Shingles (herpes zoster)
Shingles, or herpes zoster, is a viral infection that causes a blistering, painful rash. Shingles can occur anywhere on the body, but they most often develop on one side of the chest or torso.
A virus called varicella-zoster is responsible as one of the causes of shingles. This is the same virus that is responsible for chickenpox. Once a person has been ill with the chickenpox, varicella-zoster stays dormant or inactive in nerve tissues of the body. Later in life, the virus can reactivate, causing shingles lesions to appear.
Shingles is not a life-threatening illness but it can be extremely painful. There is a vaccine available to help reduce your risk of developing the condition, and getting treatment early can help shorten an episode of shingles and decrease your risk of associated complications.
Reasons for the causes of Shingles
Varicella-zoster, the same virus that is responsible for chickenpox and the causes of shingles. Any individual who has had chickenpox can eventually develop shingles. After a person has had chickenpox, the varicella-zoster remains in the body, inactive in the tissues of the nervous system. If the virus reactivates, it travels along the pathways of the nerves to the skin and the shingles rash erupts.
Doctors aren't sure why some people develop shingles. Some of the causes of shingles may be due to a lowered resistance to infection as we age. Shingles develop more frequently in the elderly and in those who have weakened immunity.
Varicella-zoster belongs to the family of viruses known as herpes. These viruses are also responsible for causing genital herpes and cold sores. The virus that causes shingles and chickenpox is not the same as the one responsible for genital ulcers and cold sores, even though shingles is also called herpes zoster.
Are shingles contagious?
When a person has shingles, they are able to infect others who haven't had chickenpox with the varicella-zoster virus. This will cause chickenpox, not shingles, in the person who has been exposed. This usually only occurs through close contact with the shingles lesions.
Chickenpox might be dangerous in some people, so if you have shingles, you should avoid physical contact with others until the lesions form scabs and you are no longer contagious. Chickenpox is especially dangerous in:
- Pregnant women
- Newborns
- People who have a weakened immune system
Risk Factors
Any individual who has had chickenpox can develop an outbreak of shingles. At the present time, most people living in the United States who are now adults had chickenpox as children. This was prior to the development and routine use of the chickenpox vaccine.
Other causes of shingles may include certain risk factors that may increase your chances of developing it, this includes the following:
- Age: If you are over the age of 50, you are at increased risk for shingles.
- Other medical conditions: If you have other diseases, like HIV that impair your immune system, you may be at increased risk for shingles
- Medical treatments: If you are receiving treatments like chemotherapy, you may be more at risk for an outbreak of shingles
- Medications: If you take steroid medications you may be at increased risk of developing shingles
Prevalence of the causes of shingles
Shingles are very common in the United States. Almost one-third of the population will develop the condition at some time in their lifetime. Approximately one million cases of shingles occur each year in the U.S. The causes of Shingles is extremely prevalent in persons who have had chickenpox, including children, but the risk of the disease increases with age. Approximately 50% of cases occur in people who are at least 60 years old.
You are at increased risk of developing shingles if you:
- Take immunosuppressive medications such as corticosteroids. These drugs are given for conditions like some types of arthritis, lupus and after an organ transplantation
- Have a medical condition that impairs your body's immune system. These are conditions like HIV and certain types of cancer such as lymphoma and leukemia
Most of the time, people who get shingles only have one episode of the illness, but it can occur twice or even three times over the course of a person's life.
Complications
An episode of shingles usually resolves over a period of a few weeks, but shingles can result in lasting and sometimes severe complications. These may include:
- Infection: If the blisters from the shingles rash don't heal they may become infected.
- Postherpetic neuralgia: This is a condition characterized by the severe pain of shingles continuing after the rash has resolved. It develops when the nerves have been damaged and the sensation of pain becomes exaggerated.
- Neurological dysfunction: Shingles may lead to brain inflammation (encephalitis), balance or hearing difficulty, or paralysis of a portion of the face. The symptoms of the dysfunction depend on which nerves the shingles virus affected.
- Vision loss: When shingles develop around or in the eye, it can lead to eye infections, resulting in loss of vision.
Shingles is a result of the very same virus that causes chickenpox. While it is contagious to adults who have not had chickenpox virus and could affect them with chickenpox and not shingles.
"If you're asking yourself what are the symptoms of shingles?' Then you should bear the following in mind.
