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Diseases and Conditions
Shingles
From MayoClinic.com
Special to CNN.com

Introduction

Shingles is a viral infection that causes a painful rash. Also known as herpes zoster, it often appears as a band of blisters that wraps from the middle of your back around one side of your chest to your breastbone. Other parts of your body can be involved as well, including your neck, face or scalp.

The pain of shingles can be excruciating, and the cause might not be immediately evident. But once the telltale rash and blisters start on one side of your body, it's more easily identified as shingles.

Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. After you've had chickenpox, the virus lies inactive (dormant) in your nerves. Years later, the virus may reactivate as shingles.

Shingles isn't a life-threatening condition, but it can be very painful. Sometimes, the rash leads to a debilitating complication called postherpetic neuralgia. This condition causes the skin to remain painful and sensitive to touch for months or even years after the rash clears up.

Vaccines can help reduce the risk of shingles, while early treatment can help shorten a shingles infection and minimize the chance of complications.

Signs and symptoms

The signs and symptoms of shingles may include:

  • Pain, burning, tingling, numbness or extreme sensitivity in a certain part of your body
  • A red rash that begins a few days after the pain
  • Fluid-filled blisters that break open and crust over
  • Itching
  • Fever and chills
  • Headache
  • Upset stomach or abdominal pain

Typically, the shingles rash occurs on only one side of your body. This is an important sign to help diagnose shingles. It may appear, for example, as a band of blisters that wraps from the middle of your back around one side of your chest to your breastbone, following the path of the nerve where the virus had been inactive. Sometimes, the shingles rash occurs around one eye or on one side of the neck or face.

Pain is usually the first symptom of shingles. For some, it can be intense, with just the slightest touch causing severe pain. Sometimes the pain can be mistaken for other problems or diseases, such as kidney stones, gallstones or appendicitis, depending on its location. Some people experience the pain without the rash, which makes diagnosing shingles more difficult.

Although the shingles rash may resemble chickenpox, the virus typically causes more pain and less itching the second time around.

Causes

Shingles is a second eruption of the varicella-zoster virus — the same virus that causes chickenpox.

Varicella-zoster is part of a group of viruses called herpes viruses, which includes the viruses that cause cold sores and genital herpes. Many of these viruses can lie hidden in your nervous system after an initial infection and remain inactive for years before causing another infection.

Anyone who's had chickenpox may develop shingles. If your immune system doesn't destroy the entire virus during the initial infection, the remaining virus can enter your nervous system and lie hidden for years. Eventually, it may reactivate and travel along nerve pathways to your skin — producing the shingles.

The reason for the encore is unclear. But it may be due to lowered immunity to infections as you grow older. Shingles is more common in older adults and in those who have weak immune systems.

Risk factors

Anyone who's had chickenpox has the potential of developing shingles. However, it's most common in older adults: More than half the shingles cases occur in adults over 60.

In addition, people with weakened immune systems from HIV/AIDS, those who are receiving medical treatments, such as steroids, radiation and chemotherapy, or those who have a history of bone or lymphatic cancer are more likely to develop shingles. Most people develop shingles only once, but recurrences in other areas are possible.

A person with shingles can pass the varicella-zoster virus to anyone who hasn't had chickenpox before. This usually occurs through direct contact with the open sores of the shingles rash. Once infected, the person will develop chickenpox, however, not shingles. The infection can be serious for certain groups of people with immune system deficiencies. The varicella-zoster virus cannot be spread to another person with a normal immune system who has already had chickenpox.

Until the shingles blisters scab over, avoid physical contact with:

  • Anyone who's never had chickenpox
  • Anyone who has a weak immune system
  • Newborns
  • Pregnant women (A chickenpox infection can be dangerous for the developing baby.)

When to seek medical advice

Contact your doctor promptly if you suspect shingles but especially in the following situations:

  • The pain and rash occur near your eyes. If left untreated, this infection can lead to permanent eye damage.
  • You or someone in your family has a weakened immune system (due to cancer, medications or chronic illness).
  • The rash is widespread and painful.

Screening and diagnosis

Shingles is usually diagnosed based on the history of pain on one side of your body along with the telltale rash and blisters. Your doctor is likely to conduct a thorough physical exam and ask questions about accompanying symptoms. Your doctor may also take a tissue scraping or culture of the blisters for examination in the laboratory.

Complications

For about one in five people who develop shingles, the pain continues in the same spot long after the blisters have cleared. This condition is known as postherpetic neuralgia.

