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 60 years of age, but young people can have it as well.

How does it occur?

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, the symptoms are called shingles.

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 immune-suppressing medicines, with another illness, or after major surgery. It is also seen as a complication of cancer or AIDS. Advancing age and chronic use of cortisone-type 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 or under 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.

After several days, you will notice a rash of small, clear, fluid-filled blisters on reddened skin. Within 3 days after they appear, the blisters will turn yellow, then dry and crust over. Over the next 2 weeks the crusts will drop off, sometimes leaving small, pitted scars.

Because they tend to follow nerve paths, the blisters are usually found in a line, often extending from the back or flank around to the abdomen, almost always on just one side. Shingles usually doesn't cross the midline of the body. The rash also may appear on one side of your face. Some people have painful eye inflammations and infections.

Is shingles contagious?

You cannot get shingles from someone else, but you may get chickenpox from contact with shingles blisters if you have not had chickenpox before. The shingles virus is in the blister fluid. The virus can spread by direct contact with a blister. It can also be spread by indirect contact, for example, if you use a washcloth that has blister fluid on it.

If you have shingles, avoid contact with infants, children, pregnant women, and adults who have never had chickenpox or the chickenpox shot until your blisters are completely dry.

How is shingles diagnosed?

Your health care provider will ask about your symptoms and examine you. 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 within 24 to 48 hours after symptoms start. Home care includes:

• Putting cool, moist washcloths on the rash.
• Taking nonprescription painkillers, such as acetaminophen.

Your health care provider may prescribe:

• an antiviral drug, such as acyclovir, to speed recovery and lessen the chance of prolonged symptoms from nerve inflammation
• stronger medicine for pain if nonprescription painkillers are not helping enough
• antibacterial salves or lotions to help prevent bacterial infection of the blisters
• capsaicin cream for pain
• 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 disappear within 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 a condition called postherpetic neuralgia. It is most likely to occur after a shingles outbreak in people over 50 years old. Antiviral medicine prescribed at the time the shingles is diagnosed and taken for 7 days can 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, although 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 health care provider.
• Put a cool compress on the rash (such as a cool, moist washcloth).
• Rest in bed during the early stages if you have fever and other symptoms.
• Try to avoid having clothing or bed linens rubbing against the rash, which might irritate it.
• Call your health care provider if:
  • You develop worsening pain or fever.
  • You develop a stiff neck, hearing loss, or changes in thinking and reasoning.
  • 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.

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.
• You can protect your immune system and lessen your chances of getting shingles by trying to keep your stress under control.