All About Shingles

Cells infected with varizella zoster virus (left) causes the childhood skin disease chickenpox (right).

   

Herpes Zoster which is known as Shingles (herpes zoster virus) is an extremely painful viral infection of the nerve roots resulting in a skin rash caused by the same virus that causes the childhood illness chickenpox. The reactivated virus responsible for these conditions is called the Varicella zoster virus (VZV).t has a characteristic rash that evolves over time. Sometimes shingles is confused with other rashes, but it's the only one that can potentially cause the complication, Postherpetic Neuralgia.

Varicella zoster virus (VZV).                       

 The following are some quick facts about shingles:
*The lifetime risk of shingles is 10% to 20%.
*In the United States, approximately 300,000 to 600,000 cases are reported yearly.
*Less than 5% of the cases occur in children under 14 years of age.
*The most important risk factor for the developing shingles is increasing age. 
*A well-defined risk factor is a compromised immune system.






Shingles and Chickenpox?
 
The rash of shingles is caused by a reactivation of the varicella-zoster virus. This is the virus that causes chickenpox. After a person has been infected with the varicella virus, the virus travels back into the body and waits. For various reasons, the virus can reactivate, travel down the nerve to the skin, and cause the shingles rash.  
VZV is still referred to by separate terms:
*Varicella: The primary infection that causes chickenpox  
* Herpes zoster: The reactivation of the virus that causes shingles Varicella (Chickenpox). 

How is shingles caused? 
   

Dormant Varicella zoster virus (chickenpox) can cause shingles.

After an individual has chickenpox, the virus lives in the nervous system where it "sleeps" (is dormant) in the nerve roots. In some people, it remains dormant forever. In others, a weakened immune system can cause the virus to "wake up," reproduce, and travel along the path of the nerve fiber to the skin's surface, resulting in shingles. If the virus becomes active again, it can only cause shingles, not chickenpox. 



"Conditions that can reactivate the varicella virus and cause shingles'' include:

*Illness.

*Trauma. 

*Bereavement.

*A suppressed immune system.

*HIV infection.

*Cancer - especially leukemia or lymphoma .

*Drugs that suppress the immune system including steroids 8Chemotherapy. 

*Organ transplant.

Appearance of Shingles:
 

The first symptoms of shingles are usually itching, tingling, or significant pain with just a light touch. This pain occurs on one side of the body in a band-like area called a dermatome. During this time, people often experience headache, sensitivity to light, and fatigue, but rarely fever. One to five days later, the rash starts as an area of redness that progresses quickly to clusters of fluid-filled blister. These blisters can continue to form for three to five days. The blisters fill with pus, pop, and then crust over. It usually takes two to four weeks for the blisters to heal. Scarring and skin discoloration often occur. 

  
Who is at risk for shingles?

Shingles most commonly occurs in people over the age of 60.

   Anyone who has ever had chickenpox is at risk for the development of shingles, although it occurs most commonly in people over the age of 60. Weakened immune systems, emotional stress, immune deficiency (from AIDS or chemotherapy), or cancer can cause the virus to reactivate. It has been estimated that up to 500,000 cases of shingles occur each year in the U.S.

 Diagnosis of Shingles:
Shingles is often diagnosed based on the appearance of the rash when it is typical. If it is difficult to diagnose, specialized tests might be performed.

 What does the shingles rash look like?
Pain, itching, tingling, or burning of the skin are symptoms of shingles that often precede an outbreak. Shingles starts as small blisters on a red base with new blisters continuing to form for three to five days. The painful rash resembles the lesions of chickenpox and is usually localized to a concentrated area. If you think you have shingles, you should see a doctor as soon as possible.

    Small blisters form during the initial stage of shingles (left) followed by a full skin rash resembling chickenpox lesions (right).   

 

How long does shingles last?

Shingles blisters eventually burst and begin to crust over

  
The cluster of blisters that forms with shingles fill with fluid, pop, then start to ooze. Eventually the affected areas crust over and heal like the rash shown here.The whole process may take three to four weeks from start to finish. Once all of the blisters are crusted over, the person is no longer contagious.

Shingles can be spread to people who have not had chickenpox.

Is shingles contagious?

Yes, shingles is contagious. It can be spread from an infected person to anyone who hasn't had chickenpox as long as there are new blisters forming and old blisters healing. But instead of developing shingles, these people develop chickenpox. Once they've had chickenpox, people cannot catch shingles from someone else. They do, however, have the potential to develop shingles later in life. 



What are complications from shingles? 

 Generally, shingles heals well, resulting in few problems. However, on occasion, blisters can become infected and are usually treated with antibiotics. The most common complication of shingles is postherpetic neuralgia, where damaged nerves cause pain to persist even after the rash is gone. A more worrisome complication is when shingles affects the face (forehead and nose), which may spread to the eye and lead to loss of vision.




Treatment of Shingles :

  There is no cure for shingles, but treatment may help you get well sooner and prevent other problems. Bathing is permitted, and the affected area can be cleansed with soap and water. Cool compresses and anti-itching lotions (calamine lotion) may also provide relief. Steroids, antiviral medicines, and pain medicines can also help ease recovery. Most people with intact immune systems recover completely from shingles although recurrences are possible.here is no cure for shingles, but treatment may help you get well  

Shingles Treatment: Antivirals, Corticosteroids

if you have a normal and healthy immune system, shingles treatment is most effective if you get medication within 72 hours (3 days) of developing a rash.
Your doctor may prescribe drugs known as corticosteroids and antivirals for shingles, such as Acyclovir.
If you have a compromised (weakened) immune system, you will probably receive similar treatment, but you need to be followed closely by your healthcare provider. You also probably will not receive corticosteroids, since they are riskier to take if your immune system is impaired. Always see your doctor for specific treatment options.

Treating Shingles Symptoms and Pain:

Placing a soft, sterile non-sticky dressing or bandage over your lesions will protect your skin from clothing, and it will protect others from direct contact with open wounds. For pain related to an acute case of shingles, usually opoids are necessary. To prevent or treat post-herpetic neuralgia, the American Academy of Neurology states that any of the following may be necessary (but see your doctor for specific treatment):
Antidepressant drugs, specifically tricyclic antidepressants such as amitriptyline, nortriptyline, and desipramine
Anticonvulsants, such as gabapentin (Neurontin) or pregabalin (Lyrica)
Pain medications, either anti-inflammatory drugs like ibuprofen, or opioids, such as morphine sustained-release or fentanyl patches
Topical anesthetics, such as lidocaine gels or patches, which should be applied to healed, intact skin only.
Capsaicin is also growing in popularity as a pain treatment

Shingles Treatment for Herpes Zoster Ophthalmicus:

 Herpes zoster ophthalmicus is a serious complication that can occur if the shingles virus affects a certain nerve around the eye. People who are suspected to have this complication are treated with oral antiviral medications as above AND should have close follow-up with an ophthalmologist.

Is there a shingles vaccine?

In 2006, the FDA approved the first vaccine for adult shingles. The vaccine, Zostavax, is approved for adults over 60 who have had chickenpox. It contains a booster dose of the chickenpox vaccine usually given to children. The single-dose vaccine is more than 60% effective in reducing shingles symptoms, and it reduces the incidence of postherpetic neuralgia by at least two-thirds. Studies are ongoing to evaluate the long-term effectiveness of the vaccine.