When you have postherpetic neuralgia, damaged nerve fibers send confused and exaggerated messages of pain from your skin to your brain. This leaves the affected area of skin sensitive to even the slightest touch. For some people, the brush of clothing or a breeze can be excruciatingly painful.

Pain medication, antidepressants or anticonvulsant medications may help provide relief until the pain subsides.

Shingles can also lead to other complications, including inflammation of the brain (encephalitis) and other neurological problems. If shingles occurs on your face, it can cause hearing problems and temporary or permanent blindness. Loss of facial movement (paralysis) is possible as well. If blisters aren't properly treated, bacterial skin infections are another potential problem.

Treatment

An episode of shingles usually heals on its own within a few weeks, but prompt treatment can ease pain, speed healing and reduce your risk of complications.

Your doctor may take a three-pronged approach to your treatment:

  • High doses of an antiviral drug to reduce the duration and severity of your symptoms. Oral antiviral medications include acyclovir (Zovirax), valacyclovir (Valtrex) or famciclovir (Famvir). For best results, start these medications within 72 hours of the first sign of the shingles rash.
  • An anti-inflammatory drug to ease inflammation. Corticosteroids (prednisone) are occasionally used to reduce inflammation and lower your risk of postherpetic neuralgia.
  • Pain relievers to control pain. For relief of severe pain, narcotics (opioids) may be needed.

Sometimes tricyclic antidepressants or certain anticonvulsants are helpful if the pain continues after shingles resolves. A topical ointment that includes capsaicin or a skin patch that contains the pain-relieving medication lidocaine may be soothing as well.

Prevention

Two vaccines may help prevent shingles — the chickenpox (varicella) vaccine and the shingles (varicella-zoster) vaccine.

Chickenpox vaccine
The varicella virus vaccine (Varivax) has become a routine childhood immunization to prevent chickenpox. It's recommended for children between ages 12 months and 18 months. The vaccine is also recommended for older kids and adults who've never had chickenpox.

Though the chickenpox vaccine doesn't guarantee you won't get chickenpox or shingles, it can reduce your chances of complications and reduce the severity of the disease.

Shingles vaccine
The varicella-zoster vaccine (Zostavax) can help prevent shingles in adults age 60 and older who've had chickenpox. Like the chickenpox vaccine, the shingles vaccine doesn't guarantee you won't get shingles. But this live vaccine will likely reduce the course and severity of the disease and reduce your risk of postherpetic neuralgia.

The shingles vaccine is given as a single injection, usually in the upper arm. It's only used as a prevention strategy, however. It's not intended to treat people who already have the disease. Common side effects include redness, pain and swelling at the needle site, itching and headache.

This shingles vaccine isn't recommended if you:

  • Have ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin or any other component of the shingles vaccine
  • Have a weakened immune system from HIV/AIDS or another disease that affects your immune system
  • Are receiving medical treatments such as steroids, radiation and chemotherapy
  • Have a history of bone or lymphatic cancer
  • Have active, untreated tuberculosis

If you are mildly ill, such as with a cold, it's OK to get the vaccine. However, if you're moderately or severely ill, wait until you feel better before getting the vaccine.

Self-care

Depending on your level of pain, you might not feel like doing much, and you may feel weak and tired. If this is the case, be sure to listen to your body — get plenty of rest and avoid strenuous activities while you're recuperating.

Also, avoid stress, which can worsen pain. Relaxation techniques, including listening to music or doing tai chi, might help. To take your mind off the pain, try doing other activities, such as reading a book, watching a movie or working on a hobby.

The following are other tips to help minimize the pain and manage the symptoms of shingles.

  • Take an over-the-counter pain reliever or anti-inflammatory drug, such as ibuprofen (Advil, Motrin, others).
  • Apply an anti-itch cream or calamine lotion to the affected area. A nonprescription hydrocortisone cream, containing at least 1 percent hydrocortisone, can temporarily relieve the itch. A nonprescription oral antihistamine, such as diphenhydramine (Benadryl, others), may be helpful if itching is severe.
  • Wash the blisters twice a day with regular soap and water but don't bandage them.
  • Apply cool, wet compresses to the blisters to relieve the pain and itch. Use water or water mixed with white vinegar — 1 ounce of vinegar to 32 ounces of water. Apply the compresses three times a day.
  • Take a comfortably cool bath. Sprinkle the bath water with baking soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal that's made for the bathtub (Aveeno, others).

September 05, 2007

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