(Herpes Zoster; Post-herpetic Neuralgia)
by Editorial Staff and Contributors
Shingles is a painful infection of the nerves and skin.
It is caused by the varicella zoster virus. This is the same virus that causes chickenpox. Shingles occurs in people who have had chickenpox. After causing the first chickenpox infection, the virus is not totally eliminated from the body. Some of the remaining virus settles in nerve roots near the spinal cord. Once reactivated, the virus travels along nerve paths to the skin. There it causes pain and a rash.
Risk Factors TOP
Factors that may increase the risk of shingles include:
Shingles can occur in those with no known risk factor.
Shingles is not usually transmitted from one person to another. But, a person who has never had chickenpox and never received the varicella vaccine is likely to get chickenpox if he came in prolonged contact with a person who has shingles. Covering shingles sores with a bandage reduces the risk of transmitting shingles to others.
Symptoms may include:
The rash usually disappears within three weeks. In some cases, though, post-herpetic neuralgia (PHN) develops. With PHN, the pain continues for months or even years after the rash has healed. PHN can be severe and difficult to treat.
The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor can diagnose the rash by its appearance. Fluids may be drawn from the blisters for testing, but this is not done very often.
Shingles cannot be cured. Treatment focuses on:
Home Remedies and Over-the-Counter Products
Your doctor may recommend that you use these treatments to reduce discomfort:
If you are not getting any relief from the over-the-counter products, your doctor may prescribe medicine. For example, your doctor may prescribe a short course of oral steroid medicine (eg, prednisone).
Certain antiviral medicines may control shingles by changing how the virus reproduces in nerve cells. Examples include:
Antiviral therapy may shorten a shingles episode. But you must start it within 48-72 hours after symptoms first develop.
Treatment for Post-herpetic Neuralgia
If you develop PHN, your doctor may recommend:
The herpes zoster vaccine (Zostavax) is recommended for people aged 60 years and older. The vaccine decreases the likelihood of getting shingles and reduces the severity of PHN if shingles does occur.
If you do have shingles, take these steps to prevent giving chickenpox to others:
National Institute of Neurological Disorders and Stroke
VZV Research Foundation
Canadian Family Physician
Public Health Agency of Canada
Shingles. Family Doctor.org website. Available at: http://familydocto... . Updated January 2011. Accessed September 7, 2012.
Shingles (herpes zoster). Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/shingles/about/overview.html . Updated January 10, 2011. Accessed September 7, 2012.
1/14/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Tseng HF, Smith N, Harpaz R, Bialek SR, Sy LS, Jacobsen SJ. Herpes zoster vaccine in older adults and the risk of subsequent herpes zoster disease. JAMA . 2011;305(2):160-166.
Last reviewed September 2012 by Peter Lucas, MD
Last Updated: 09/27/2012