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Shingles (herpes zoster)

What are shingles and what are the symptoms?

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Shingles are also called herpes zoster and it is caused by a virus called varicella-zoster which also causes chickenpox.  It is often believed that provided you have had chickenpox in the past that you cannot catch shingles, however, this is not true;  in actual fact, a person can only develop shingles if they have been infected with chickenpox, sometimes decades earlier. The virus remains dormant and will reactivate as shingles under some circumstances

 

Symptoms of Shingles

The first symptoms of shingles tend to be burning and shooting pain in the skin. The symptoms tend to be one side of the body and also appear in small patches.

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It is common for a rash to then develop followed by red, fluid-filled blistering of the skin.

Other Symptoms which may be early signs of shingles are:

  • Raised dots on the skin with redness of the skin
  • A sensation of tingling under or in the skin
  • Stabbing or shooting pain
  • Irritation and itchiness
  • The symptoms may wrap around the body from the spine to the torso
  • Symptoms may appear on the face and ears
  • Aside from symptoms appearing on the skin, the sufferer may also experience fever, chills, and headache as well as an upset stomach
  • Lethargy and fatigue Muscle weakness

 

Complications

There are some complications associated with shingles that may persist after the rash has disappeared

  • Shingles on the face - it may be that the symptoms found on the body also arise on one side of the face. This becomes risky if the rash is close to or in the ear whereby it may cause problems such as hearing loss, balance issues, and weakness in the muscles of the face. If the infection reaches inside the mouth it can be very painful making it difficult to eat;  the sense of taste may also be affected
  • Shingles in the eye - if the infection develops in or around the eye it is known as ophthalmic herpes zoster (herpes zoster opthalmicus).

This form of the condition is very unpleasant with a blistering rash on the eyelids and forehead.  Other symptoms such as burning and throbbing pain in the eye alongside redness, swelling and blurred vision.

Once the rash has disappeared there may be nerve pain in the eye as a result of damage to the nerves.

It is extremely important that shingles in the eye are treated as it can result in blindness

  • Shingles on the back - sometimes a stripe of blisters may occur along one side of the back or lower back
  • Shingles on the buttocks - it may be that the shingles rash appears on the buttocks and as shingles only affect one side of the body it may be that one buttock has the rash but the other one does not

 

Shingles in pregnancy

 It is not common to contract shingles in pregnancy and the most likely scenario where this would happen is if the pregnant woman had come into contact with someone who had active chickenpox or shingles infections.

It is very risky if someone catches chickenpox whilst pregnant because it can result in the fetus developing congenital abnormalities. For this reason, it is recommended to have a vaccination against chickenpox before becoming pregnant

It tends to be less of a problem if a pregnant person catches shingles but nevertheless it can still be unpleasant

 

Diagnosis of Shingles

If you are feeling unwell in general and suspect that you may have shingles, it is important to have a diagnosis from your doctor.

It is likely that your doctor will make the shingles diagnosis from the examination of any rashes and blisters that you may have.

In some cases, your doctor will want to test a sample of skin or fluid from your blisters.  The sample will then be sent to a laboratory to be tested for varicella-zoster virus

 

Who is more likely to contract Shingles?

Anyone who has had chickenpox in the past has some risk of developing shingles;  however, some factors increase that risk quite significantly.

These may include:

  • Having any condition which may cause an immune system to be compromised, for example, HIV, AIDS, and cancer all weaken the immune system
  • Treatment for cancer including chemotherapy and radiation therapy
  • Any drugs that weaken the immune system, in particular, those given after an organ transplant to prevent organ rejection (immunosuppressants) and steroids
  • People aged 60 years or over.  It has been observed that shingles are more common in older people.  It is said that 1 in 3 people will contract shingles in their lifetime and of those people, half of them will be over 60.  The main reason for this is believed to be the fact that the older we get, the weaker our immune systems become.

It is also true that as we get older our weakening immune systems will leave us open to more complications as a result of the disease;  it may be that more rashes will develop as well as more infections in open blisters.  More cases of pneumonia and inflammation of the brain are seen in older people with shingles

 

Shingles vaccine

As shingles are riskier for people as they get older, it is often advised that older people are vaccinated against the disease.  The vaccination is the same as that given to prevent chickenpox

 

Is Shingles Contagious?

The varicella-zoster virus is not airborne and so cannot be spread if someone with shingles coughs or sneezes near you or if you drink out of the same cup or use the same spoon.

The shingles virus is contagious but the only way that it is likely to be transmitted to another person is if the person were to come into contact with a blister which is oozing on a person with shingles.  It is highly unlikely that you will contract shingles from this sort of contact but if you have never had chickenpox or been vaccinated, it is possible that you will develop that disease

 

Treatment for Shingles

There is no cure for shingles

 

Home treatment

There are some treatment that can be carried out at home and will help alleviate symptoms

  • Cool baths or showers will help to soothe inflamed skin
  • Cold wet compresses applied to the rash will help alleviate pain and itching
  • A paste made of baking soda or cornstarch and water or an application of calamine lotion will help to relieve the itching
  • Taking a bath with colloidal oatmeal in it will reduce pain and itching
  • #Foods which contain vitamins A, B12, C and E as well as lysine, an amino acid, will help to strengthen the immune system which will in turn mean the body will be better served to fight the infection

 

Drug Treatment

There is a selection of antiviral drugs now available that are invaluable in the treatment of shingles.  They help reduce the duration of the disease as well as reducing the risk of complications.  Ideally, treatment with antivirals needs to begin within 3 days of the appearance of the rash so it is important to seek help as soon as possible.

There are three drugs which are generally given to treat shingles:

  • Acyclovir (Zovirax)
  • Famciclovir (Famvir)
  • Valacyclovir (Valtrex)

 

Drug treatments specifically recommended for the pain include:

  • Anticonvulsants (Gabapentin)
  • Antidepressants (amitriptyline)
  • Anaesthetic medication such as lidocaine
  • Medicated lotion

 

Conclusion

It is without a doubt that shingles can be a very uncomfortable and unpleasant disease with some complications that are very serious.

However, provided we seek the right help early enough in the disease we can avert many of the complications and discomfort

 

Sources

  1. Shingles https://www.nhs.uk/conditions/shingles/
  2. Shingles https://www.webmd.com/skin-problems-and-treatments/shingles/shingles-skin#1
  3. Shingles (Herpes Zoster) https://www.cdc.gov/shingles/hcp/clinical-overview.html
  4. Everything you need to know about shingles https://www.healthline.com/health/shingles#What-is-shingles?

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