Shingles (Herpes Zoster)

 

What Is It?

Shingles, also known as herpes zoster or just zoster, is a reactivation of a virus in nerve cells that results in a distinctive skin rash.

The virus that causes shingles, varicella-zoster virus, is the same virus that causes chickenpox. It is a member of the herpes virus family. Once you have had chickenpox, varicella-zoster virus lies dormant in your body’s nerve tissues and never really goes away. Shingles occurs when the virus is reactivated.

Physicians are unsure how or why the varicella-zoster virus reactivates, but the prevailing theory is that your protective immune response wanes over the years after childhood chickenpox. When the virus does reactivate, it travels through nerves, often causing a burning or tingling sensation in the affected areas. Two or three days later, when the virus reaches the skin, blisters appear grouped in the distribution of the affected nerve. The skin may be very sensitive, and you may feel a lot of pain.

If you have had chickenpox, you are at risk of developing shingles. Shingles, however, most often appears in people older than 50 and in people with weakened immune systems. If you are undergoing cancer treatment, for example, you are more likely to get shingles. People with HIV commonly get shingles, which is often one of the first signs that the immune system is in trouble.

Your chances of getting shingles increase as you get older, although the disease can occur at any age. When shingles appears in children, which is uncommon, it usually is very mild. Up to 20 percent of the U.S. population develops the disease at some point.

Potential complications of shingles include:

  • Post-herpetic neuralgia — About 10 percent of adults who get shingles experience long-term pain in the area of skin where blisters occurred, even after the rash has completely healed. This condition, called post-herpetic neuralgia, may last for months or, very rarely, years. This severe pain is most common in older patients and often is accompanied by extreme sensitivity to heat and cold in the affected area of skin.
  • Herpes zoster ophthalmicus — This occurs when shingles involves the eye. Herpes zoster ophthalmicus can affect your vision, even causing blindness, and can be very painful.
  • Otic zoster — Otic zoster, also called Ramsay Hunt syndrome or geniculate zoster, occurs when shingles affects the ears. Hearing loss may result.
  • Bell’s palsy — Shingles can cause Bell’s palsy, in which a facial nerve is paralyzed.

Symptoms

Shingles typically begins with a burning sensation, a mild itching or tingling or a shooting pain in a specific area of skin. The affected area usually is located only on one side of the chest, abdomen or face or on a portion of an arm or leg. The affected skin may be extremely sensitive, so that even the touching or rubbing of clothing may be intolerable.

After about five days, the affected skin becomes red and mildly swollen, and a rash appears. Blisters may cluster in a patches or form a continuous line that roughly corresponds to the path of the infected nerve. The blisters may be painful or itchy, and some may be as large as the palm of your hand. Blisters continue to appear over two to seven days and eventually break, form crusts and subsequently heal.

Shingles is often associated with fatigue, a low-grade fever, and mild muscle aches.

Diagnosis

Diagnosis may be difficult before visible signs of the disease appear. Once a rash and blisters do appear, however, your physician will probably diagnose shingles based on your symptoms and the appearance of your skin. Your physician also may use blood tests to determine whether the varicella-zoster virus has been reactivated and may scrape tissue and vesicle fluid from the affected skin and examine it under a microscope and culture for the virus.

If you have a rash across the bridge of your nose or anywhere near your eyes, your doctor immediately will include an ophthalmologist in your care.

Expected Duration

Shingles usually takes seven to 10 days to run its course, although blisters may take several weeks to disappear completely. Your skin will return to normal in about four weeks, but pain may continue for far longer. Most people’s pain abates within two or three months; fewer than 1 percent to 3 percent of people are affected for longer than one year.

Prevention

Although the chickenpox vaccine is not recommended to prevent shingles, the hope is that children who have had the vaccine to prevent primary chicken pox will not experience shingles when they get older. Clinical trials are being run to evaluate the most effective strategies.

Treatment

If your condition is diagnosed within 72 hours after its appearance, your physician may prescribe antiviral medication. Some antiviral medications used to treat shingles include acyclovir, famciclovir, and valacyclovir. Antiviral medications may help reduce the risk of developing chronic pain from shingles. Sometimes antiviral medication is combined with prednisone (a corticosteroid-based anti-inflammatory drug).

The skin rash and blisters should be cleaned gently once or twice per day with cool water. Antibiotic ointment may be advised to use on open areas. Because the pain that accompanies shingles can be intense, your physician probably will prescribe a pain medication. For post-herpetic neuralgia, the pain that lingers well after the rash has resolved, different medications are often prescribed. These drugs decrease the action of pain fibers and alter the way pain signals are perceived by our central nervous system. Amitriptyline, doxepin and gabapentin are three examples. When shingles affects the eyes, an eye specialist (ophthalmologist) should be consulted immediately.

When To Call A Professional

Early treatment may help deter long-term complications, so call your doctor immediately if you are experiencing symptoms of shingles.

Prognosis

Most people have an excellent recovery, with no pain and return of skin color to normal. Once you have had shingles, recurrence is rare. Shingles recurs in only about 2 percent of patients but in up to 20 percent of patients with AIDS. Skin darkening in the area of the rash is possible. Post-herpetic neuralgia sometimes can last for many months to years. Long-term complications from shingles, such as Post-herpetic neuralgia, may continue for months or many years. The disease also may cause varying degrees of scarring on your skin.

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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