Shingles (Herpes Zoster)

Definition

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 near the spinal cord. Once reactivated, the virus travels along the nerve paths to the skin. There it produces 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

Most cases of shingles occur in individuals with no known risk factor other than age.

Shingles cannot 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 typically does not cross the midline
  • In severe cases may spread to multiple parts of the body —the so-called “disseminated” zoster
  • 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 is unusually sensitive to touch
• Fever
• Headache
• Tiredness

The rash usually disappears within three weeks. In some patients, however, the pain continues long after the rash has healed. This complication is called postherpetic 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. In very rare situations fluids are drawn from the blisters and sent to a lab for diagnosis.

Treatment

Like any viral condition, shingles cannot be cured. Treatment, therefore, is focused on alleviating symptoms, speeding recovery, and preventing PHN.

Prevention

There is no proven way to prevent an outbreak of shingles, although undue stress and fatigue may contribute to an outbreak. Future cases of shingles should theoretically diminish as more children avoid chickenpox by receiving the varicella vaccine.

The US Food and Drug Administration recently approved a vaccine (Zostavax) for people over 60 who have had chickenpox, to help decrease the likelihood of getting shingles and to decrease severity if shingles does occur.