Shingles (Herpes Zoster)

Shingles (formally known as Herpes Zoster) is a viral infection caused by the same virus that causes chickenpox. Anyone who has had chickenpox can develop shingles. After a person recovers from chickenpox, the virus remains dormant (inactive), in certain nerve cells of the body, and when it reactivates it causes shingles. About 20% of those people who have had chickenpox will get shingles.

It is not clear what makes the virus reactivate or “awaken”.  A temporary weakness in immunity (the body’s ability to fight infection) may cause the virus to multiply and move along the nerve fibers towards the skin. Although children can get zoster, it is more common in people over the age of 50. Illness, trauma, and stress may also trigger shingles. People with a weakened immunity for any reason like cancers, leukemia or lymphoma, and aids are prone to developing zoster. Medical treatments like chemotherapy or radiation for cancer, drugs taken to prevent rejection of transplanted organs, and prednisone taken for a long time can make someone susceptible to shingles.

First, there may be burning, itching, tingling, or extreme sensitivity in one area of the skin usually limited to one side of the body.  This may be present for one to three days before a red rash appears at that site.  There may also be fever or headache. The rash soon turns into groups of blisters that generally last for 2 to 3 weeks. The blisters start out clear but then like yellow or bloody before they crossed over and disappear. It is unusual to have pain without blisters, or blisters without pain.

Shingles is most common on the trunk and buttocks, but it can also appear on the face, arms, or legs if nerves in those areas are involved. An emergency appointment with an eye doctor is needed if the blisters involve the eye because permanent eye damage can result. Having blisters on the tip of your nose is a signal possible eye involvement.

One of the most common complications of shingles is a condition called post-herpetic neuralgia.  Post-herpetic neuralgia is pain, numbness, itching, and tingling which lasts months to years after the skin lesions of shingles clear. This is more common in older people. The use of oral antiviral medication in the early stages of zoster may help prevent this complication.

A bacterial infection of the blisters can occur and can delay healing. If pain and redness increase or reappear you should return to your dermatologist for a follow-up for an antibiotic.   An infection in association with shingles lesions can lead to scarring if not properly treated in a timely manner.

If shingles affects the eye and is not treated early, it can lead to complications such as glaucoma, scarring, or blindness.

Most shingles cases are diagnosed from clinical examination alone.  The diagnosis is based on the way the blisters look at history of pain before the rash on one side of the body appears. Your dermatologist may scrape the skin cells from a blister onto a glass slide for examination under microscope. Although not routinely performed, the blister fluid containing the virus can be sent to the laboratory for special testing.

A person with shingles can transmit the virus if blisters are broken open. Newborns, children under the age of one or and person not immune to chickenpox are at high-risk for contracting chickenpox from someone who has shingles.

Shingles usually clears on its own in a few weeks and very rarely recurs.  Pain relievers and cold compresses are helpful in drying out the blisters and relieving pain or tenderness. If diagnosed early (within 72 hours), oral antiviral drugs (acyclovir or valacyclovir) can be prescribed to decrease both viral shedding in the duration of skin lesions. These are routinely prescribed for severe cases of zoster, cases with involvement, and for those with decreased immunity.  Topical corticosteroids (hydrocortisone or triamcinolone ointments) are also helpful for helping symptoms improve faster.