Shingles, Herpes Zoster, Varicella Zoster Virus

Introduction: Shingles is a viral infection that causes a painful skin rash on one side of the body in a limited area. Also known as herpes zoster, shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. After an episode of chickenpox during your youth, the varicella-zoster virus can lay dormant in your body for many years and later re-emerge as shingles.

The virus can be transmitted to adults (by contact with the blister fluid, not by an infected person coughing or breathing on you) who never had chickenpox as a child or received a chickenpox vaccine. However, instead of getting shingles, a severe form of chickenpox will develop.(1) Approximatley 1 in 5 adults who have had chicken pox in the past, will get shingles at some point in their lives.

Shingles is a common disorder with approximatley 600,000 to 1,000,000 cases in the US each year. Shingles can affect anyone at any age who has had chicken pox in the past, but is more likely to occur in those with a suppressed immune system. Seniors over 60, children who had chicken pox before their first birthday, and others with a weak immune system are most vulnerable. According to the National Institute of Health, only 5 percent of shingles cases are attributed to children with older adults, 60 to 80, making up the majority of shingles cases.(3)

Symptoms: When dormant, the virus resides in a non-active state in the nerve tracts that emerge from the spine called dermatomes. When re-activated, shingles follow a 3 stage pattern by first spreading along those nerve tracts, causing pain or a burning sensation in the skin.(2)

In a few days, the painful, sensitive patch of skin gives way to a rash with small blisters and both will continue to evolve and grow over the next few days.When the blisters break, the affected area will start to dry and crust. This crusty patch of red lesions will be painful and sensitive to touch until they heal 2-4 weeks later.

Shingles lesions occur only on one side of the body, and usually above the waist. "Outbreaks that start on the face or eyes can cause vision or hearing problems," the NIH reports. Blindness can also occur if the cornea is affected. If a shingles outbreak persists for months or years, it is called posthepetic neuralgia. See Images of Shingles

During the early stages of shingles, some people feel weak and feverish. Sensitive skin to the point of becoming quite painful is normal. "Many shingles patients say that it was the intense pain that ultimately sent them to the doctor. They often report that the sensation of anything brushing across the inflamed nerve endings on the skin to be almost unbearable."(3)

Causes: Shingles is caused by the same virus that causes chicken pox. This virus is a type of herpes virus and once infected, it remains in your body for life. It will later re-emerge as shingles when your immune system is weak. If you have never had chicken pox, you cannot get shingles. Shingles is a re-emergence of the chickenpox, years later. If you come into direct contact with the blister fluid of someone who has shingles, you may get chickenpox, but you will not get shingles.

Treatment: If left untreated, shingles usually goes away in 2-3 weeks. However, if you suspect you are in the first stage of a shingles outbreak, consult with your doctor immediately. Antiviral medications (such as acyclovir) given in the first 48 to 72 hours can speed the healing process and reduce the risk of complications. Antivirals cannot "cure" shingles, they only weaken the virus and it's effects. Your doctor may also prescribe medication to treat the pain that accompanies shingles if the pain is especially severe. (1,3)

The pain and irritation can be eased with cool, wet compresses, soothing baths and lotions such as calamine lotion. Talk to your doctor about home treatments you can use to relieve the symptoms.

Prevention: If you have never had chickenpox, doctors recommend vaccination with Varivax, a popular childhood immunization vaccine. Varivax is effective in preventing chickenpox 70 to 90 percent of the time. The remainder who do get the disease report milder side effects.

For those adults 60 and older who have HAD chickenpox, but have not yet had shingles, doctors recommend Zostavax, a new shingles vaccine approved by the FDA in May 2006. Zostavax is a stronger version of Varivax and is effective in reducing the risk of shingles by 50 percent in adults over 60. In the 60 to 69 age group, Zostavax was 64 percent effective.(2,3)

During a shingles episode, special care should be taken so as not to infect other family members. Items used by the affected individual should be washed thoroughly in hot, soapy water and and should not come into contact with others. Isolation within the home may be necessary.

Sources:
(1). Herpes Zoster, MedlinePlus Medical Encyclopedia, May 2006
(2). Shingles, MayoClinic, November 2006, DSOOO98
(3). Shingles, National Institute of Health, Senior Health, August 2006

Conditions & Diseases: Skin Diseases

Shingles