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Shingles, also known as zoster or herpes zoster, is a viral disease characterized by a painful skin rash with blisters in a localized area. Typically the rash occurs in a single, wide stripe either on the left or right side of the body or face. Two to four days before the rash occurs there may be tingling or local pain in the area. Otherwise, there are typically few symptoms though some patients may have fever or headache, or feel tired.
The rash usually heals within two to four weeks; however, some people develop ongoing nerve pain which can last for months or years, a condition called postherpetic neuralgia (PHN).In those with poor immune function the rash may occur widely.If the rash involves the eye, vision loss may occur.
Distinctive human diseases
Shingles and chickenpox are distinct human diseases but are closely related in their life cycles. Both originate from infection of an individual with the varicella zoster virus (VZV). Chickenpox, also called varicella, results from the initial infection with the virus, typically occurring during childhood or adolescence. Once the chickenpox has resolved, the virus can remain inactive (dormant) in human nerve cells for years or decades, after which it may reactivate.
Shingles results when the dormant varicella virus is reactivated. Then the virus travels along nerve bodies to nerve endings in the skin, producing blisters. During an outbreak of shingles, exposure to the varicella virus found in shingles blisters can cause chickenpox in someone who has not yet had chickenpox; this initial infection will not trigger shingles, however. How the virus remains dormant in the body or subsequently re-activates is not well understood.
Reactivation of the virus
Risk factors for reactivation of the dormant virus include old age, poor immune function, and having contracted chickenpox before 18 months of age. Diagnosis is typically based on the signs and symptoms presented. Varicella zoster virus is not the same as herpes simplex virus, although both belong to the same family of herpesviruses.
Shingles vaccines reduce the risk of shingles by 50% to 90%, depending on the vaccine used. It also decreases rates of postherpetic neuralgia, and, if shingles occurs, its severity. If shingles develops, antiviral medications such as aciclovir can reduce the severity and duration of disease if started within 72 hours of the appearance of the rash. Evidence does not show a significant effect of antivirals or steroids on rates of postherpetic neuralgia. Paracetamol, NSAIDs, or opioids may be used to help with acute pain.
Old and young people
It is estimated that about a third of people develop shingles at some point in their lives. While shingles is more common among older people, children may also get the disease. The number of new cases per year ranges from 1.2 to 3.4 per 1,000 person-years among healthy individuals to 3.9 to 11.8 per 1,000 person-years among those older than 65 years of age. About half of those living to age 85 will have at least one attack, and fewer than 5% will have more than one attack. The disease has been recognized since ancient times.
What to expect when you have shingles
Shingles causes a painful rash, itching, and burning skin, and lasts for 3 to 5 weeks in most cases. People usually only experience shingles once, but the infection can recur.
It can occur in anyone who has had chickenpox, as both shingles and chickenpox are caused by the varicella-zoster virus (VZV). This virus remains in the body after chickenpox has cleared and can reactivate at any time, leading to shingles.
Shingles symptoms tend to develop on one side of the face or body. They often affect just a small area. The most common location is on the side of the waist, although they can occur anywhere.
Timeline of symptoms
Several days before a rash appears, shingles may cause skin sensitivity or pain. Further early symptoms include:
- general discomfort
- hot skin
Within the next 1 to 5 days, a red rash will normally form around the sensitive area. A few days later, fluid-filled blisters will develop at the site of the rash.
The blisters will ooze before drying up, typically within 10 days of appearing. At this point, scabs will form on the skin, tending to heal within 2 weeks.
There may be other symptoms accompanying the skin sensitivity and rash, including:
- malaise or feeling of being unwell
- sensitivity to light
A person’s vision may be affected if the shingles occurs near the eyes.
It should be noted that shingles symptoms range from mild to severe, with some people experiencing itching and mild discomfort and others having intense pain.
