Shingles: Symptoms, Causes, Diagnosis, Treatment, Prevention and Complications

Shingles also called herpes zoster is a viral infection that causes a painful rash. Shingles is caused by reactivation of the varicella zoster virus, the same virus that causes chickenpox.

Updated: June 16, 2022

Shingles also called herpes zoster is a viral infection that causes a painful rash. Shingles is caused by reactivation of the varicella zoster virus, the same virus that causes chickenpox.
After you have had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. The virus may reactivate as shingles after few years.Older adults and individuals with a weakened immune system are at greatest risk for developing shingles. Early treatment can help shorten a shingles infection and lessen the chance of complications. Vaccine is available to help prevent shingles for certain individuals. Although most people who develop shingles will only have a single episode, some people may develop recurrent cases of shingles.

Signs and Symptoms of Shingles:

Usually, signs and symptoms of shingles affect only a small section of one side of your body. The shingles rash develops as a stripe of blisters that wraps around either the left or right side of your torso. Sometimes the shingles rash occurs around one eye or on one side of the neck or face.
It starts with burning, tingling, itching, or stinging in the region where the rash is developed. This usually appears in one or more distinct bands, called dermatomes which correspond to a single sensory nerve. This is the reason isolated skin lesions are caused by infection, rather than a body wide rash, and nerve pain.The common sign and symptoms include acute pain, tingling, numbness, and itching on a specific part of the skin, on a single side of the body.
A rash appears between 1 to 5 days after the pain begins. The rash looks like chickenpox but only on the band of skin supplied by the affected nerve which may involve the face, eyes, mouth, and ears in some cases. Red blotches emerge that develop into itchy fluid filled blisters. Sometimes, the blisters merge, forming a solid red band that looks like a severe burn. In people with weakened immune systems the rash may be more extensive and look similar to a chickenpox rash which is very rare.
If shingles affects the eye, this is called optical shingles. The virus invades an ophthalmic nerve and causes painful eye inflammation and temporary or permanent loss of vision. New blisters may appear for up to a week and soft tissue under and around the rash may be inflamed. People with lesions on the torso may feel spasms of pain at the gentlest touch.The blisters will gradually dry up and form scabs or crusts within 7 to 10 days. At this point, the rash is no longer considered infectious and may have minor scarring at the point of blisters. A shingles episode normally lasts 2 to 4 weeks. In some cases, there is a rash but no pain, or no visible rash but a band of pain.
Other symptoms include:

  • fever
  • headache
  • nausea
  • malaise
  • chills
  • muscle pain and weakness
  • upset stomach
  • difficulties with urination
  • fatigue
  • joint pain
  • swollen glands (lymph nodes)

Shingles can also lead to pneumonia, brain inflammation, or encephalitis, or death in people who have an impaired immune system. This occurs in very rare cases.
If the rash affects areas of the face, symptoms may include:

  • difficulty moving some facial muscles
  • drooping eyelids
  • vision problems
  • loss of eye motion
  • problems with taste
  • hearing loss

Contact your doctor as soon as possible if you experience any of the above sign and symptoms. If you suspect shingles, in the following situations contact your doctor immediately:

  • The pain and rash occur near an eye. This infection can lead to permanent eye damage if left untreated.
  • You are 60 or older, because age significantly increases your risk of complications.
  • You or someone in your family has a weakened immune system because of cancer, medications or chronic illness.
  • The rash is widespread and painful.

Is Shingles Contagious?

The varicella-zoster virus can be spread from a person with shingles at the active stage to someone who has never had chickenpox. The infected individual would get chickenpox, but not shingles in these case. However, Shingles can occur after you have had chickenpox in coming years.
Shingles does not spread through coughing or sneezing, but through direct contact with fluid from the blisters. So, the person is not contagious before the blisters develop and after the crusts form. Shingles is less contagious than chickenpox. The risk of spreading the virus is low if the rash is covered. Until your shingles blisters scab over, you should avoid physical contact with anyone who has not yet had chickenpox or the chickenpox vaccine, especially people with weakened immune systems such as older adults, pregnant women and newborns.

Causes of Shingles:

The varicella-zoster virus that is responsible for chickenpox is the causes of shingles. The virus remains in the body in dormant stage in the central nervous system (CNS) after a person recovers from chickenpox.
Shingles is also known as herpes zoster as varicella-zoster virus belongs to a group of viruses called herpes viruses. The herpes zoster virus can reactivate, or wake up from hibernation, and travel down nerve fibers to cause a new active infection in certain condition. But, not necessarily everyone who has had chickenpox will develop shingles. The reason for shingles is unclear. However, it may be due to lowered immunity to infections as you grow older or other medical condition.
Possible triggers include:

  • older age
  • cancer treatments, such as chemotherapy and radiation therapy, as these lower a person's resistance to disease
  • stress or trauma
  • medications, and especially immunosuppressive drugs, used by patients after an organ transplant
  • some diseases, including certain cancers and HIV or AIDS
  • certain autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, Crohn's disease, and ulcerative colitis
  • children who had chickenpox in infancy or whose mothers had chickenpox late in pregnancy

Diagnosis of Shingles:

Shingles is usually diagnosed based on the history of pain on one side of your body. The rash and blisters are also taken in to consideration. Based upon the distinctive appearance and distribution of the characteristic shingles rash it can be diagnosed.
Diagnosing can be difficult before the appearance of the rash or in cases of zoster without rash. In such cases, a tissue scraping or culture of the blisters can be taken by your doctor for examination in the laboratory. A blood test to detect antibodies to the varicella zoster virus can also be done.

