Shingles

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Introduction

What is shingles?

Shingles is a painful disease caused by reactivation of the same virus that causes chickenpox, the varicella zoster virus. Shingles, also called herpes zoster, attacks nerve cells and causes severe nerve pain and a skin rash that appears over the affected nerve.

Shingles develops in people who have had chickenpox in the past. The chickenpox virus (varicella zoster virus) can remain in the body in an inactive form for years. In some people, the dormant virus is reactivated later in life by something that stresses the immune system, such as an illness.

Shingles is not spread through contact with a person who has shingles. However, a person who has never had chickenpox can contract chickenpox from a person with shingles through direct contact with the shingles rash.

Shingles is most common in older adults and the elderly who have had chickenpox at some point during their lives. Shingles is preventable 50% of the time through a shingles vaccination, and it has become less common since the introduction of the shingles vaccine. The pain of shingles generally resolves within three to five weeks. Most people who develop shingles will have only one episode, but in rare cases a person will have a second or third episode.

Complications of untreated shingles can be serious and include vision damage, meningitis, and postherpetic neuralgia (ongoing pain at the site). Seek prompt medical care if you, or someone you are with, have symptoms of shingles, including itching, tingling, or severe burning pain that precedes the appearance of a rash in the affected area. Prompt diagnosis and treatment of shingles reduces the risk of serious complications.

Symptoms

What are the symptoms of shingles?

Symptoms of shingles affect the nerves and the skin. Shingles can occur in almost any part of the body, but most often affects one side of the torso. Symptoms of shingles include:

  • Chills

  • Fatigue

  • Fever

  • Headache

  • Itching, tingling, or severe burning pain that precedes a rash, often on one side of the torso

  • Rash in a band or patch-like shape over the affected area that develops into fluid-filled blisters that eventually dry out, crust over, and heal

Symptoms that might indicate a serious complications of shingles

In some cases, shingles can affect the nerves of the face, eyes or ears and cause serious symptoms and complications, such as facial paralysis or impaired vision and hearing. Seek prompt medical care if you, or someone you are with, have symptoms of shingles, particularly the following symptoms or conditions:

  • Decreased or double vision

  • Painful, widespread rash

  • Poor immune system caused by a chronic disease or immune-suppressing medications

  • Rash near your eyes or involving the tip of the nose

Causes

What causes shingles?

Shingles is a disease caused by the same virus that causes chickenpox, the varicella zoster virus. When a person has chickenpox, the varicella zoster virus can invade the nerve cells in the brain stem or spinal cord. The virus can then remain there in an inactive form for years until it is reactivated later in life and causes shingles. The varicella zoster virus can be reactivated by anything that taxes the immune system, such as illness or stress. 

What are the risk factors for shingles?

A number of factors increase your risk of reactivating the dormant varicella zoster virus and developing shingles including:

  • Being an older adult with a history of having had chickenpox who has not gotten the shingles vaccination

  • Having a condition that weakens the immune system, such as HIV/AIDS, cancer, chemotherapy, or an organ transplant.

  • Having a weakened or impaired immune system also increases the risk for having recurring episodes of shingles.

  • Recent illness

  • Stress

    Reducing your risk of shingles

    You can best lower your risk of shingles and its complications by getting vaccinated for shingles. The shingles vaccine is generally given to adults older than age 60 who have had chickenpox. It is possible that a person who has had the shingles vaccine may still get shingles, but the disease is generally less severe and of shorter duration.

    Some people should not get the shingles vaccine, including people with a weakened immune system and people who have had a severe allergic reaction to the vaccine components (gelatin, neomycin or other component). Unfortunately, immunocompromised people who should not get the vaccine are also at a higher risk for developing shingles.

    You can reduce your risk of chickenpox and subsequent development of shingles by avoiding exposure to a person with chickenpox and by getting vaccinated for these diseases as recommended by your health care provider.

    Treatments

    How is shingles treated?

    There is no cure for shingles, but antiviral medications can reduce the severity and duration of the disease. Antiviral medications can also reduce the risk of developing postherpetic neuralgia, which is a serious complication of shingles. Antiviral medications include:

    • Acyclovir

    • Famcyclovir

    • Valcyclovir

    • Other medications that may be used to treat shingles include:

    • Antidepressant medications, which can help reduce pain

    • Corticosteroids, which may reduce the risk of developing postherpetic neuralgia, although this treatment is controversial

    • Pain medications

    What are the possible complications of shingles?

    Untreated shingles can lead to serious complications. People with compromised immune systems are at a higher risk for developing serious complications of shingles including:

    • Bacterial skin infections such as impetigo

    • Ear pain

    • Facial paralysis

    • Meningitis

    • Permanent eye damage and impaired vision

    • Postherpetic neuralgia, which is shingles pain that lingers for months or even years

    • Scarring and loss of hair over the affected area

    You can best treat shingles and lower your risk of complications by following the treatment plan that you and your health care professional design specifically for you.

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    Medical Reviewer: William C. Lloyd III, MD, FACS
    Last Review Date: 2019 Jan 4
    1. Protect yourself against shingles: Get vaccinated. Centers for Disease Control and Prevention. http://www.cdc.gov/features/shingles
    2. Shingles. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/shingles.html
    3. Shingles (Herpes Zoster). Centers for Disease Control and Prevention. http://www.cdc.gov/shingles/about/prevention-treatment.html
    4. Shingles VIS. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/hcp/vis/vis-statements/shingles.html
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