Shingles

Shingles is a painful infection of the nerves and skin caused by the varicella zoster virus. This is the same virus that causes chickenpox.

Causes

Shingles occurs in people who have already had chickenpox. It is considered a reactivation of the dormant varicella zoster virus. After causing the initial chickenpox infection, the virus does not leave the body. Instead, it settles in the nerve roots. Once reactivated, the virus travels along the nerve paths to the skin. This produces the pain and rash.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Age: 50 or older
  • Compromised immune system, as in:
    • People infected with HIV
    • Patients with lymphoma or leukemia
  • Excessive fatigue
  • Physical or psychological stress
  • Radiation therapy
Shingles can be transmitted from one person to another. However contact with a person who has shingles could lead to chickenpox in someone who has never had chickenpox and has not received the varicella vaccine.

Symptoms

Symptoms include:
  • Rash:
    • Appears as a red, slightly raised band or patch often overlain with multiple small fluid-filled blisters
    • Develops on one side of the body or the other, but does not cross the midline
    • Blisters usually dry out and crust over within several days
    • Most commonly affects the torso and face
  • In severe cases, the eyes may be affected, which can seriously threaten vision.
  • Pain on the skin at the site of the rash, which is usually severe
  • Tingling or itchiness on the skin, which may start a few days before the rash
  • Skin in the affected area that is unusually sensitive to touch
  • Fever
  • Headache
  • Tiredness
The rash usually disappears within 3 weeks, but the pain may linger. In some patients, however, the pain continues long after the rash has healed. This complication is called post-herpetic neuralgia (PHN). It refers to pain that is present in the affected area for months, or even years afterward. The pain of PHN is difficult to treat and can be very severe.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Usually the rash can be diagnosed by its appearance. Rarely, drawing fluid from the blisters and sending it to a lab is necessary to confirm the diagnosis.

Treatment

Like any viral condition, Shingles cannot be cured.
Treatment includes:
Itch and Pain Relief
Relief for itching includes:
  • Calamine lotion
  • Wet compresses
  • Frequent oatmeal baths
Over-the-counter pain relievers include:
  • Acetaminophen (Tylenol)
  • Ibuprofen (Advil)
  • Naproxen (Aleve)
Prescription drugs may be given to help relieve pain that doesn't respond to over-the-counter remedies. Oral Antiviral Drugs
Certain antiviral medications may help control shingles by hindering reproduction of the virus in the nerve cells. They include:
  • Acyclovir (Zovirax)
  • Famciclovir (Famvir)
  • Valacyclovir (Valtrex)
Antiviral therapy may shorten the course of an episode of shingles, but only if started within 48-72 hours after symptoms develop. Relief for PHN
Tricyclic Antidepressants – medications that help some people with PHN pain. These drugs are typically prescribed in doses lower than those needed to treat depression. They include:
  • Amitriptyline
  • Nortriptyline
  • Doxepin
Lidoderm Patch – a transdermal form of lidocaine (a local anesthetic)
Transcutaneous Electrical Nerve Stimulation (TENS) – a device that generates low-level pulses of electrical current and applies it to the skins surface. This causes a tingling sensation that offers some pain relief.
Nerve Blocks – invasive procedures that may be used to provide temporary pain relief (only used as a last resort)

Prevention

Most cases of Shingles could not have been prevented. However, cases of Shingles should theoretically diminish as more children avoid chickenpox by receiving the varicella vaccine.