Herpes
Zoster - Shingles
Also known as shingles,
is a viral infection caused by the same virus that causes chicken
pox. Anyone who's had chicken pox can develop herpes zoster. The
virus remains dormant or inactive in certain nerve root cells of the
body and only when it reactivates does shingles occur. About 20 percent
of those people who have had chicken pox will get shingles at some time
during their lives. Fortunately, most people will get shingles only
once.
It is not clear
what prompts the virus to reactivate or "awaken" in healthy
people. A temporary weakness in immunity (the body's ability to fight
infection) may allow the virus to multiply and move along nerve fibers
toward the skin. Although children can get shingles, it is more common
in people over the age 50. Illness, trauma and stress may also trigger
a shingles attack.
People with a weakened
immunity for any reason are more prone to develop shingles. They are
also more likely to have a serious form of it. Diseases that weaken
immunity include cancers, such as leukemia or lymphoma, and AIDS. Some
medical treatments including chemotherapy or radiation for cancer, drugs
taken to prevent rejection of transplanted organs, and cortisone pills
or injections taken for a long time for any reason, may also lower immunity.
What
are the symptoms of Shingles?
The first symptom
of shingles is burning pain, tingling or extreme sensitivity in
one area of the skin usually limited to one side of the body. This may
be present for one to three days before a red rash appears at that site.
There may also be fever or headache.
The rash soon turns
into groups of blisters that look a lot like chicken pox. The blisters
generally last for two to three weeks. The blisters start out clear
but then pus or dark blood collects in the blisters before they crust
over (scab) and begin to disappear. T
he pain may last
longer. It is unusual but possible to have pain without blisters or
blisters without pain.
How
severe is the pain?
The pain is often
severe enough for the physician to prescribe painkillers.
Where
does shingles usually appear on the body?
Shingles
are most common on the trunk and buttocks. But it can also appear on
the face, arms or legs if nerves in these areas are involved.
Great care is needed
if the blisters involve the eye, because permanent eye damage can result.
Blisters on the tip of the nose signal possible eye involvement. The
dermatologist will usually refer the patient to an ophthalmologist (eye
specialist) immediately.
What
are the complications of Shingles?
Post-herpetic neuralgia
is constant pain or periods of pain that can continue after the skin
has healed. It can last for months or even years and is more common
in older people. A bacterial infection of the blisters can occur, and
can delay healing. If pain and redness increase or reappear, you should
return to the dermatologist. Antibiotic treatment may be needed. Another
complication is the spread of Shingles all over the body or to
internal organs. This can also happen with chicken pox. It occurs rarely
and most often in those with weakened immunity.
How
is Shingles diagnosed?
The diagnosis is
based on the way the blisters look and a history of pain before the
rash on one side of the body. The dermatologist may scrape skin cells
from a blister onto a glass slide for examination. The glass slide is
then examined under a microscope for changes characteristic of zoster.
If there is any doubt, blister fluid containing virus can be sent to
the laboratory for special testing.
If
someone has Shingles, is there any reason to worry about a more serious
disease or a poorly functioning immune system?
The majority of
people who develop Shingles are otherwise healthy; however, if you have
other medical problems or could have been exposed to the AIDS virus,
be sure to let your dermatologist know. This could affect treatment.
Your doctor will ask questions about your medical history and may order
tests, such as chest x-ray or blood studies, to be sure there are no
other problems.
Is
Shingles contagious?
The virus that
causes Shingles can only be passed on to others who have not had chicken
pox and then they will develop chicken pox, not Shingles. Shingles is
much less contagious than chicken pox. Persons with Shingles can only
transmit the virus if blisters are broken. Newborns or those with decreased
immunity are at the highest risk for contracting chicken pox from someone
who has Shingles. Patients with Shingles rarely require hospitalization.
Is
there much scarring?
Scarring usually
occurs only after more severe infections, such as in those with weakened
immune systems, elderly persons or those whose blisters become infected.
What
about treatment?
Shingles, usually
clears on its own in a few weeks and seldom recurs. Pain relievers and
cool compresses are helpful in drying the blisters.
If diagnosed early,
oral anti-viral drugs can be prescribed to decrease both viral shedding
and the duration of skin lesions. They are routinely prescribed for
severe cases of Shingles - with eye involvement, for example - or for
those with decreased immunity.
Corticosteroids,
sometimes in combination with anti-viral drugs, also are used for severe
infection, such as in the eyes, and to reduce severe pain. An ointment
containing capsaicin, an extract of pepper, is helpful for some people.
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