Shingles Herpes Zoster

Shingles virus (herpes zoster) presents as a red rash that often wraps around the torso, but may appear anywhere on the body, accompanied frequently by a headache with fever and fatigue.

There are two preventive shingles vaccines that have been approved in the United States:

  • Zostavax (zoster vaccine live) is a subcutaneous injection that can prevent shingles in adults 60 years or older.
  • Shingrix (herpes zoster subunit vaccine) is a preventative vaccine used on adults 50 years or older. This vaccine is given in two doses, with the second dose administered between 2 and 6 months after the first, and is the preferred treatment option due to its high probability of success (>90% effectiveness).

Shingles is a product of the virus that causes chickenpox, the varicella-zoster virus. Regardless of when the disease was contracted, anyone who has had chickenpox is at risk for shingles later down the line.

Those with impaired immune systems, such as the elderly, and while it can be painful, there are early treatment options to lessen symptom development like antivirals such as Valtrex.

Shingles (herpes zoster)

What is shingles?

Shingles is a type of rash that results from a viral infection; the same virus that causes chickenpox, the varicella (chickenpox) zoster (shingles) virus. This type of rash can be very painful, and symptoms can last for months after being cured.

What causes shingles?

Once you have contracted the chickenpox virus, the virus can stay dormant in the nerves nearest the spinal cord or nearest the head and neck. The virus may not ever become active again, but if it does, it will multiply and spread through the nerves until it reaches the skin. Once the virus reaches the skin the shingles rash will appear.

The only way to get shingles is is you have been infected with chickenpox, but only about 20% of people infected will ever get shingles in their lifetime.

There is no real reason why the virus could become active again, but there are factors that can increase the likelihood of its occurrence:

  • The elderly are more at risk for shingles.
  • Physical and emotional stress can provoke a reaction.
  • A weakened immune system due to an illness such as HIV infection, leukaemia, or lymphoma.
  • Any kind of treatments that suppress the immune system, such as radiotherapy for cancer, chemotherapy, steroids, and any medications used to prevent organ rejection.

Is shingles contagious?

Shingles cannot be transmitted from someone who has shingles, but rather, can only occur when a person who has already been infected with the herpes zoster virus experiences a change in their immune systems ability to fight off the virus. However, a person with an active shingles infection can transmit chickenpox to someone that has not had the virus yet; the virus can be transferred until the blisters crust over, which takes about a week.

Is shingles hereditary?


What are the symptoms of shingles?

Shingles is infamous for the pain it causes, which is the first symptom to typically appear. However, not always will pain be present, especially in the young, but rather a mild itching or burning sensation can develop in the affected area.

When pain is present, it usually tends to stay localized, and can be mild to severe. The pain may include a tingling, aching or burning sensation, with a rash developing a few days following the onset of pain. A fever and/or headache may follow.

What does shingles look like?

The first thing you should notice is a patch of red spots that develop on the skin, causing the skin around them to turn pink/red. After a while these will blister, and can fill with blood or pus. Following this, the blisters will scab, and fall off over a period of 2-3 weeks.

The rash typically presents on a single area of skin on one side of the body only, never crossing over to the other side. The shape of the rash is wholly dependent on the the nerve endings affected. While shingles can affect any area, the virus typically presents as a band running around half of the chest, or along the arm/leg. Dark scabs may present following the infection, especially if the attack is severe. It is not common for shingles to affect the area around the face, but in some cases it can present near the eye and cause further complications.

As the shingles virus appears, there may be additional rashes resembling chicken pox that present. This often means that there could be a serious, widespread shingles reaction or that an underlying condition may be at fault.

How is shingles diagnosed?

Early recognition of the virus is often difficult, but as symptoms progress the diagnosis is fairly simple. The presence of pain before the rash, as well as the presentation of the rash are telltale signs that a person may be infected with shingles.

If there is doubt about the diagnosis, scrapings may be taken from a blister, by your doctor or dermatologist, and examined under a microscope or a viral swab test will be taken. If your doctor needs to confirm the presence of the disease, a piece may be removed from a blister to be examined under a microscope. I viral swab test can also be performed to determine the source of the scabs.

Can shingles be cured?

After a while, shingles will go away on its own, but oral antiviral treatments may be prescribed to help clear rashes sooner and mitigate some of the symptoms.

These medications can help when certain parts of the body are affected:

  • If shingles takes on or around the area affecting the eye, it is possible that the infection can lead to inflammation and ulceration of the structures supporting the eye, leading to potential scarring, glaucoma and/or blindness. If you are experiencing symptoms in these areas, contact your doctor immediately and they may refer you to an ophthalmologist (eye doctor) for further treatments.
  • When the muscles supplied by the affected nerves begin to experience symptoms, they may begin to weaken, and this may be especially noticeable in the muscles of the face, which may undergo temporary paralysis.

The pain associated with shingles may persist for a while after the infection has cleared (this pain is known as postherpetic neuralgia). This usually occurs in the elderly, and can last for a range of 6 months to a year or more.

How can shingles be treated?

  • Antiviral drugs can shorten the attack, such as acyclovir tablets/cream, but are only effective in the first few days of symptoms. As such, it is important to see your doctor for an early diagnosis once symptoms appear.
  • Pain-killers and rest can help mitigate the pain, as well as anti-inflammatories and a cool-compress.
  • A bacterial infection may occur as a complication to the infection, and will likely require antibiotic intervention. If there are any issues involving the eyes a specialist may have to get involved, and eye drops may need to be prescribed.
  • While antiviral drugs can help prevent an attack, they are also equally useful at preventing postherpetic neuralgia, and also shortening the duration of the attack.
  • If you do experience postherpetic neuralgia, applying an over the counter anaesthetic ointment such as lidocaine followed by a doctor prescribed topical analgesic cream (capsaicin) can help mitigate the pain. Antidepressants, anticonvulsants, and pain-killers can also be prescribed by your physician on a case by case basis.
  • Live varicella-zoster vaccines are accessible for those at high risk for chickenpox, but are not recommended for regular innoculation for children. While highly uncommon, those that have received the vaccine can transmit chickenpox to those in close contact with them.

Self help (What can I do?)

  • High risk individuals include newborns, the elderly, those who have a weak immune system and those that have not yet contracted chicken pox should avoid contact with those that have shingles until the blisters crust over.
  • If you suspect that you have shingles, it is important to get early intervention as fast as possible, so please speak to your doctor as soon as possible. Antiviral treatments in the early stages have the greatest chance of effectiveness.
  • Time off from work may be required while you heal, as you do not want to risk getting your co-workers infected. You should be fine to return once the blisters crust over.
  • You should rest while not working, especially if a fever develops.