What is shingles?
Shingles, or herpes zoster, is a rash caused from the varicella-zoster virus, which is also the cause of chickenpox. This virus remains inactive after someone has had chickenpox. The virus may reactivate in the nerves in adulthood, causing the painful rash.
What causes shingles?
It isn’t understood why some people develop shingles and others don’t; typically, there is just one attack and patients are often older than age 60 and had chickenpox as a baby. Herpes zoster is interesting in that if a child is exposed to someone with shingles, he or she will likely develop chickenpox (if unvaccinated), however, if an adult comes into contact with someone with shingles, the illness is not infectious.
Your doctor can make a shingles diagnosis by looking at your skin and asking questions about your medical history. Tests are rarely needed, but may include taking a skin sample to see if the skin is infected with the virus that causes shingles. Blood tests may show an increase in white blood cells and antibodies to the chickenpox virus, but cannot confirm that the rash is due to shingles.
Preliminary symptoms of shingles include tingling and burning before a rash appears. From there, the rash typically increases to small blisters, which burst and create small ulcers. Within two to three weeks, the ulcers heal. The rash is often seen on the spine, stomach, and chest, although it may also be found on the face and mouth.
Cool, wet compresses can be used to reduce pain. Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or calamine lotion, may help to relieve itching and discomfort.
Resting in bed until the fever goes down is recommended.
The skin should be kept clean, and contaminated items should not be reused. Non Disposable items should be washed in boiling water or otherwise disinfected before reuse. The person may need to be isolated while lesions are oozing to prevent infecting other people who have never had chickenpox, especially pregnant women.
Your doctor may prescribe a medicine that fights the virus, called an antiviral. The drug helps to reduce pain and complications and shorten the course of the disease. Acyclovir, famciclovir, and valacyclovir may be used.
The medications should be started within 24 hours of feeling pain or burning and preferably before the blisters appear. The drugs are usually given in pill form, in doses many times greater than those recommended for herpes simplex or genital herpes. Some people may need to receive medicine by IV.
Strong anti-inflammatory medicines called corticosteroids, such as prednisone may be used to reduce swelling and the risk of continued pain. These drugs do not work in all patients. Other medicines may include:
- Antihistamines to reduce itching (taken by mouth or applied to the skin)
- Pain medicines
- Zostrix, a cream containing capsaicin (an extract of pepper) that may reduce the risk of postherpetic neuralgia
Healing and relief
Herpes zoster usually clears in two to three weeks and rarely recurs. If the virus affects the nerves that control movement (the motor nerves), you may have temporary or permanent weakness or paralysis. Sometimes, the pain in the area where the shingles occurred may last from months to years.
Avoid touching the rash and blisters of persons with shingles or chickenpox if you have never had chickenpox or the chickenpox vaccine.
A herpes zoster vaccine is available. It is different than the chickenpox vaccine. Older adults who receive the herpes zoster vaccine are less likely to have complications from shingles. Adults older than 60 should receive the herpes zoster vaccine as part of routine medical care.