Shingles

Learn Shingles in 5 minutes

Overview

Shingles is a viral infection that leads to a painful rash. It is caused by the varicella-zoster virus, which also causes chickenpox. After recovering from chickenpox, the virus remains in the body and can reactivate later in life as shingles. Shingles typically presents as a single stripe of blisters on one side of the body, and can cause symptoms such as pain, burning, sensitivity to touch, fever, headache, and fatigue. The risk of developing shingles increases with age, and severe complications can occur, particularly postherpetic neuralgia, a condition characterized by persistent pain. If you suspect shingles, especially if it affects the area around an eye or if you are over 60, it is important to contact a healthcare provider as soon as possible.

Understanding the disease

Symptoms

The symptoms of shingles typically include pain, burning, or tingling, sensitivity to touch, a red rash that begins a few days after the pain, fluid-filled blisters that break open and crust over, and itching. Some people may also experience fever, headache, sensitivity to light, fatigue, or a rash that occurs near an eye, which may lead to permanent eye damage if left untreated.

Risk Factors

Risk factors for developing shingles include age, weakened immune system, history of chickenpox, and certain medications. People over the age of 50 and those with weakened immune systems due to diseases like HIV/AIDS or cancer, or from medications such as steroids or drugs preventing organ transplant rejection, are more likely to develop shingles. Additionally, complications from shingles can include postherpetic neuralgia, which is a painful condition that can persist long after the rash has cleared.

Development

Shingles typically develop due to the reactivation of the varicella-zoster virus (VZV), which is the same virus that causes chickenpox. After a person has chickenpox, the VZV remains in their body and can reactivate later in life, causing shingles. The exact cause of the virus reactivation is not always clear, but factors that may increase the risk include aging, weakened immune systems, and certain medical conditions or medications that weaken the immune system. When the virus reactivates, it travels along nerve pathways to the skin, causing a painful rash with fluid-filled blisters. The rash often appears as a single stripe on one side of the body, usually on the torso. The rash can also occur around one eye or on the face, neck, or other parts of the body. In some cases, the virus may not cause any visible rash but still results in pain, burning, or tingling sensations. Shingles is contagious, and a person can spread the varicella-zoster virus to those who haven't had chickenpox or haven't been vaccinated against it through direct contact with the open sores. It's important to see a healthcare provider if you suspect shingles, especially if the pain and rash occur near an eye, as prompt treatment can help prevent complications and reduce the risk of postherpetic neuralgia.

Assessment and Diagnosis

Triage

You should see a doctor if shingles is suspected, especially in the following situations:

1. If the pain and rash occur near an eye, as leaving it untreated may lead to permanent eye damage.
2. If there are other serious symptoms along with the rash, such as dizziness, new confusion, a fast heartbeat, shortness of breath, shakiness, loss of the ability to use muscles together, a cough that becomes worse, vomiting, a stiff neck, or a fever higher than 102 F (38.9 C).

Diagnosis

Health care providers usually diagnose shingles based on the history of pain on one side of your body, along with the telltale rash and blisters. Your health care provider may also take a tissue sample or culture of the blisters to send to the lab.

Management and Treatment

Complications

Potential complications of shingles include postherpetic neuralgia, which is ongoing pain after the blisters have cleared, and skin infections if the blisters are not properly treated. Shingles can also cause neurological problems such as encephalitis, facial paralysis, or problems with hearing and balance. In individuals over the age of 50, the risk of developing shingles increases, and those over 60 are more likely to experience severe complications. People with weakened immune systems, such as those with HIV/AIDS or cancer, or those undergoing cancer treatments like radiation or chemotherapy, are also at higher risk.

Prevention

Shingles can be prevented by getting vaccinated with the Shingrix vaccine, which is recommended for people aged 50 and older. The vaccine may also be given to those with weakened immune systems due to disease or medication. Shingrix is a non-living vaccine made from a virus component, given in two doses with 2 to 6 months between doses. The vaccine may not guarantee complete protection against shingles but can likely reduce the severity of the disease and the risk of postherpetic neuralgia. If you have specific concerns or risk factors related to age, immune system, cancer treatment, or medications, it's essential to consult your healthcare provider for personalized advice on vaccination options.

Home Remedies

There are some general skin care practices that may help with various skin conditions. These include:

1. Using mild, nonsoap cleansers and lukewarm water to wash your hands.
2. Drying your hands well.
3. Applying moisturizer at least twice a day.
4. Wearing gloves, especially cotton gloves to prevent irritation. It is important to note that shingles are caused by the varicella-zoster virus, which is the same virus that causes chickenpox. Antiviral medications and pain relievers are typically prescribed by a healthcare professional to manage shingles. Home remedies may provide temporary relief, but it is crucial to seek medical advice for proper diagnosis and treatment.

Treatment

The treatment for shingles typically involves prescription antiviral drugs, such as acyclovir, famciclovir, or valacyclovir, which can help speed healing and lower the risk of complications. In addition to antiviral medication, health care providers may also prescribe numbing agents, such as lidocaine, in the form of a cream, gel, spray, or skin patch, anticonvulsants like gabapentin, tricyclic antidepressants like amitriptyline, or an injection including corticosteroids and local anesthetics to help manage pain and discomfort. Shingles usually lasts between 2 and 6 weeks, and most people only experience it once. It is possible to get shingles more than once, but this is less common.

Preparing for medical consultation

To prepare for an appointment for shingles, you should:

1. Make the appointment with your primary care health care provider.
2. Find out any pre-appointment restrictions, such as fasting before specific tests or isolation to avoid spreading the infection.
3. Make a list of your key medical information, including other conditions you're being treated for and any medications, vitamins, or supplements you're currently taking.
4. Note down the symptoms you've experienced, their duration, and any recent exposure to possible sources of infection, such as travel abroad.
5. Bring a copy of your vaccination record if possible.
6. Prepare a list of questions to ask your doctor during the appointment, such as the cause of your symptoms, the best course of action, possible alternatives, and any restrictions you need to follow. Remember to discuss any concerns you have with your healthcare provider during the appointment, and follow their advice on managing and treating your shingles.