Shingles is a skin rash caused by the same virus that causes Chicken Pox. This virus is called the Varicella zoster virus (VZV) and is in the Herpes family of viruses. After an individual has Chicken Pox, this virus lives dormant in the nervous system and is never fully cleared from the body. Under certain circumstances, such as emotional stress, immune deficiency (from AIDS or chemotherapy), or with cancer, the virus reactivates and causes Shingles. In most cases of Shingles, however, a cause for the reactivation of the virus is never found. Anyone who has ever had Chicken Pox is at risk for the development of Shingles, although it occurs most commonly in people over the age of 60. It has been estimated that up to 1,000,000 cases of Shingles occur each year in the U.S.
The Herpes virus that causes Shingles and Chicken Pox is not the same as the Herpes viruses that causes genital Herpes (which can be sexually transmitted) or Herpes mouth sores. Shingles is medically termed Herpes zoster.
Before a rash is visible, the patient may notice several days to a week of burning pain and sensitive skin. When the characteristic rash is not yet apparent, it may be difficult to determine the cause of the often severe pain. Shingles rash starts as small blisters on a red base, with new blisters continuing to form for three to five days. The blisters follow the path of individual nerves that come out of the spinal cord in a specific "ray-like" distribution (called a dermatomal pattern) and appear in a band-like pattern on an area of skin. The entire path of the affected nerve may be involved, or there may be areas in the distribution of the nerve with blisters and areas without blisters. Generally, only one nerve level is involved. In a rare case, more than one nerve will be involved.
Eventually, the blisters pop, and the area starts to ooze. The affected areas will then crust over and heal. The duration of the outbreak may take three to four weeks from start to finish. On occasion, the pain will be present but the blisters may never appear. This can be a very confusing cause of local pain.
Yes, Shingles is contagious. Shingles can be spread from an affected person to children or adults who have not had Chicken Pox. But instead of developing Shingles, these people develop Chicken Pox. Once they have had Chicken Pox, people cannot catch Shingles (or contract the virus) from someone else. Once infected, however, people have the potential to develop Shingles later in life.
There are several effective treatments for Shingles. Drugs that fight viruses (antivirals), such as acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir), can reduce the severity and duration of the rash if started early (within 72 hours of the appearance of the rash). In addition to antiviral medications, pain medications may be needed for symptom control. Both nonsteroidal anti-inflammatory medications and narcotic pain control medications may be used for pain management in Shingles.
The affected area should be kept clean. Bathing is permitted, and the area can be cleansed with soap and water. Cool compresses and anti-itching lotions, such as calamine lotion, may also provide relief. An aluminum acetate solution (Burow's or Domeboro solution, available at your pharmacy) can be used to help dry up the blisters and oozing.
Generally, Shingles heal well and problems are few. However, on occasion, the blisters can become infected with bacteria, causing cellulitis, a bacterial infection of the skin. If this occurs, the area will become reddened, warm, firm, and tender. You might notice red streaks forming around the wound. If you notice any of these symptoms, contact your health-care professional. Antibiotics can be used to treat these complications.
A more worrisome complication occurs when Shingles affect the face, specifically the forehead and nose. In this situation, it is possible, although not likely, that Shingles can affect the eye, leading to loss of vision. If you have Shingles on your forehead or nose, your eyes should be evaluated by a health-care professional.
A rare complication of Shingles is known as Ramsay Hunt syndrome. In this case, the cranial nerves (cranial nerves V, IX, and X) are involved. Symptoms may include peripheral facial nerve weakness and deafness. The typical rash is often observed around the ear and ear canal.
The most common complication of Shingles is postherpetic neuralgia. This occurs when the nerve pain associated with Shingles persists beyond one month, even after the rash is gone. It is a result of irritation of the nerves of sensation by the virus. The pain can be severe and debilitating. Postherpetic neuralgia occurs primarily in people over the age of 50 and affects 10%-15% of people with Shingles.
There is evidence that treating Shingles with antiviral agents can reduce the duration and occurrence of postherpetic neuralgia. The pain of postherpetic neuralgia can be reduced by a number of medications. Tricyclic antidepressant medications (amitriptyline [Elavil] and others), as well as antiseizure medications (gabapentin [Neurontin], carbamazepine [Tegretol], pregabalin [Lyrica]), have been used to relieve the pain associated with postherpetic neuralgia. Capsaicin cream (Zostrix), a derivative of hot chili peppers, can be used topically on the area after all the blisters have healed, to reduce the pain. Lidocaine pain patches (Lidoderm) applied directly to the skin can also be helpful in relieving nerve pains by numbing the nerves with local lidocaine anesthetic. These options should be discussed with your health-care professional.
In May 2006, the U.S. Food and Drug Administration (FDA) approved the first vaccine for adult Shingles. The vaccine, known as Zostavax, is approved for use in adults ages 60 and over who have had Chicken Pox. The Shingles vaccine contains a booster dose of the Chicken Pox vaccine usually given to children. Tests over an initial four-year period showed that the vaccine significantly reduced the incidence of Shingles in these older adults. The single-dose vaccine was shown to be more than 60% effective in reducing Shingles symptoms and it reduced the incidence of postherpetic neuralgia (PHN, see above) by at least two-thirds. Studies are ongoing to evaluate the effectiveness of the vaccine over a longer term.
People with weakened immune systems due to immune-suppressing medications, cancer treatment, HIV disease, or organ transplants should not receive the Shingles vaccine because it contains live, weakened viral particles.
Since vaccination against VZV is now recommended for children, the incidence of Chicken Pox has been reduced. This is also expected to reduce the incidence of Shingles in adults as these children age.