Dr. Tariq Jagnarine
Family medicine, Endocrinology/Diabetes
Shingles is a viral infection that results from the varicella-zoster virus (VZV), the same virus that causes chickenpox. It typically affects a single sensory nerve ganglion and the skin surface that the nerve supplies.
In fact, according to the Centers for Disease Control and Prevention (CDC), an estimated 1 in 3 people develop shingles during their lifetime. People can develop shingles if they had chickenpox in the past. This virus can lie dormant for years, and then reactivate as shingles. A person who has not had chickenpox before can get chickenpox through exposure to someone with shingles.
Shingles is most common after the age of 50, but it can appear at any age if a person has previously had chickenpox.
SYMPTOMS
Shingles usually affects one side of the body – most often the waist, chest, abdomen, or back. Symptoms can also appear on the face and in the eyes, mouth, and ears. The virus can also affect some internal organs. Shingles typically affects a single sensory nerve ganglion near the spinal cord, called a dorsal root ganglion. This is why the symptoms occur in specific areas of the body, rather than all over it. The pain results from nerve involvement, rather than the rash itself.
Symptoms can vary in nature, depending on where on the body they appear. Some people have pain but no rash. Others may have a rash with pain that is accompanied by other symptoms, such as fever, chills, or headache. Some of the most common symptoms of shingles include:
* Constant dull, burning, or gnawing pain, or a sharp, stabbing pain that comes and goes.
* Skin rash that resembles a chickenpox rash but only affects certain areas.
* Fluid-filled blisters that develop as part of the rash.
Other symptoms
There may also be other symptoms, including fever, fatigue, chills, headache, upset stomach.
Symptom progression
Symptoms typically progress as follows:
* Pain, tingling, numbness, and itching start to affect a specific part of the skin.
* After up to 2 weeks, a rash appears.
* Red blotches and itchy, fluid-filled blisters develop
* The blisters may merge, forming a solid red band that looks similar to a severe burn. The gentlest touch may be painful.
* Inflammation may affect the soft tissue under and around the rash.
* After 7–10 days, the blisters gradually dry up and form scabs or crusts. As the blisters disappear, they may leave minor scarring.
Shingles usually last around 2–4 weeks. It is contagious until the blisters dry up and crust over. Most people will only have an episode of shingles once, but it can recur in some people.
TREATMENT
A doctor may prescribe antiviral drugs to stop the virus from multiplying. Antiviral treatment can help with:
* Reducing the severity and duration of symptoms
* Preventing complications from developing
* Lowering the risk of the rash coming back
In addition to antiviral drugs, there are several other ways to help manage symptoms, including:
* Using pain relief medication
* Reducing stress as much as possible
* Eating regular, nutritious meals
* Getting some gentle exercise
* Wearing loose-fitting clothes for comfort
* Relaxing activities that will reduce stress and take a person’s mind off the pain, such as watching television, reading books, socialising, listening to music, or engaging in hobbies.
* Applying calamine lotion for itching
* Take a lukewarm oatmeal bath.
* Placing a cool, damp washcloth on the blisters
Most people will recover with home treatment, but a person should seek medical help if other symptoms appear, such as a fever. Around 1–4% of people will need to spend time in the hospital due to complications.
CONTAGIOUSNESS
It is not possible to directly transmit shingles to another person. However, a person who has never had chickenpox can contract the virus by coming into direct contact with the fluid in the blisters of a person who currently has shingles. If this happens, and the person has not received a vaccination against chickenpox, they will develop chickenpox first, not shingles.
Taking the following precautions can help prevent the transmission of the virus:
* Covering the rash
* Washing the hands often
* Avoiding touching or scratching the rash
DIAGNOSIS
Doctors usually diagnose shingles through a physical exam by evaluating the appearance of the rash and blisters on the body. In some cases, they may collect a tissue sample from the fluid of the blisters and send it to a lab to check if the virus is present.
They may also conduct a blood test to look for antibodies, which can determine whether a person has ever been exposed to the virus.
VACCINE
Vaccination can offer protection from both chickenpox and shingles.
For children: Chickenpox vaccine
Experts recommend routine immunisation with the varicella vaccine (chickenpox vaccine) during childhood. With two doses of the vaccine, there is at least a 90% chance of preventing chickenpox. Preventing chickenpox will also prevent shingles. Children should receive the first dose at 12-15 months. The second dose is 4-6 years.
For older adults: Shingles vaccine
A different vaccine, the herpes zoster vaccine, is available for people aged 50 and older who have had chickenpox and therefore carry VZV. Experts also recommend this vaccine for those who have not had chickenpox or shingles. The options available are Zostavax and a newer vaccine called Shingrix. After two doses of Shingrix, a person will have more than 90% protection against shingles, falling to just above 85% after 4 years, according to the CDC.
POSSIBLE RISK FACTORS AND TRIGGERS INCLUDE:
* Older age
* Certain cancers or cancer treatment options
* HIV
* Treatments that suppress the immune system
* Stress or trauma
COMPLICATIONS
Rarely, complications can arise — especially in people with an impaired immune system. Possible complications of shingles include:
* Postherpetic neuralgia (PHN)
* Inflammation of the brain or spinal cord, increasing the risk of stroke, encephalitis, and meningitis
* Eye and vision problems
* Weakness
* Problems with balance and hearing
* Damage to blood vessels, which could lead to stroke.
* Pneumonia
According to the CDC, around 10-18% of people who have shingles will develop PHN, a long-term complication in which the pain of a shingles rash lasts long beyond the rash itself. It is more likely to occur if a person develops shingles after the age of 40, and the risk continues to increase with age.
