Shingles

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Shingles is a rash caused from the varicella-zoster virus, which is also the cause of chickenpox. The virus remains inactive after chickenpox, but can reactivate in the nerves in adulthood, causing the painful rash. It is not understood why some people develop shingles.  Typically there is just one attack and Shingles is not infectious, but the virus can be passed to others who have never had chickenpox. Terrible belly-aches at the young women

Symptoms of shingles include tingling and burning prior to the appearance of a rash. A rash will develop and will intensify to small blisters.  The blisters can burst and create small ulcers. Within two to three weeks, the ulcers will heal. The rash is often seen on the spine, stomach and chest, although it may also be found on the face and mouth. Other symptoms include abdominal pain, chills, facial distortion due to muscle cramping, fever, headaches, joint pain, swollen glands and impaired vision.

Signs and tests

Tests are rarely needed, but if required it may include taking a skin sample to see if the skin is infected with the virus that causes shingles. Blood tests may show an increase in white blood cells and antibodies to the chickenpox virus but is not conclusive for diagnosis.

Shingles Treatment

Your doctor may prescribe an antiviral. The drug helps reduce pain and complications and shorten the course of the disease.

The medications should be started within 24 hours of feeling pain or burning, and preferably before the blisters appear. Some people may need to receive the medicine intravenously.

Strong anti-inflammatory medicines or corticosteroids, may be used to reduce swelling and the risk of continued pain.

Other medicines may include:

  • Antihistamines to reduce itching
  • Pain medications
  • Creams containing capsaicin (an extract of pepper)

Cool wet compresses can be used to reduce pain. Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, and calamine lotion, may help to relieve itching and discomfort and plenty of bed rest is recommended.

The skin should be kept clean, and contaminated items should not be reused. Non-disposable items should be washed in boiling water or otherwise disinfected before reuse. The person may need to be isolated while lesions are oozing to prevent infecting other people who have never had chickenpox and especially pregnant women.

Complications

Sometimes, the pain in the area where the shingles occurred may last for months or years. This pain is called post herpetic neuralgia. It occurs when the nerves have been damaged after an outbreak of shingles. Pain ranges from mild to very severe pain. It is more likely to occur in people over 60 years.

Other complications may include:

  • Another attack of shingles
  • Blindness (if shingles occurs in the eye)
  • Deafness
  • Infection, including encephalitis or sepsis (blood infection) in persons with weakened immune systems
  • Bacterial skin infections
  • Ramsay Hunt syndrome if shingles affected the nerves in the face

Prevention

Call your health care provider if you have symptoms of shingles, particularly if you have a weakened immune system or if your symptoms persist or worsen. Shingles that affects the eye may lead to permanent blindness if you do not receive immediate medical attention.

References

  • Shingles – PainDoctor.com
  • Sampathkumar P, Drage LA, Martin DP. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc. 2009 Mar;84(3):274-80. [PubMed]
  • Whitley RJ. Varicella-Zoster virus. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 137.
  • Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2010. Ann Intern Med. 2010;152:36-39.