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Education Library: Shingles

Introduction

Shingles are a painful rash that develops in nearly 1 in 3 Americans. The risk of developing shingles increases with age. More than half of all shingles cases occur in people over the age of 60, although children can develop shingles as well. Shingles develop in people who have had the viral infection chicken pox as a child or the chicken pox vaccine.

The shingles rash first appears as a painful or tingling area on one side of the body and progresses to a rash of small red blisters. Anti-viral drugs that are started at the first sign of shingles, and prescription pain medications may help ease symptoms. Fortunately, in 2011, the FDA approved the shingles vaccine for people ages 50 and older. This is a change from the FDA approval in 2006 for people ages 60 and older.

Anatomy

The medical term for the shingles virus is herpes zoster. The varicella zoster virus that causes chickenpox is the same virus that causes shingles. After a person experiences the chicken pox, the varicella zoster virus remains in the body in an inactive state near nerve tissue. At a later time, for unknown reasons, the virus reactivates and causes shingles.

The varicella zoster virus, the virus that causes shingles is not the same virus that causes cold sores or genital herpes (herpes zoster), a sexually transmitted disease.

Causes

Shingles is caused by the varicella zoster virus. This is the same virus that causes chickenpox. After a person experiences the chicken pox, the varicella zoster virus remains in the body in an inactive state. For reasons that are not known at this time, the varicella zoster virus can reactivate years later to cause shingles.

Shingles cannot be transmitted from person to person; however, the varicella zoster virus can spread from direct contact with blister fluid from a person with shingles to a person who has not had chickenpox. In such cases, the exposed person could develop the chickenpox. A person with shingles is contagious when the rash blisters. A person with shingles is not contagious before the rash appears or after the rash has developed crusts or scabs.

Symptoms

A tingling, painful, itching area usually precedes a red painful rash of blisters by about 1 to 5 days. The rash lasts for about 7 to 10 days before scabbing over. The rash usually clears within 2 to 4 weeks.

Shingles typically appear on only one side of the face or body. The most common location for shingles is in a stripe along one side of the body. Other locations tend to include the side of the face and the top of the shoulder and neck. Shingles can cause fever, headache, chills, tiredness, and upset stomach.

In rare cases, for people with compromised immune systems, shingles can develop as a widespread rash or affect the eye causing vision loss. Another complication of shingles is postherpatic neuralgia, a condition that can be extremely painful.

Diagnosis

You should contact your doctor immediately if you suspect that you have shingles. A doctor can diagnose shingles by looking at your skin, examining cell samples, or with lab tests.

Treatment

Several anti-viral medications can help shorten the severity and length of shingles; however, they must be initiated at the first sign of a rash. You should call your doctor immediately if you suspect that you might have shingles. Your doctor may recommend pain medication, lotions, and certain baths to help relieve pain and itching.

If you have shingles:

  • Keep the rash covered
  • Avoid scratching or touching the rash
  • Frequently wash your hands to help prevent spreading the varicella zoster virus.
  • Avoid contact with people who have not had the chicken pox, especially pregnant women who have not had the chicken pox or the chicken pox vaccine, premature or low birthweight infants, and people with compromised immune systems, such as those with certain cancers, receiving cancer treatments, organ transplant recipients, and people with HIV.

Prevention

The CDC states that more than 99% of adults age 40 and over had had the chickenpox, even if they don't remember having the chicken pox. In 2011, the FDA approved the shingles vaccine, varicella zoster vaccine Zostavax, for people ages 50 and older for the prevention of shingles. Studies have shown that the risk of developing shingles can be reduced by about 70% and the risk of developing post-herpatic neuralgia can be lowered by about 67% for people who receive the Zostavax vaccine. In addition, people that have had shingles can still receive the vaccine to help prevent future episodes of shingles.

Am I at Risk?

You may be at risk for shingles if:

  • You have had the chickenpox. The CDC estimates that more than 99% of adults have had the chickenpox, even if they do not remember it.
  • You are over the age of 50. More than half of adults over the age of 60 develop shingles.
  • You have a compromised immune system from certain cancers, such as leukemia and lymphoma.
  • You have HIV.
  • You are receiving cancer treatments, such as radiation or chemotherapy.
  • You take immunosuppresive medications, such as steroids or prednisone.
  • You take immunosuppresive medications after an organ transplant.

Complications

  • Postherpatic Neuralgia
    About 20% of people with shingles, develop severe pain after the shingles rash resolves. This painful condition, Post-herpatic neuralgia, results from damaged nerves that send over-exaggerated pain signals to the brain. Pain management, including pain medication, anti-depressant medication, anti-convulsant medication and more sophisticated methods of pain management can help relieve pain associated with postherpatic neuralgia.
  • Vision Loss
    Shingles can spread to the eyes and cause vision loss or blindness.
  • Neurological Problems
    Shingles can cause brain inflammation (encephalitis), hearing or balance problems, and facial paralysis.
  • Bacterial Skin Infections
    Shingles that are not cared for properly can develop bacterial skin infections.

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