Most cases of shingles resolve without causing long-term effects. However, potential complications include:
Post-herpetic neuropathy (PHN)
Post-herpetic neuropathy (PHN) is a common complication of shingles. It refers to nerve damage that causes pain and burning that persists after the shingles infection is gone.
Some sources suggest that up to 20 percent of people who get shingles develop PHN with older adults thought to be especially at risk.
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Treating PHN is difficult, and the symptoms can last for years. However, most people fully recover within 12 months.
It is not known why some people who have shingles go on to develop PHN. The risk factors for PHN include:
- a weakened immune system
- having pain during the early stages of a shingles infection
- advanced age
- having severe shingles that covers a large portion of the skin
According to some researchTrusted Source, older women who get severe pain and rash symptoms may have a 50 percent chance of developing PHN.
How is shingles diagnosed and treated?
If you think you might have shingles, talk to your doctor as soon as possible. It’s important to see your doctor no later than three days after the rash starts. The doctor will confirm whether you have shingles and can make a treatment plan. Most cases can be diagnosed from a visual examination. If you have a condition that weakens the immune system, your doctor may order a shingles test. Although there is no cure for shingles, early treatment with antiviral medications can help the blisters clear up faster and limit severe pain. Shingles can often be treated at home.
How long does shingles last?
Most cases of shingles last three to five weeks.
- The first sign is often burning or tingling pain; sometimes it includes numbness or itching on one side of the body.
- Somewhere between one and five days after the tingling or burning feeling on the skin, a red rash will appear.
- A few days later, the rash will turn into fluid-filled blisters.
- About one week to 10 days after that, the blisters dry up and crust over.
- A couple of weeks later, the scabs clear up.
Am I at risk for shingles?
Everyone who has had chickenpox is at risk for developing shingles. Researchers do not fully understand what makes the virus become active and cause shingles. But some things make it more likely:
- Older age. The risk of developing shingles increases as you age. About half of all shingles cases are in adults age 60 or older. The chance of getting shingles becomes much greater by age 70.
- Trouble fighting infections. Your immune system is the part of your body that responds to infections. Age can affect your immune system. So can HIV, cancer, cancer treatments, too much sun, and organ transplant drugs. Even stress or a cold can weaken your immune system for a short time. These all can put you at risk for shingles.
Most people only have shingles one time. However, it is possible to have it more than once.
When should I get the shingles vaccine?
The current shingles vaccine (brand name Shingrix) is a safe, easy, and more effective way to prevent shingles than the previous vaccine. In fact, it is over 90% effective at preventing shingles. Most adults age 50 and older should get vaccinated with the shingles vaccine, which is given in two doses. You can get the shingles vaccine at your doctor’s office and at some pharmacies.
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See your doctor as soon as you notice the rash forming. They can prescribe an antiviral drug to help ease your symptoms and clear the virus.
Some antiviral options include:
- famciclovir (Famvir)
- valacyclovir (Valtrex)
- acyclovir (Zovirax)
Your doctor may also recommend over-the-counter or prescription options to help relieve any pain and irritation you’re experiencing.
For moderate pain and irritation, you can use:
- anti-inflammatory drugs, such as ibuprofen (Advil), to reduce pain and swelling
- antihistamines, such as diphenhydramine (Benadryl), to reduce itching
- numbing creams or patches, such as lidocaine (Lidoderm) or capsaicin (Capzasin) to reduce pain
If your pain is more severe, your doctor may recommend prescription pain medication. Your doctor may also recommend treatment with corticosteroids or local anesthetics.
In some cases, your doctor may prescribe a low-dose antidepressant to help with pain. Certain antidepressant medications have been shown to reduce the pain of shingles over time.
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Anticonvulsant medications may be another option. They have proved useful in reducing shingles nerve pain, although their main use is in epilepsy. The most commonly prescribed anticonvulsants are gabapentin (Neurontin) and pregabalin (Lyrica).
Although it may be tempting, you shouldn’t scratch. This can lead to infection, which can worsen your overall condition and lead to new symptoms.
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