Shingles (herpes zoster)

How does shingles develop?

Before a rash is visible, the patient may notice several days to a week of burning pain and sensitive skin. Shingles starts as small blisters on a red base, with new blisters continuing to form for 3-5 days. The blisters follow the path of individual nerves that comes out of the spinal cord. The entire path of the nerve may be involved or there may be areas with blisters and areas without blisters. Generally, only one nerve level is involved. In a rare case, more than one nerve will be involved. Eventually, the blisters pop and the area starts to ooze. The area will then crust over and heal. The whole process may take 3-4 weeks from start to finish. On occasion, the pain will be present but the blisters may never appear. This can be a very confusing cause of local pain.

Is shingles contagious?

Shingles can spread from an affected person to children or adults who have not had chickenpox. Instead of developing shingles, these people develop chickenpox. Once they have had chickenpox, people cannot catch shingles (or contract the virus) from someone else. Once infected, however, persons have the potential to develop shingles later in life.

Shingles is contagious, to persons who have not previously had chicken pox, as long as there are new blisters forming and old blisters healing. Once all of the blisters are crusted over, the virus can no longer be spread.

What are the complications of shingles?

Generally, shingles heals well and problems are few. However, on occasions, the blisters can become infected with bacteria causing cellulitis, a bacterial infection of the skin. If this occurs, the area will become reddened, warm, firm, and tender. There may be red streaks formed around the wound. A more worrisome complication occurs when shingles affects the face, specifically the forehead and nose. In these cases, it is possible, although not likely, that shingles can affect the eye leading to loss of vision.

The most common complication of shingles is postherpetic neuralgia. It is localised pain in the area of involvement of shingles that persists beyond one month. This occurs when the pain associated with shingles persists beyond one month, even after the rash is gone. It is a result of irritation of the nerves of sensation by the virus. The pain can be severe and debilitating and occurs primarily in persons over the age of 50. There is some evidence that treating shingles with steroids and antiviral agents can reduce the duration and occurrence of postherpetic neuralgia. However, the decrease is minimal.

What is the treatment for shingles?

There are several effective treatments for shingles. Drugs that fight viruses (antivirals) can reduce the duration of the rash if started early (within 48 hours of the appearance of the rash). The addition of steroids may also limit the length of time that a patient has pain with shingles. However, the benefit of both of these drugs is limited. In addition to antiviral medication, pain medications may be needed for symptom control. The affected area should be kept covered and dry. However, bathing is permitted and the area can be cleansed with soap and water.

What is shingles?

Shingles is a skin rash caused by the same virus that causes chickenpox. The virus responsible for these conditions is called varicella zoster. After a person has chickenpox, this virus lives in the nerves and is never fully cleared from the body. Under certain circumstances, such as emotional stress, immune deficiency (from AIDS or chemotherapy) or with cancer, the virus re- activates causing shingles. In most cases, however, a cause for the reactivation of the virus is never found. Shingles is medically termed Herpes zoster.