Shingles most often affect a section of the body on one side, and you should look out for the following as these are some of the symptoms of shingles:
- Extreme sensitivity to touch
- Pain that may feel like burning, tingling or numbness
- Itching
- A few days after the pain begins, a red rash appears
- Blisters filled with fluid form, break, then crust over
When looking out for what are the symptoms of shingles you should also be wary of fatigue, a fever, headache as well as light sensitivity. The first sign of shingles is usually pain and it can be very severe. Sometimes shingles pain is mistaken for heart, lung or kidney dysfunction. Sometimes, people develop shingles pain but a rash never occurs.
Typically, the rash of shingles occurs in a path around one side of the trunk of the body. It can occur on the side of the face or neck or affect one eye.
Painful rash and sensitivity to touch
Another fact of what the symptoms of shingles are when it comes to the rash include the following:
The rash that develops with shingles will be more painful than an itching sensation and this is due to the fact that nerve roots run along your body providing sensation. Once reactivated, the shingles virus will travel up the nerve roots to the skin surface and will result in the painful, sensitive rash.
The rash can present itself anywhere on the body and wrap right around it as well as become present on the face.
The rash appears in two parts namely prodromal and active stages. What are the symptoms of shingles during these two stages:
What are the symptoms of shingles during the Prodromal stage
This is the stage before the rash appears, and the skin will experience sensations such as :
- Numbness, tingling, pain or burning within the region of the back, chest, belly, neck, face, and head. In many cases, the rash will be more common on the back and chest area.
- The patient may also experience chills, diarrhea, and stomachache
- Swelling or tenderness of the lymph nodes
What are the symptoms of shingles during the Active stage
- A rash will form on one side of the body, later this will become blisters with clear fluid inside at first which will after a few days become murky.
- The rash may also be present on the face (forehead around one eye, on the cheek or nose).
- Piercing needle-like pain
- Blisters can break, ooze fluid out and crust over during the time
Not all patients with shingles will develop a rash but could still exhibit the other symptoms of shingles. If herpes zoster ophthalmicus or keratitis is left untreated, it can lead to vision problems and possible blindness.
When to see a doctor
If you think you might have shingles, notify your doctor right away. It's especially important to seek medical attention if:
- You are 70 years old or older. The risk of complications related to shingles in significantly increased by age
- Your symptoms involve one of your eyes. Untreated shingles can lead to permanent damage to an eye
- You or someone you live with has weakened immunity or takes corticosteroid medications
- You have severe pain
Diagnostic procedures
Your physician will most likely diagnose shingles based on your history which includes pain located on one side of your body, face or neck or around one eye, and the appearance of the typical shingles rash and blisters. Only rarely is it necessary to take cultures of the blisters for laboratory examinations to make a diagnosis of shingles.
Sometimes the first stages of shingles can be mistaken for hives, scabies or even bug bites. As soon as you think there's a possibility that you may have shingles, medical attention should be sought immediately.
Having adhered to what are the symptoms of shingles are, diagnostic procedures will be as follows:
Tzanck smear
The Tzank smear is no longer used that much due to more improved methods for diagnosing shingles.
The method involves taking samples of the fluid and skin tissue which will be examined microscopically after being stained first. The specialist will check for viral changes within the cell tissue.
NB: *The method is not able to differentiate between Varicella-zoster virus (VZV) and the herpes simplex virus (HSV). Varicella-zoster virus causes chickenpox and shingles while the herpes simplex virus is responsible for cold sores and genital herpes.
Special antibody test
A Direct Fluorescent Antibody test or (DFA) of the blister will be able to tell the presence of the varicella-zoster virus and the results only take a few hours.
Viral cultures
Viral culture tests can take a week or two for results to show and is able to differentiate between the HSV and VZV viruses.
Skin biopsy
The skin biopsy will examine the skin tissue with the rash under a microscope, sometimes this will require a culture of the tissue that has been biopsied.
Another diagnostic may include a Polymerize Chain Reaction (PCR)
In many cases, clinical findings will be adequate enough to diagnose shingles, but in some cases, the tests are needed for diagnosis.
Shingles can happen to anybody who has had the chickenpox virus as a child or later chickenpox as an adult. Herpes zoster or Varicella zoster is the very same virus that causes chickenpox, which later in life re-activates in some people within their elderly years manifesting as shingles.
