Shingles is a skin condition that begins with pain for several days to a week, followed by a red rash and blisters, usually in a strip from the back to the front of the body. It is caused by the virus varicella-zoster, the same virus that causes chickenpox. The virus lies dormant in the body of those who have had chickenpox and can develop into a case of shingles at any time, but usually in older adults. Since most adults had chickenpox before the vaccine was invented, those same adults are now at risk for a case of shingles.

What Causes the Shingles?

Shingles is caused by the varicella-zoster virus, sometimes known as herpes zoster. The virus is in the same family as the herpes virus that causes cold sores and genital herpes, though it is not the same virus and will not cause these conditions.

After a person has chickenpox, the virus remains in the nervous system, inactive. At some point, the virus may become active again, following nerve pathways until it reaches the skin where it causes pain, sometimes severe. A few days later, a red rash may appear along with fluid-filled blisters and itching. Some only have pain without developing the rash or blisters. Other symptoms may include fever, chills, muscle aches. fatigue, and headache.

The pain and blisters can appear anywhere on the body but generally appear on one side of the torso, wrapping from the spine around to the breastbone.

Who Gets Shingles?

Anyone who has had chickenpox, as a child or adult, can develop shingles. The disease typically occurs in adults older than 50 but can occur at any age. The risk of developing shingles also increases in those with a weakened immune system which may be caused by cancer or cancer treatments, prolonged use of steroids like prednisone, HIV/AIDS, or immune-suppressing drugs prescribed after an organ transplant.

How Are Shingles Diagnosed?

The shingles diagnosis is made based on the history of pain on one side of the body that lasts for a few days, followed by the rash. Because the virus follows nerve pathways as they fan out from the spinal column to the skin, the rash occurs in a specific pattern called a dermatome. This pattern helps make the diagnosis. A culture from the blister and fluid may also be sent to the laboratory for analysis.

Some patients develop pain without the blisters or rash. These cases are more difficult to diagnose.

Can I Pass Shingles To Others?

A person with shingles can spread chickenpox, but not shingles, to anyone who has never had the disease or the vaccine. Like chickenpox, the disease is passed through contact with the open blisters. A person with developing or open blisters should avoid contact with others until all blisters dry and scab over.

How Are Shingles Treated?

Antiviral medications are available that may decrease the severity of the symptoms, especially if started within 72 hours of the appearance of the rash. The antiviral drugs that a doctor may prescribe are: acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir).

The pain of shingles can be severe and may require prescription pain medication and narcotics, such as oxycodone. Topical numbing medicines such as lidocaine may be helpful. Other methods of controlling pain are cold compresses to the rash and anti-itching lotions available over-the-counter such as calamine lotion. Methods of relaxation, stress-relief, or a diversional activity such as reading a book or listening to music may also provide relief. There are also natural treatments for shingles that some people have tried with success also, however they are not guaranteed to work.

The open blisters should be kept clean to prevent bacterial infections and cellulitis. Bathing the area with soap and water is permitted.

Can Shingles Cause Other Complications?

The blisters typically occur on the trunk of the body, but can, though rarely, affect the face, head, or neck. Shingles in these areas may lead to loss of vision, facial nerve weakness or loss of hearing. Shingles on the face should be evaluated by a health care provider.

Post-herpetic neuralgia is a complication that occurs in approximately 10-15% of those with shingles. Severe and sometimes debilitating pain continues well after the rash is gone because the nerve fibers damaged by the virus continue to send messages of pain to the brain. There is some evidence that treatment with antiviral medications decreases the severity and occurrence of post-hepatic neuralgia. Treatment may include pain medication, antidepressants, or anticonvulsant medications, taken until the pain subsides.

Can Shingles Be Prevented?

There are two vaccines that can prevent shingles. The varicella vaccine (Varivax) is given to children and adults who have never had chickenpox. The varicella-zoster vaccine (Zostavax) is the primary shingles vaccine given to older adults who have had chickenpox to prevent shingles. It may also be given after a case of shingles to prevent further outbreaks.