingles. It simply has to run its course. Treatment focuses on pain relief. Painkillers may help relieve some of the pain. Antiviral drugs may help lessen some of the symptoms, reduce nerve damage, reduce the amount of time that you have a shingles rash, decrease the severity of the rash  and lower your risk of developing long-lasting nerve pain and other health problems.⁵

 Other treatments include creams or lotions to help relieve itching, cool compresses applied to affected skin areas, steroids, antidepressants and anticonvulsants. It is important to start treatment as soon  as the symptoms of shingles start to reduce the severity of the disease.  Antiviral drugs that can be used to soothe the symptoms  include acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex). In addition, antidepressants such as duloxetine(Cymbalta) and nortriptyline (Pamelor) and Opioid painkillers are also used.⁷ Over-the-counter medications that you can buy for pain include acetaminophen and ibuprofen. For severe pain, the dermatologist may prescribe a medication that reduces inflammation, such as a corticosteroid.⁴

Moreover, to manage the rash one needs to keep the rash dry and clean to reduce the risk of infection by wearing loose-fitting clothing for comfort and  avoiding rub-on antibiotic creams or adhesive dressings that can slow the healing process.⁷

FAQs

How are shingles diagnosed

Your GP or pharmacist will normally be able to diagnose shingles mainly from the appearance of  rash and blisters. Testing is not usually necessary.³

However if it's confusing, your dermatologist will scrape a bit of fluid from a blister to check if the fluid contains herpes-zoster virus under a high-powered microscope.

Can shingles be prevented

Vaccination is the best way to avoid getting shingles. Children should receive the chickenpox vaccine, and adults should receive one of the two U.S. Food and Drug Administration-approved shingles vaccines: zoster vaccine live (ZVL, Zostavax) or recombinant zoster vaccine (RZV, Shingrix).⁷ Researchers at the Kaiser Permanente Center for Health Research found children who receive the varicella vaccine are significantly less likely to contract pediatric shingles. 

Who os at risk of shingles

The elderly, especially after the age of 40 and immunosuppressed individuals (people living with conditions such as HIV or taking immune-suppressing medication to keep them from rejecting a transplanted organ or chemotherapy) are certainly at greater risk of developing shingles. According to the National Institute of Neurological Disorders and Stroke, a person who is 60 years old is 10 times more likely to develop shingles than a child who is 10 years old.⁷

Is shingles contagious

Shingles is not contagious and thus cannot be passed from one person to another however the VZV can spread from a person with active shingles and cause chickenpox in someone who had never had chickenpox or received the varicella vaccine. Furthermore, VZV from a person with shingles is less contagious than the virus from someone with chickenpox. 

How long do shingles last

The whole episode usually lasts 2–4 weeks. Complications of shingles can arise, and these are more likely in the elderly or in those who are immunocompromised.¹

How common is shingles

Today, almost one in three people in the U.S. will develop shingles during his or her lifetime, with an estimated one million cases each year.⁷ While shingles are uncommon in children, they can occur at any age, with approximately one million cases of pediatric shingles occurring in the U.S. each year.⁷

When should I see a doctor

Shingles isn’t usually serious, but see your pharmacist as soon as possible if you recognise the symptoms. In most cases your pharmacist should be able to provide treatment, however, they may recommend that you need to contact your GP practice for treatment if required.³

Summary

Shingles which can also be referred to as  herpes zoster is an excruciating painful rash that develops on one side of the face or body. The rash consists of blisters that typically scab over in 7 to 10 days and The whole episode usually lasts 2–4 weeks.^{1 2} Shingles is caused by the varicella-zoster virus, which also causes chickenpox.³ Symptoms include painful rash and itchy blisters. In addition to pain, other symptoms include long-term nerve pain, fever, headache, chills, upset stomach, muscle weakness, skin infection, scarring and decreased or loss of vision or hearing. There is no cure for shingles. It simply has to run its course. Treatment includes painkillers, antivirals and antidepressants and corticosteroids.