Treatment
No cure for shingles exists, but starting treatment right away with antiviral medications can help you heal faster and can also help reduce the risk of complications. These drugs are available only by prescription. Medications sometimes used to treat shingles include:
- Famciclovir (Famvir)
- Valacyclovir (Valtrex)
- Acyclovir (Zovirax)
Side effects of shingles are that it may also be very painful. To help control pain, your doctor may also recommend:
- Topical creams, sprays or gels that contain anesthetics like lidocaine to temporarily numb the skin
- Capsaicin cream
- Narcotic medications
- Tricyclic antidepressants, such as amitriptyline (Elavil)
- Anticonvulsant medications such as gabapentin (Neurontin)
- An injection of a steroid medication
Most of the time, an episode of shingles resolves in two to six weeks. It is possible to get shingles more than once, but most people only get them one time.
Prevention
You may be able to prevent the side effects of shingles if it is diagnosed early enough and treatment is commenced.
There are two vaccines that may help to prevent the shingles virus. These are the varicella-zoster (shingles) and varicella (chickenpox) vaccines.
Chickenpox vaccine
The varicella vaccine, Varivax, is now a routine immunization given in childhood for the prevention of chickenpox. Adults who have never had chickenpox are also advised to have this vaccination. While Varivax cannot guarantee protection against shingles or chickenpox, it will reduce the severity of this illness if you do get them and can reduce your risk of complications.
Shingles vaccine
Zostavax is the varicella-zoster vaccine for the prevention of shingles. It has been approved by the United States Food and Drug Administration for people 50 years old and above. It is for prevention only and is not for treatment of shingles. It doesn't guarantee protection against shingles, but it will reduce the severity of the illness if it does develop and can reduce the risk of complications such as postherpetic neuralgia.
Zostavax contains live virus and cannot be given to those people whose immune system is weakened by illness or medication.
Side effects of shingles
Side effects of shingles can be due to its link to chickenpox stemming from the same virus "varicella zoster".
While in its active stage shingles can pose these effects:
- A continuous burning and aching
- Periodic piercing pain
- Severe spasms similar to an electric shock
- Allodynia (pain caused by very little stimulation such as light breeze, the touch of clothing on the skin)
- Hyperalgesia results in a more intense response to pain than usual
Shingles can affect your sleep, work and daily activities with the discomfort it presents. Other side effects of shingles may also include:
- Fatigue
- Loss of appetite
- Mood changes
- Social withdrawal
- Depression
The development of Postherpetic Neuralgia (PHN) adds to the side effects of shingles in some patients and this is a severe pain that lasts for more than a month.
Nerve damage
The herpes zoster virus can cause long-term damage and scarring to the nerves of the spine when it causes persistent inflammation during its attack.
If nerves heal abnormally, it can result in a higher response to pain receptors inside the brain
Side effects of shingles like PHN will affect people who are:
- Over the age of 60 years (25%) and the risk of it prevailing longer is more so for people who are older
- Sometimes women are at higher risk of developing shingles than men
PHN can last for an approximate of 3 months but there is a small chance that pain can persist for a year.
The side effects of shingles on the face and ears
Some patients can experience Ramsey Hunt Syndrome which results in the paralysis of the face as well as a rash on the ear known as herpes zoster oticus. Ramsey Hunt Syndrome can result in:
- Hearing loss
- Ringing in the ears
- A chance of permanent facial paralysis
- In some cases swelling of the brain
Patients may also experience Bells Palsy which is the partial paralysis of the face which is another side effect of shingles on the face.
Herpes zoster can also affect the eyes with a retina infection called "Imminent Acute Retinal Necrosis Syndrome".
Natural treatment measures to help alleviate shingles
Natural treatment for shingles from home is possible and could be effective. Taking good care of your skin's rashes is very important. You can make use of baking soda to help dry out the sores and help it to heal faster. Using a cool moist compress mist followed by calamine lotion can assist in easing the discomfort. Avoid scratching or picking at the sores as this will only worsen the condition.
Useful advice
If you can, try to find ways to relax and eliminate stress. Some people find deep breathing exercises or meditation helpful. Seek immediate treatment when you suspect shingles because the longer it goes untreated the more severe the side effects of shingles may be on the patient.
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