Shingles: symptoms, cause and Treatment
Shingles is a
skin rash caused by the same virus that causes chickenpox. The
virus responsible for these conditions is called Varicella zoster. After an
individual has chickenpox, this virus lives in the nerves and is never fully
cleared from the body. Under certain circumstances, such as emotional
immune deficiency (from AIDS or chemotherapy) or with
cancer, the virus
re-activates causing shingles.
Shingles is a second eruption of the varicella-zoster virus ó the same virus
that causes chickenpox.
Varicella-zoster is part of a group of viruses called herpes viruses, which
includes the viruses that cause cold sores and genital herpes. Many of these
viruses can lie hidden in your nervous system after an initial infection and
remain inactive for years before causing another infection.
Anyone who's had chickenpox may develop shingles. If your immune system
doesn't destroy the entire virus during the initial infection, the remaining
virus can enter your nervous system and lie hidden for years. Eventually, it may
reactivate and travel along nerve pathways to your skin ó producing the
shingles. However, it's most common in older adults: More than half the shingles
cases occur in adults over 60.
A person with shingles can pass the varicella-zoster virus to anyone who
hasn't had chickenpox before. This usually occurs through direct contact with
the open sores of the shingles rash. Once infected, the person will develop
chickenpox, however, not shingles. The infection can be serious for certain
groups of people with immune system deficiencies. The varicella-zoster virus
cannot be spread to another person with a normal immune system who has already
The first symptom of shingles is often extreme sensitivity or pain in a
broad band on
one side of the body. The sensation can be itching, tingling,
burning, constant aching, or deep, shooting, or "lightning bolt" pain.
Typically, 1-3 days after the pain starts, a rash with raised, red bumps
and blisters erupts on the skin in the same distribution as the pain. They
become pus-filled, then form scabs by 10-12 days.
Fever and chills
Upset stomach or abdominal pain
The rash disappears as the scabs fall off in the next 2-3 weeks, and
scarring may result.
For some, pain can be intense, with just the slightest touch causing severe
pain. Sometimes the pain can be mistaken for other problems or diseases, such as
kidney stones, gallstones or appendicitis, depending on its location. Some
people experience the pain without the rash, which makes diagnosing shingles
Although the shingles rash may resemble chickenpox, the virus typically causes
more pain and less itching the second time around.
Before the shingles rash appears, diagnosis of this condition may be
difficult. Symptoms of shingles can mimic other conditions. The initial symptoms
may include itching, numbness, tingling, or pain on one side of the body or
face. During this stage, the pain may be so severe that it may be mistaken for
kidney stones, pleurisy, gallstones, appendicitis, or even a
heart attack depending on where the affected nerve is located on the body.
Your doctor can distinguish shingles from chicken pox, poison ivy, or other
types of rash by the way the lesions are distributed on the body. The blisters
of the shingles rash generally appear in the pattern of a band (dermatome) on
one side of the body.
In addition to looking at how the rash appears on your body, your doctor may
also take a scraping or swab of the blisters to send to a laboratory for
analysis, beyond which, no further test will be required.
The goals of treatment for shingles are to:
Shorten the duration of the eruptive stage or rash
Speed up healing of the lesions
Relieve patient discomfort
Shorten the duration of postherpetic neuralgia (PHN) or pain associated
with shingles even after the rash is healed.
There is no cure for shingles, but treatment may shorten the length of
illness and prevent complications. Treatment options include:
Antiviral medicines, sometimes in combination with corticosteroids, to
reduce the pain and duration of shingles.
Pain medicines, antidepressants, and topical creams to relieve long-term
Topical creams containing capsaicin may provide some relief from pain.
Capsaicin may irritate or burn the skin of some people, and it should be used
A new skin patch containing a 5% lidocaine solution is the only prescription
medication approved by the Food and Drug Administration specifically for the
treatment of the pain associated with PHN. However, patients with severe PHN may
be ordered a nerve block through transcutaneous electrical nerve stimulation
(TENS), which involves sending electrical impulses to the affected nerves to
block the pain sensation.
Things you can do to promote healing of the shingles rash
and reduce the pain:
Apply cool compresses over the zoster lesions or take a cool bath
twice a day
Avoid exposure to warm and hot water because this could lead to
Cover shingles lesions with a clean cloth or loose-fitting gauze after
Trim fingernails to reduce the chance of bacterial infection from
Avoid wearing tight clothing over the rash because this could irritate
The U.S. Food and Drug Administration (FDA) has approved a vaccine that may
help prevent shingles or make it less painful if you do get it. The shingles
vaccine is known as Zostavax. One dose is recommended for adults 60 years of age
and older. Ask your doctor about the availability of this vaccine. Zostavax has
not been studied in people who have already had shingles. Itís not known if the
vaccine will prevent shingles from occurring again. The U.S. Food and Drug
Administration (FDA) does not recommend this vaccine for people who have already
If you have never had chickenpox, you may avoid getting the virus that causes
both chickenpox and later shingles by receiving the varicella vaccine.