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Shingles

(Herpes Zoster; Post-herpetic Neuralgia)

Definition

Shingles is a painful infection of the nerves and skin.

Causes  ^

Shingles is caused by the varicella zoster virus. This is the same virus that causes chickenpox. Shingles occurs in people who have had chickenpox in their lifetime. 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. When reactivated, the virus travels along nerve paths to the skin where it causes pain and a rash.

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Risk Factors  ^

Shingles is more common in women, and in people aged 50 years and older. Other factors that may increase the chances of shingles include:

Shingles can occur in those with no known risk factors.

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 contact occurs with a person who has shingles. Covering shingles sores with a bandage reduces the risk of transmitting shingles to others.

Symptoms  ^

Shingles may cause:

  • Rash:
    • Red and has a slightly raised band or patch, often with multiple small fluid-filled blisters that dry out and crust within several days
    • Develops on one side of the body, but typically does not cross the midline
    • Affects mostly the torso and face
  • The eyes to be affected, in severe cases, which can threaten vision
  • Sensitivity and pain on the skin at the site of the rash—pain may be severe and persist after the rash is gone
  • Tingling or itchiness on the skin, which may start a few days before the rash
  • Fever
  • Headache
  • Tiredness

The rash usually disappears within 3 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.

Diagnosis  ^

You will be asked about your symptoms and medical history. A physical exam will be done. The rash can be diagnosed by its appearance. Fluids may be drawn from the blisters for testing, but this is not done often.

Treatment  ^

Shingles cannot be cured. Treatment focuses on:

  • Easing symptoms
  • Speeding recovery
  • Preventing PHN

Home Remedies and Over-the-Counter Products

The following will help relieve pain and ease symptoms:

  • Calamine lotion
  • Wet compresses
  • Frequent oatmeal baths
  • Over-the-counter pain relievers
  • Topical pain relievers that are applied to the skin

Antiviral Medication

Antiviral medications may control shingles. Antiviral therapy may shorten a shingles episode, but you must start it within 48-72 hours after symptoms first develop. They are especially used in people with suppressed immune systems.

Treatment for Post-herpetic Neuralgia

If you develop PHN, your doctor may recommend:

  • Antidepressants
  • Antiseizure medications
  • Prescription pain relievers
  • Topical pain relievers
  • Lidoderm patch
  • Nerve blocks
  • Transcutaneous electrical nerve stimulation (TENS)—a device that generates low-level pulses of electrical current on the skin's surface

Treatment for Shingles of the Eye

If you develop shingles on your face, contact your doctor right away. You may be prescribed medications, such as steroids, to treat this condition. Without treatment, permanent eye damage can result, including glaucoma, scarring, and blindness.

Prevention  ^

There are now 2 vaccines that are used to reduce the risk of shingles and the severity of PHN if shingles occurs. The live HSV is advised for people 60 years and older. It is a single dose vaccine used in adults with healthy immune systems. The dead virus is a 2-shot series, which may be given 2-6 months apart starting at age 50 years old. Talk to your insurance company and doctor about your options.

If you do have shingles, take these steps to prevent giving chickenpox to others:

  • Keep all blisters covered with a bandage until they are dry and crusted over.
  • If you are a healthcare worker, do not return to work until the blisters are dry and crusted over.
  • Avoid contact with people who are at risk of getting severe varicella, such as:
    • Pregnant women
    • Premature infants
    • People who have a compromised immune system
RESOURCES:

National Institute of Neurological Disorders and Stroke
https://www.ninds.nih.gov

National Shingles Foundation
http://www.vzvfoundation.org

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

The College of Family Physicians of Canada
http://www.cfpc.ca

REFERENCES:

Herpes zoster. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T113997/Herpes-zoster. Updated March 13, 2018. Accessed March 13, 2018.

Ocular shingles. Wills Eye Institute website. Available at: https://www.willseye.org/disease_condition/ocular-shingles. Accessed March 13, 2018.

Shingles. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/shingles. Updated September 2017. Accessed March 13, 2018.

Shingles: overview. American Academy of Dermatology website. Available at: https://www.aad.org/public/diseases/contagious-skin-diseases/shingles. Accessed March 13, 2018.

Shingles (herpes zoster). Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/shingles. Updated January 30, 2018. Accessed March 13, 2018.

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.

6/9/2014 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T113997/Herpes-zoster: Forbes H, Bhaskaran K, Thomas SL, et al. Quantification of risk factors for herpes zoster: population based case-control study. BMJ. 2014;348:g2911.

Last reviewed March 2018 by EBSCO Medical Review Board Marcie L. Sidman, MD  Last Updated: 3/13/2018