Shingles

Causes

Shingles is caused by the same virus that causes chickenpox. Shingles most often occurs in people who have had chickenpox. The virus never fully leaves the body. Some of it settles in nerve roots. Shingles happens when the virus becomes active again. It may become active because of weakening of the immune system. Once active, the virus travels along nerve paths to the skin where it can cause a rash.

Most people who get shingles only have it once.

Shingles can happen in people who have only had a chickenpox vaccine, but this is rare.

Herpes Zoster

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Shingles does not pass from one person to another. The virus itself can pass from someone with shingles. It may cause chickenpox in someone who has never had chickenpox or the vaccine.

Risk Factors

Shingles can occur in anyone. One out of 3 people in the United States and Canada will get shingles in their lifetime. It is more common in people aged 50 and older. Other things that may raise the risk of shingles include:

• Health issues involving immune system, such as HIV infection, lymphoma, or leukemia
• Autoimmune diseases such as rheumatoid arthritis or systemic lupus erythematosus
• Radiation therapy

Symptoms

Symptoms of shingles may be:

• A rash:
  • Red with a slightly raised band or patch
  • Often has many small fluid-filled blisters that dry out and crust within several days
  • Often stays on one side of the body
  • Affects mostly the torso and face
• Skin may be sensitive and painful at the site of the rash—pain may be severe and continue after the rash is gone
• Tingling or itchiness on the skin—may start a few days before the rash
• Fever
• Headache
• Tiredness

If face, ear, or mouth are involved it may lead to:

• Problems moving one side of the face
• Hearing loss, ringing in the ears
• Sensation of spinning, nausea and vomiting
• Loss of taste
• Uncontrolled eye movements
• Burning, redness, tearing of the eyes
• Eyesight problems

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. The doctor can diagnose shingles based on the rash.

Treatment

Shingles cannot be cured. Treatment can help to ease discomfort until it passes. Some treatment may also help to shorten illness and prevent more problems.

Home care will help to ease pain. Wet compresses and oatmeal baths may help. The doctor may also recommend medicine such as:

• Calamine lotion
• Over-the-counter pain relievers
• Medicine applied to the skin to ease pain

Antiviral medicine may help to control shingles. It may shorten illness time for some. This medicine is most helpful in healthy people if it is started within 72 hours of first symptoms. It may also be used at any time if the rash is large or on the face.

Antiviral medicine will almost always be used for people with immune system problems.

Treatment for Post-herpetic Neuralgia (PHN)

The rash usually disappears within 3 weeks. In some cases, the pain continues for months or even years after the rash has healed. This is called post-herpetic neuralgia (PHN). PHN can be severe and difficult to treat. It may be treated with a combination of medical treatments such as:

• Antidepressants
• Antiseizure medicines
• Prescription pain relievers
• Topical pain relievers
• Lidoderm patch
• Nerve blocks
• Transcutaneous electrical nerve stimulation (TENS)—a device that generates low-level pulses of electrical current on the skin's surface

Complication Treatment and Prevention

Shingles near the eye can cause permanent damage to vision. Medical care is important to prevent complications like scarring and blindness. Antiviral medicine and steroids will be used to slow rash progress.

The infection can also cause problems to the nerves of the ear and face. Antiviral medicine and steroids may be used slow rash progress if there is muscle weakness on one side of the face.

Keep Others Healthy

To prevent giving chickenpox to others while shingles is active:

• Keep all blisters covered with a bandage. Keep them covered until they are dry and crusted over.
• Health workers should check with company guidelines before returning to work. Most cannot return to work until the blisters are crusted over.
• Avoid contact with people who are at risk of getting severe chickenpox infections, such as:
  • Pregnant people
  • Premature infants
  • People who have immune system illnesses

Prevention

Getting vaccinated is the best way to prevent shingles. The vaccine is given to people aged 50 and older. It is given as a shot under the skin in 2 doses that are 2 to 6 months apart.