Shingles

Shingles, also called herpes zoster, is a painful rash caused by the varicella-zoster virus—the same virus that causes chickenpox. After you've had chickenpox, the virus lies dormant in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles.

Shingles typically appears as a stripe of blisters on one side of the body, usually on the torso, face, or eyes. The pain can be severe, and shingles can lead to serious complications, especially in older adults. However, vaccination can prevent shingles, and early treatment can reduce the risk of complications.

Shingles symptoms may include:

Early Symptoms (before rash appears):

• Pain, burning, or tingling: Usually on one side of body
• Sensitivity to touch: Skin may be very sensitive
• Itching: In affected area
• Fever: Low-grade fever
• Headache: May occur
• Fatigue: Feeling tired
• Sensitivity to light: If affecting face

Rash Phase:

• Red rash: Appears a few days after pain
• Blisters: Fluid-filled blisters
• Blisters break open: Then crust over
• Usually on one side: Doesn't cross midline
• Common locations: Torso, face, around one eye

Pain:

• Can be severe
• Described as burning, stabbing, or shooting
• May persist after rash heals (postherpetic neuralgia)

Seek emergency care if:

• Rash near eye (can cause vision loss)
• Severe pain
• Signs of infection (increasing redness, pus, fever)
• Severe headache with rash on face
• Confusion or difficulty thinking

Managing shingles involves:

1. Take Medications as Prescribed:

   • Antiviral medications (most effective if started early)
   • Pain medications
   • Don't skip doses
   • Start treatment as soon as possible

2. Keep Rash Clean and Dry:

   • Gently wash with soap and water
   • Don't scratch blisters
   • Keep covered with loose, non-stick bandage
   • Avoid tight clothing

3. Pain Management:

   • Over-the-counter pain relievers (as approved)
   • Cool compresses (not ice directly on blisters)
   • Calamine lotion (may help with itching)
   • Avoid scratching

4. Rest:

   • Get plenty of rest
   • Don't overexert
   • Allow body to heal

5. Avoid Spreading:

   • Keep rash covered
   • Wash hands frequently
   • Avoid contact with:
     • Pregnant women (if never had chickenpox)
     • People with weakened immune systems
     • Newborns
   • Until blisters crust over

6. Comfort Measures:

   • Loose, comfortable clothing
   • Cool, soft fabrics
   • Avoid heat and humidity
   • Relaxation techniques for pain

• Rash near eye
• Severe symptoms
• Signs of severe infection
• Severe headache with facial rash
• Confusion

• Suspected shingles (especially if early)
• Rash appears
• Pain is severe
• Rash near eye
• Signs of infection
• Questions about treatment
• Need for pain management

• Following treatment plan
• Rash healing normally
• Pain manageable
• No complications
• No new concerning symptoms

Diagnosing shingles usually involves:

1. Physical Examination:

   • Visual inspection of rash
   • Characteristic appearance
   • Location and pattern
   • Usually diagnosed by appearance

2. Medical History:

   • Previous chickenpox
   • Symptoms
   • When rash appeared

3. Laboratory Tests (if needed):

   • Scraping from blisters
   • Test for varicella-zoster virus
   • Usually not needed if typical appearance

Treatment aims to shorten duration and prevent complications:

1. Antiviral Medications (most important):

   • Acyclovir, valacyclovir, or famciclovir
   • Most effective if started within 72 hours of rash
   • Reduces severity and duration
   • Reduces risk of complications
   • Usually taken for 7-10 days

2. Pain Medications:

   • Over-the-counter (acetaminophen, ibuprofen)
   • Prescription medications if needed
   • May need stronger options for severe pain

3. Topical Treatments:

   • Calamine lotion (itching)
   • Cool compresses
   • Keep clean and dry

4. Treatment of Complications:

   • Postherpetic neuralgia: Persistent pain after rash heals
     • May need specialized pain management
     • Medications (antidepressants, anticonvulsants)
     • Topical treatments
   • Eye involvement: Requires ophthalmologist
   • Infection: Antibiotics if bacterial infection

5. Supportive Care:

   • Rest
   • Comfort measures
   • Good hygiene

Prevent shingles by:

• Get Vaccinated:
  • Shingles vaccine recommended for adults 50+
  • Even if you've had shingles before
  • Reduces risk and severity
  • Two-dose series (Shingrix) is most effective
• Maintain Healthy Immune System:
  • Adequate sleep
  • Balanced diet
  • Regular exercise
  • Stress management
  • Manage chronic conditions

Vaccination is the best prevention.

In shingles:

1. Virus Reactivates: Varicella-zoster virus wakes up
2. Travels Along Nerves: Moves to skin
3. Rash Develops: In area served by that nerve
4. Pain Occurs: Nerve inflammation causes pain
5. Healing: Rash heals, but pain may persist

Risk Factors:

• Age: Risk increases with age (50+)
• Previous chickenpox: Must have had chickenpox
• Weakened immune system:
  • HIV/AIDS
  • Cancer treatments
  • Medications that suppress immune system
  • Organ transplants
• Stress: Can trigger reactivation
• Other factors: Various conditions

• Much higher risk (50+)
• More severe symptoms
• Higher risk of complications
• Postherpetic neuralgia more common
• Vaccination especially important

• Higher risk
• More severe disease
• Higher risk of complications
• May need different treatment
• Vaccination may be recommended (discuss with doctor)

• Less common but can occur
• Usually less severe
• Still need treatment
• Vaccination may be considered

Possible Complications:

• Postherpetic neuralgia: Persistent pain after rash heals (most common)
• Vision loss: If affects eye
• Neurological problems: Various nerve problems
• Skin infections: Bacterial infection of blisters
• Ramsay Hunt syndrome: If affects facial nerve (rare)

No. You can only get shingles if you've had chickenpox. However, you can get chickenpox from someone with shingles if you've never had chickenpox or been vaccinated.

Shingles itself is not contagious, but the virus can spread to people who haven't had chickenpox or been vaccinated, causing chickenpox (not shingles). The risk is low if the rash is covered.

Yes, though it's uncommon. Most people only get shingles once, but it can recur, especially in people with weakened immune systems.

The rash usually heals within 2-4 weeks. However, pain may persist longer (postherpetic neuralgia), sometimes for months or years.

The shingles vaccine is recommended for adults 50 and older, even if you've had shingles before. It significantly reduces the risk and severity of shingles. Discuss with your doctor.