About Shingles

Shingles, or varicella zoster virus, is a painful viral infection that manifests as a band or strip of rash that eventually turns into a cluster of blisters. Shingles is actually a re-awakening of the chickenpox virus that many of us had as children.  Many years after the varicella-zoster virus causes chickenpox, the dormant or inactive virus that lives in the nerve cells can be reactivated into shingles. While not life-threatening, shingles can be very painful and can lead to lingering complications.

It is not entirely understood why the varicella zoster virus reactivates, but we know that one cause may be a lower immunity to infections as we age or take certain medications. For instance, shingles is most common in adults over 50. Likewise, individuals with HIV/AIDS and cancer who have compromised immune systems are more likely to get shingles. Additionally, medications and radiation treatments for certain conditions can lower our immune systems and make us more susceptible to shingles. These include chemotherapy medications, anti-rejection medications that are given after organ transplants, and use of steroids for various health conditions.

Aside from the often telltale rash of shingles, one may experience myriad of symptoms including fever, fatigue, headaches, and other flu-like symptoms. The most distinguishing symptom is pain on the skin that may precede the rash by sometimes as much as several days. Once the rash appears, it’s usually isolated to a particular region of the body, most typically around one side or the other of the torso. However the rash can also appear elsewhere including the neck or face. The rash is often fine to start and will eventually appear as fluid-filled blisters. Itching is a common symptom to the rash, and the blisters will eventually pop and crust. Generally, the entire rash should resolve anywhere from 2 to 4 weeks. Many times the skin is extremely sensitive to touch, and many find that even clothing will cause irritation and pain.

The open sores of shingles that may come in contact with individuals who have not had either the chickenpox or the varicella-zoster vaccine can be contagious and result in exposure to the virus. Therefore, it is recommended that someone with shingles avoid contact with others until the blisters have scabbed over. Pregnant women, newborns, and individual with compromised immune systems should avoid exposure to anyone with shingles as well as anyone who has never had chickenpox or received the chickenpox vaccination.

The typical case of shingles can be painful and annoying, but sometimes complications can occur. For instance, shingles around the face that involves the eyes or ophthalmic shingles can lead to painful eye infections and long-term vision loss. Severe cases of shingles can result in bacterial skin infections that will require treatment with antibiotics. Postherpetic neuralgia is a condition whereby damaged nerve fibers send pain signals to the brain resulting in pain long after the shingles rash is gone. In the most acute cases, shingles can cause a swelling in the brain known as encephalitis which can cause long-term problems like facial paralysis and problems with balance, hearing, and vision. These serious complications are not typical but can occur, which makes the need for treatment and prevention important.

A healthcare provider generally diagnoses shingles by the evidence of symptoms and rash; however, cultures of the blisters can be taken to confirm a diagnosis. Once diagnosed, shingles can be treated although not cured. Antiviral medications such as acyclovir or valacyclovir can help hasten the duration of shingles and help to reduce complications. Your healthcare provider can help alleviate the pain associated with shingles by prescribing various medications that help to minimize pain including gels and creams that work to numb painful skin. More severe pain may require narcotic medications and possibly certain antidepressants that help lessen the nerve pain associated with shingles. All these treatments are taken for a short duration until the virus has run its course.

Since we know that shingles is a latent form of the chickenpox’s virus, if you have never had chickenpox, it is wise to get the varicella or chickenpox vaccine that came out in the mid 1990s and is routinely given to children today as part of a normal vaccination schedule. Varicella vaccine will help your body develop antibodies to the chickenpox virus and hence prevent a subsequent case of shingles.

If you have already had the chickenpox virus and want to reduce the risk of reactivation of the virus, there is now a vaccine on the market, Zostavax, which can prevent or at least lessen the severity of shingles should you still get it. All adults over the age of 60 who have had chickenpox should consider getting the vaccine. The vaccine can be given earlier to individuals in certain high-risk group between the ages of 50-59 including those who may be required to take medications that will compromise their immune systems.

Shingles can be a painful and sometimes serious condition, so check with your healthcare provider to see what steps you can take to treat or possibly prevent this viral infection. 

Timothy J. Hardy, M.D.

Dr. Timothy Hardy, M.D. has been practicing medicine in the community for many years. He received his medical degree from Eastern Virginia Medical School and founded his own practice, Atlantic OB-GYN, in 1990, where he has been providing women with exceptional care ever since. Website: www.atlanticobgyn.com
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