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Shingles result from the activation of the chickenpox virus already present, but inactive (dormant), in nerve tissues. The virus remains dormant in spinal nerves usually after the person has had chickenpox as a child.
The varicella-zoster virus that causes shingles can spread to others causing chickenpox in patients who have not had it in the past. It is not possible to get shingles from another person with shingles, but it is possible to get chickenpox.
Shingles are contagious from the time the blisters are oozing until the time the blisters have scabbed.
To reduce the risk of spreading the virus, the patient is advised to keep the affected area clean and avoid touching the blisters. Patients should wash their hands often. Patients with shingles should also avoid being around high-risk individuals and those who have not had chickenpox or who are not vaccinated against the varicella-zoster virus.
What is shingles?
Shingles (herpes zoster) is a viral disease caused by the varicella-zoster virus, the same virus that causes chickenpox. It is characterized by a painful rash on certain body parts.
After the first chicken pox infection, the virus may lie in the nerve tissue in an inactive state. It reactivates years later as singles.
Risk factors for shingles
If patients have had a history of chickenpox, the risk of shingles includes
- Physical or emotional stress
- Weakened immune system due to human immunodeficiency virus (HIV) and cancer
- Diabetes mellitus
- Long-term steroid treatment or immunosuppressant treatment
- Transplant patients
- Poor nutrition and health
- Major physical injury
What are the signs and symptoms of shingles?
The shingles rash typically occurs over one side of the face or body. Common signs and symptoms include:
- Pain (usually the first symptom in shingles and can vary in intensity)
- Burning sensation, numbness or tingling and itching
- Multiple blisters that appear in a cluster pattern (an area of redness may accompany the rash)
- Blisters contain fluid and they break open with crusting
- Fever, chills, fatigue and body ache
- Headache
- Photophobia (sensitivity to light) (only if the face is involved)
- Fatigue
How does a shingles rash look?
The typical shingles red rash or blisters follow pain, itching and tingling. It is usually limited to one side of the face and body.
- Shingles on the face, scalp, mouth and ear
Rash and blisters of shingles appear on one side of the face extending to the scalp, ear and inside the mouth. It may be seen over the lip area as well.
- Shingles of the eye and forehead
Rash and blisters appear around the eye, over the eyelids and one side of the forehead, extending to the tip of the nose.
- Shingles on the waist and back
Rash and blisters appear over one side of the waist and back in a stripe pattern, extending up to the lower back.
- Shingles on the buttocks:
Shingles rash and blisters over the buttocks, usually on one side.
How is shingles treated?
Treatment is most effective when started within 72 hours of the appearance of a rash. Antiviral drugs (acyclovir, valacyclovir, etc.) can help patients recover faster and reduce the risk of complications.
Shingles rash and blisters can cause severe pain that may not be relieved with over-the-counter pain medication. Treatment of pain includes:
- Anti-seizure medicines (e.g. Pregabalin)
- Antidepressants
- Cool compresses
- Medicated lotions to reduce pain and itching (e.g. topical diphenhydramine)
- Numbing creams (e.g. lidocaine gel)
- Over-the-counter painkillers such as paracetamol or ibuprofen
- Prescription painkillers such as codeine for intense pain
Prevention: A vaccine is available against the varicella-zoster virus to prevent chickenpox and shingles.
What are the complications of shingles?
Shingles can have complications that last long after the rash is gone. Complications can also occur if the infection has not been treated appropriately.
- Postherpetic neuralgia: Pain that lasts long after the infection resolves.
- Facial nerve paralysis causing disfigurement of the face.
- Loss of vision if the cornea is infected.
- Loss of hearing and balance problems.
- Systemic spread of the virus to the brain in case of poor immunity (human immunodeficiency virus [HIV], transplant patients).
- Bacterial infection of the skin causes increased swelling, redness, warmth, pain, tenderness and pus formation.