Shingles (Herpes Zoster)
Shingles is an infection caused by the virus varicella-zoster, which is the same virus that causes chickenpox. Even after chickenpox is treated, the virus may live on in your nerve tissues for years before reactivating as shingles. Shingles may also be referred to as herpes zoster.
This type of viral infection is characterized by a red skin rash that usually causes pain and burning. Shingles usually appears as a stripe of blisters on one side of the body, typically on the torso, neck, or face.
According to the Centers for Disease Control (CDC), each year there are an estimated one million cases of herpes zoster in the United States (CDC, 2011).
Most cases of shingles clear up within two to three weeks. Shingles rarely recurs more than once in the same individual.
Shingles can occur in anyone who has had chickenpox. However, certain factors put individuals at risk for developing shingles.
Risk factors include:
- being 60 or older
- having had chickenpox before the age of 1
- having diseases that weaken the immune system, such as HIV/AIDS or cancer
- having had chemotherapy or radiation treatment
- taking drugs that weaken the immune system, such as steroids or medications given after an organ transplant
The first symptoms of shingles are usually pain and burning. The pain is usually on one side of the body and occurs in small patches. A red rash typically follows.
Rash characteristics include:
- red patches
- fluid-filled blisters that break easily
- a rash that wraps around from the spine to the torso
- a rash on the face and ears
Some individuals experience symptoms beyond pain and a rash with shingles. These symptoms may include:
- fatigue or muscle weakness
Most cases of shingles can be diagnosed with a physical examination of rashes and blisters. Your doctor may also ask questions about your medical history.
Rarely, your doctor may need to test a sample of your skin or the fluid from your blisters. This involves using a sterile swab to collect a sample of tissue or fluid. Samples are then sent to a medical laboratory to confirm presence of the virus.
There is no cure for shingles, but medication may be prescribed to ease symptoms and shorten the length of the infection.
Medications prescribed for shingles may include:
- antiviral medications, including acyclovir, valcyclovir, and famciclovir (to reduce pain and speed recovery)
- anti-inflammation drugs (to ease pain and swelling)
- narcotic medications or analgesics (to reduce pain)
- anticonvulsants or tricyclic antidepressants (to treat prolonged pain)
- antihistamines, such as Benadryl (to treat itching)
- numbing creams, gels, or patches, such as lidocaine (to reduce pain)
- zostrix cream, which can help reduce the risk of postherpetic neuralgia (nerve pain experienced after recovery from shingles)
Home treatment can also help ease symptoms. Home treatments may include:
- applying cold wet compresses to the rash to reduce pain
- applying calamine lotion to reduce itching
- taking colloidal oatmeal baths to ease pain and itching
Shingles typically clears up within a few weeks and rarely recurs.
Vaccines can help keep you from developing severe shingles symptoms or complications from shingles. All children should receive a chickenpox vaccine, also known as a varicella immunization. Adults who have never had chicken pox should also get this vaccine. The immunization does not necessarily mean that you won’t get chickenpox, but it can help reduce the severity of your symptoms.
Adults who are age 60 or older should get a shingles vaccine, also known as the varicella-zoster immunization. This vaccine helps to prevent severe symptoms and complications associated with shingles.
Shingles is contagious. If you become infected, certain steps must be taken to prevent spread of the infection.
Preventing the spread of shingles includes:
- keeping your skin clean
- avoiding contact with individuals who have not had chickenpox or who have weakened immune systems
- washing any items you touch with boiling water to kill the virus
Although rare, complications from varicella zoster infection may arise. Complications may include:
- postherpetic neuralgia (long-term pain as a result of nerve damage)
- bacterial skin infection
- vision loss (if shingles infection occurs near or in the eye)
- Ramsay Hunt syndrome, which occurs when shingles affects a facial nerve, causing facial paralysis and hearing loss
Written by: Janelle Martel
Medically reviewed by George Krucik, MD