Shingles (Herpes Zoster)

What is shingles?

Shingles is an infection caused by the same virus that causes chickenpox. This virus is called varicella zoster. You cannot develop shingles unless you have had a previous infection of chickenpox (usually as a child).

Shingles is also called herpes zoster. This infection is most common in people over 50 years old, but young people can have it as well.

How does it occur?

If you have had chickenpox, you are at risk for later developing shingles. After you recover from chickenpox, the chickenpox virus stays in your body. It moves to the roots of your nerve cells (near the spinal cord) and becomes inactive (dormant). Later, if the virus becomes active again, shingles is the name given to the symptoms it causes.

What exactly causes the virus to become active is not known. A weakened immune system seems to allow reactivation of the virus. This may occur with normal aging, immune-suppressing medicines, or another illness, or after major surgery. It can also happen as a complication of cancer or AIDS or treatment of these illnesses. Chronic use of steroid drugs may trigger shingles. The virus may also become active again after the skin is injured or sunburned. Emotional stress seems to be a common trigger as well.

What are the symptoms?

The first sign of shingles is often burning, sharp pain, tingling, or numbness in your skin on one side of your body or face. The most common site is the back or upper abdomen. You may have severe itching or aching. You also may feel tired and ill with fever, chills, headache, and upset stomach or belly pain.

One to 14 days after you start feeling pain, you will notice a rash of small blisters on reddened skin. Within a few days after they appear, the blisters will turn yellow, then dry and crust over. Over the next 2 weeks the crusts drop off, and the skin continues to heal over the next several days to weeks.

Because shingles usually follows nerve paths, the blisters are usually found in a line, often extending from the back or side around to the belly. The blisters are almost always on just one side of the body. Shingles usually doesn't cross the midline of the body. The rash also may appear on one side of your face or scalp. The painful rash may be in the area of your ear or eye. When shingles occurs on the head or scalp, symptoms can include headaches and weakness of one side of the face, which causes that side of the face to look droopy. The symptoms usually go away eventually, but it may take many months.

In some cases the pain can last for weeks, months, or years, long after the rash heals. This is called postherpetic neuralgia.

Is shingles contagious?

You cannot get shingles from someone else. However, if you have never had chickenpox, you may get chickenpox from close contact with someone who has shingles because the blisters contain chickenpox virus.

If you have shingles, make sure that anyone who has not had chickenpox or the chickenpox shot does not come into contact with your blisters until the blisters are completely dry. Once your blisters are crusted over, they are no longer contagious.

How is it diagnosed?

Your healthcare provider will ask about your medical history and symptoms and will examine you. The diagnosis is usually obvious from the appearance of the skin. To confirm the diagnosis, your provider may order lab tests to look for the virus in fluid from a blister.

How is it treated?

It is best to start treatment as soon as possible after you see the rash. Contact your healthcare provider to discuss treatment with antiviral medicine, such as acyclovir. This medicine is most effective if you start taking it within the first 3 days of the rash. Antiviral medicine may speed your recovery and lessen the chance that the pain will last for a long time.

Your provider may also recommend or prescribe:

• medicine for pain
• antibacterial salves or lotions to help prevent bacterial infection of the blisters
• corticosteroids (if you are over 50).

How long will the effects last?

The rash from shingles will heal in 1 to 3 weeks and the pain or irritation will usually go away in 3 to 5 weeks.

If the virus damages a nerve, you may have pain, numbness, or tingling for months or even years after the rash is healed. This is called postherpetic neuralgia. This chronic condition is most likely to occur after a shingles outbreak in people over 50 years old. Taking antiviral medicine as soon as the shingles is diagnosed may help prevent this problem.

When shingles occurs on the head or scalp, symptoms can include headaches and weakness of one side of the face (causing that side of the face to look droopy). Even if you have a lot of weakness of the face muscles, the symptoms usually go away eventually, but it may take many months.

How can I take care of myself?

• Take a pain-relief medicine such as acetaminophen. Take other medicine as prescribed by your healthcare provider.
• Put cool, moist washcloths on the rash.
• Rest in bed during the early stages if you have fever and other symptoms.
• Try not to let clothing or bed linens rub against the rash and irritate it.
• Call your healthcare provider right away if:
  • You develop worsening pain or fever.
  • You develop a severe headache, stiff neck, hearing loss, or changes in your ability to think.
  • The blisters show signs of bacterial infection, such as increasing pain or redness, or milky yellow drainage from the blister sites.
  • The blisters are close to the eyes or you have pain in your eyes or trouble seeing.
  • You have trouble walking.
  • You have trouble breathing or a severe cough.
  • You have a fever higher than 101.5° F (38.6° C.)
  • You have a rash involving your eye or difficulty looking at bright light.
  • The blisters appear infected. Signs or symptoms of infection include:
    • Your skin is becoming redder or more painful.
    • You have red streaks from the blisters going toward your heart.
    • The blister area gets very warm to touch.
    • Pus or other fluid starts leaking from the blisters.
    • You have chills, nausea, vomiting, or muscle aches.

How can I help prevent shingles?

• If you have never had chickenpox, you can get a shot to help prevent infection with the chickenpox virus.
• If you have had chickenpox, a vaccine, called Zostavax, is available for people 60 years of age and older. The vaccine can help prevent or lessen the symptoms of shingles. It cannot be used to treat shingles once you have it.
• You can protect your immune system and lessen your chances of getting shingles by trying to keep stress under control, exercising regularly, and eating a healthy diet.