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Shingles

Definition

Shingles is a painful infection of the nerves and skin.

Causes

Shingles is caused by the varicella zoster virus. This is the same virus that causes chickenpox. Shingles occurs in people who have had chickenpox. After causing the first chickenpox infection, the virus is not totally eliminated from the body. Some of the remaining virus settles in nerve roots near the spinal cord. When reactivated, the virus travels along nerve paths to the skin where it causes pain and a rash.

Shingles Blisters
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Risk Factors

Shingles is more common in women, and in people aged 50 years and older. Other factors that may increase your chance of shingles include:

Shingles can occur in those with no known risk factors.

Shingles is not usually transmitted from one person to another. But, a person who has never had chickenpox and never received the varicella vaccine is likely to get chickenpox if contact occurs with a person who has shingles. Covering shingles sores with a bandage reduces the risk of transmitting shingles to others.

Symptoms

Shingles may cause:

  • Rash:
    • Red and has a slightly raised band or patch often with multiple small fluid-filled blisters that dry out and crust within several days
    • Develops on one side of the body, but typically does not cross the midline
    • Affects mostly the torso and face
  • Affected eyes in severe cases, which can threaten vision
  • Sensitivity and pain on the skin at the site of the rash; pain may be severe
  • Tingling or itchiness on the skin, which may start a few days before the rash
  • Fever
  • Headache
  • Tiredness

The rash usually disappears within three weeks. In some cases, though, post-herpetic neuralgia (PHN) develops. With PHN, the pain continues for months or even years after the rash has healed. PHN can be severe and difficult to treat.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor can diagnose the rash by its appearance. Fluids may be drawn from the blisters for testing, but this is not done very often.

Treatment

Shingles cannot be cured. Treatment focuses on:

  • Easing symptoms
  • Speeding recovery
  • Preventing PHN

Home Remedies and Over-the-Counter Products

The following will help relieve pain and ease symptoms:

  • Calamine lotion
  • Wet compresses
  • Frequent oatmeal baths
  • Over-the-counter pain relievers
  • Topical pain relievers that are applied to the skin

Antiviral Medication

Antiviral medications may control shingles. Antiviral therapy may shorten a shingles episode, but you must start it within 48-72 hours after symptoms first develop. They are generally used in people with suppressed immune systems.

Treatment for Post-herpetic Neuralgia

If you develop PHN, your doctor may recommend:

  • Antidepressants
  • Antiseizure medications
  • Prescription pain relievers
  • Topical pain relievers
  • Lidoderm patch
  • Nerve blocks
  • Transcutaneous electrical nerve stimulation (TENS)—a device that generates low-level pulses of electrical current on the skin's surface

Treatment for Shingles of the Eye

If you develop shingles on your face, contact your doctor right away. You may be prescribed medications, such as steroids to treat this condition. Without treatment, permanent eye damage can result, including glaucoma, scarring, and blindness.

Prevention

The herpes zoster vaccine is recommended for people aged 60 years and older. The vaccine decreases the likelihood of getting shingles and reduces the severity of PHN if shingles does occur.

If you do have shingles, take these steps to prevent giving chickenpox to others:

  • Keep all blisters covered with a bandage until they are dry and crusted over.
  • If you are a healthcare worker, do not return to work until the blisters are dry and crusted over.
  • Avoid contact with people who are at risk of getting severe varicella, such as:
    • Pregnant women
    • Premature infants
    • People who have a compromised immune system

Revision Information

  • National Institute of Neurological Disorders and Stroke

    http://www.ninds.nih.gov

  • VZV Research Foundation

    http://www.vzvfoundation.org

  • Public Health Agency of Canada

    http://www.phac-aspc.gc.ca

  • The College of Family Physicians of Canada

    http://www.cfpc.ca

  • Ocular shingles. Wills Eye Institute website. Available at: http://www.willseye.org/health-library/ocular-shingles. Updated October 5, 2011. Accessed August 28, 2014.

  • Shingles. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/shingles.html. Updated April 2014. Accessed August 28, 2014.

  • Shingles: diagnosis, treatment, and outcome. American Academy of Dermatology website. Available at: http://www.aad.org/dermatology-a-to-z/diseases-and-treatments/q---t/shingles/diagnosis-treatment. Accessed August 28, 2014.

  • Shingles (herpes zoster). Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/shingles/about/overview.htm . Updated May 1, 2014. Accessed August 28, 2014.

  • 1/14/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Tseng HF, Smith N, Harpaz R, Bialek SR, Sy LS, Jacobsen SJ. Herpes zoster vaccine in older adults and the risk of subsequent herpes zoster disease. JAMA. 2011;305(2):160-166.

  • 6/9/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Forbes H, Bhaskaran K, et al. Quantification of risk factors for herpes zoster: population based case-control study. BMJ 2014;348.

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