Shingles

Overview

Shingles, induced by the varicella-zoster virus, is a painful viral infection that can affect anyone who has had chickenpox. After a chickenpox infection, the virus lies dormant in nerve tissues, and reactivates after years, causing blisters or painful rashes. While most cases are mild, complications such as postherpetic neuralgia can occur.
Early diagnosis and antiviral medication can help an individual recover from the pain while helping them manage the other symptoms. Also, receiving a shingles vaccination happens to be the most effective way to prevent the disease and its complications.

What are Shingles?

Shingles or herpes zoster is a viral infectious disease that is characterised by rashes or fluid-filled blisters on the skin. Varicella-zoster (VCZ) virus (also causes chickenpox), is responsible for the cause of shingles.

The virus remains dormant in the body's nerve tissues even after a person recovers from chickenpox. And after several years, it can reactivate and cause shingles. The shingles rash may appear as a band of blisters or rashes in one body part, including the torso, back, eyes and buttocks. It can be quite painful and may lead to complications like postherpetic neuralgia which is a condition characterised by long-lasting nerve pain.

Types of Shingles

The following are the different types of shingles:

Herpes Zoster (Classic Shingles): This is the most common form of shingles, characterised by an aching rash which occurs on one of the body sides. It is caused when the varicella-zoster virus reactivates, which is the same chickenpox-causing virus.

Ophthalmic Shingles: This type of shingles affects the eye and surrounding areas, including the forehead, scalp, and nose. It can cause serious eye problems if not treated promptly.

Internal Shingles: This rare form of shingles affects internal organs, such as the lungs or brain. It can cause life-threatening complications and hence requires immediate medical attention.

Zoster Sine Herpete: This is a type of shingles where the characteristic rash is absent or minimal. Instead, an individual may feel severe pain in the affected area.

Ramsay Hunt Syndrome: This is a complication of shingles that causes facial paralysis, ear pain and hearing loss by affecting the facial nerve.

Disseminated Shingles: It is a rare and serious complication of shingles where the rash spreads to multiple areas of the body. People with weakened immune systems are more prone to this type of shingles.

Symptoms of Shingles

The symptoms that an individual may experience in the early stages may include chills, fever, headache, fatigue, light sensitivity, and an upset stomach. After a few days of developing the disease, an individual may experience raised rashes in a small area of their skin; tingling, itching, or a burning sensation in one area of the skin; mild to severe pain in the affected skin area; redness in the impacted area; and fluid-filled blisters that burst and scab over.

Feeling sensitive while touching the concerned area and a tingling sensation in a limited area are other symptoms. However, an individual may usually feel pain initially as it is the first symptom of shingles. The shingles rash can appear as a blister around either of the torso sides, the face, or the neck. When the rash gets closer to or in the ear, it leads to an infection causing issues with balance, loss of hearing, and weakness in facial muscles.

The shingles virus can also affect the eye, causing symptoms such as blurry vision, iritis, conjunctivitis, rash on either or both of the eyelids, optic neuritis, and keratitis. In addition, the disease can also appear on an individual’s buttocks, spreading down to their leg.

Causes of Shingles

Varicella zoster (herpes zoster) virus causes shingles, which also causes chickenpox. If an individual already has recovered from chickenpox, the virus enters the nervous system and reactivates as it travels through an individual’s nerve pathways to the skin, causing shingles. However, medical experts have found that not everybody who has had chickenpox will develop shingles.

While it is unclear why some individuals may not develop the disease, some people may develop it due to lower immunity to infections. The disease is more prevalent in individuals with weakened immune systems and older adults.

The other risk factors include emotional stress, being 60 years and older, having HIV or cancer, and undergoing major surgery or cancer treatments. Taking medications after an organ transplant or steroids (prednisone) can also increase one’s risk of developing shingles.

Diagnosis of Shingles

A medical professional diagnoses shingles based on the way the rashes are spread across a patient’s body. The doctor may also ask about the individual’s medical history. In some cases, they may request a sample of the infected person’s skin or the blister fluid. This may involve laboratory diagnosis using swabs or scrapings of the fluid or tissue.

Shingles runs its course through a period of 2 - 6 weeks. The following are its stages:

Pre-Rash: In this stage, the skin feels tingly or sensitive, followed by pain across some body parts. Symptoms include a general feeling of being unwell, fatigue and headache. It occurs 48 hours before the rash appears.

Eruptive: Painful blisters or rashes appear in this stage, which may burst open or crust over. In this most painful stage of shingles, an infected individual is most contagious and may continue to have a headache while being tired. It may last for up to 4 weeks.

Chronic: The pain may remain for more than 4 weeks if the infection becomes chronic. One may feel “pins and needles” or shocks across the infected area because shingles affect the nerves.

Treatment for Shingles

Shingles cannot be cured, however, treatment plans help to alleviate the complications of the disease, leading to a speedy recovery. Treatment provided within 72 hours of developing the symptoms includes antiviral medicines including acyclovir (Zovirax®), famciclovir (Famvir®) and valacyclovir (Valtrex®). These medications help in preventing the pain of postherpetic neuralgia. Moreover, capsaicin (Zostrix) can also be given to an infected patient to limit the risk of this condition.

Over-the-counter medications including ibuprofen (Motrin®, Advil®) and acetaminophen (Tylenol®) may help relieve pain. An individual who has developed a bacterial infection through the rash may be recommended antibacterial drugs. In addition, prednisone (an anti-inflammatory drug) may be given if the shingles virus has spread to the eyes or other parts of the face. Prolonged changes may be treated with anticonvulsants or tricyclic antidepressants.

Home remedies can help to ease the symptoms. This includes taking cold showers or baths; eating foods with vitamins C, A, B12, and E; applying calamine lotion or a paste of water and baking soda on the affected skin area; pressing wet cold compresses against the rash to alleviate itching and pain; and taking L-lysine supplements to strengthen the immune system.

Prevention of Shingles

Getting vaccinated can help avoid severe symptoms or complications of shingles. Children must receive two doses of the varicella immunisation or the chickenpox vaccine. This vaccine can also be taken by individuals who have never had chickenpox.

Adults above 50 years should receive the shingles vaccine, which is known as the herpes-zoster immunisation. Zostavax is one shingles vaccine that can alleviate the chances of developing shingles and postherpetic neuralgia. The second vaccine, Shingrix is recommended after 2 - 6 months of receiving the first dose.

Myths and Facts Related to Shingles

The myths and facts related to shingles are outlined below:

Myth 1: Shingles can be Cured with Moisturisers and Oils
Fact: Shingles is a viral disease which cannot be cured with body oils or face moisturisers. It affects the nerves in the body and requires early diagnosis and prompt treatment from a medical expert.

Myth 2: Shingles is the Same as Chickenpox
Fact: While both diseases are caused by the same varicella-zoster virus, chickenpox is milder than the other. Shingles can cause long-term health complications and pain.

Myth 3: Shingles Virus Cannot Spread
Fact: While the virus cannot spread through open blisters and cause shingles, the infected person can spread the virus in an individual who isn’t immune to chickenpox and cause the infection. The varicella-zoster virus can then reactivate in the body, making the individual vulnerable to shingles.