Treatment of Shingles:

The goal of treatment for shingles is to diminish the effects of the virus, as well as pain management. Majority of cases of shingles can be managed at home. However, people with an impaired immune system or individuals with severe symptoms or complications may require hospitalization.
Prescription antiviral drugs can speed healing and reduce your risk of complications which include Acyclovir and Valacyclovir. Antiviral medications are most effective when started within 72 hours of the first appearance of the rash. But in select cases of shingles as in an immuno-compromised person, it can be started after 72 hours.
Pain medication can be used to help relieve the discomfort caused by the rash, which can sometimes be severe. Over the counter analgesics such as acetaminophen or the anti-inflammatory drug ibuprofen can be taken for mild shingles pain. Individuals with more severe pain may require stronger opioid pain medication. These include:

  • Capsaicin topical patch
  • Anticonvulsants, such as gabapentin
  • Tricyclic antidepressants, such as amitriptyline
  • Numbing agents, such as lidocaine, delivered via a cream, gel, spray or skin patch
  • Medications that contain narcotics, such as codeine
  • An injection including corticosteroids and local anesthetics

Over-the-counter antihistamine medication such as diphenhydramine may help reduce the localized itching. In complicated shingles, such as those with eye or ear involvement, corticosteroid medication, such as prednisone can be used. It should be used with concurrent antiviral therapy.
Shingles generally lasts between two and six weeks. Although most people who develop shingles will only have a single episode, some people may develop recurrent cases of shingles.

Prevention of Shingles:

Both the chickenpox (varicella) vaccine and the shingles (varicella-zoster) vaccine are avalable to prevent these disease.

Chickenpox vaccine:

The varicella vaccine (Varivax) has become a routine childhood immunization to prevent chickenpox. The vaccine has two dose, given once between the age of 12 and 15 months and again between 4 and 6 years. The vaccine is also recommended for adults who have never had chickenpox. Although after getting the vaccine it is not necessary that you won't get chickenpox or shingles, it can reduce your chances of complications and reduce the severity of the disease.

Shingles vaccine:

Shingles vaccine have two options including Zostavax and Shingrix. Zostavax is a live vaccine given as a single injection, usually in the upper arm which provides protection against shingles for about five years. It is recommended for people aged 60 years and above as this age group has the highest risk of getting shingles and of experiencing a complication. Zostavax is not recommended until age 60.
Shingrix is the preferred alternative to Zostavax which offers protection against shingles beyond five years. It is a nonliving vaccine made of a virus component, and is given in two doses, with two to six months between doses. Shingrix is approved and recommended for people age 50 and older, including those who have previously received Zostavax.
The most common side effects of both shingles vaccine are redness, pain, tenderness, swelling and itching at the injection site, and headaches. As with the chickenpox vaccine, the shingles vaccine doesn't guarantee you won't get shingles. But this vaccine will likely reduce the course and severity of the disease and reduce your risk of postherpetic neuralgia.These vaccines are not used to treat people who currently have the disease. It can be used as a prevention strategy only.

Complications of Shingles:

Complications from shingles can include:

Postherpetic neuralgia:

This is the most common complication of shingles. When shingles pain continues long after the blisters have cleared, the condition is known as postherpetic neuralgia. It occurs when damaged nerve fibers send confused and exaggerated messages of pain from your skin to your brain.The pain can sometimes be severe and difficult to control, and develop in to postherpetic neuralgia which increases with age. This chronic post-herpetic pain can sometimes lead to depression and disability.

Vision loss:

Shingles in or around an eye called as ophthalmic shingles can cause painful eye infections that may result in vision loss. Individuals with a rash involving the eye, forehead, or nose should have a careful eye evaluation. The evaluation should be performed by a doctor, as prompt medical treatment which is very essential.

Neurological problems:

Depending on which nerves are affected, shingles can cause an inflammation of the brain (encephalitis), facial paralysis, or hearing or balance problems. Symptoms may include ear pain, ringing in the ears, hearing loss, and dizziness. Encephalitis can be life-threatening if severe, especially in people with an impaired immune system.

Skin infections:

A secondary bacterial infection of the skin blisters can sometimes develop, leading to cellulitis or impetigo. Bacterial skin infections may develop if shingles blisters aren't properly treated. Increased redness, tenderness, and warmth in and around the area of the rash are some of the symptoms of bacterial infection which can be treated with antibiotics.

Disseminated herpes zoster:

This is a serious and potentially life-threatening condition occurs most commonly in people with an impaired immune system. With disseminated herpes zoster, the varicella zoster virus becomes more widespread causing a more widespread rash. The virus can also spread to other organs of the body, including the brain, lung, and liver.
Shingles typically resolves within two to four weeks in most individuals. However, in older individuals and in those with compromised immune systems, complications are more likely.

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