Shingles, also known as herpes zoster, is a painful blistering rash caused by the same virus that causes chickenpox (the varicella-zoster virus).
If you have chickenpox, the virus that caused it may live on after the spots have cleared, in an inactive state, in the nerves linked to your spinal cord. The virus becomes active again when there is a temporary decrease in the body’s resistance. It will then multiply and move along the nerve fibres to the skin supplied by them. Shingles then appears in the skin.
Most attacks of shingles occur for no obvious reason, but an attack is most likely:
- If you are elderly
- If you are under stress
- If you have an illness that weakens the immune system such as cancer (e.g leukaemia, a lymphoma) or AIDS
- If you are have been given treatments that suppress the immune system – including irradiation for cancer, chemotherapy and drugs taken to prevent organ rejection
What are the symptoms of shingles?
The first symptom is often a burning pain or tingling sensation, or extreme sensitivity in one area of the skin. This may be present for one to three days before a red rash occurs. Groups of blisters on a red base usually follow. The blisters last for two to three weeks, during which time pus may appear and then crust over and begin to disappear. The pain may last longer. The blisters usually appear on only one side of the body.
How severe is the pain?
The pain can be severe enough for you to request for painkillers. Post-herpetic neuralgia, a persistent painful complication of shingles can occur, especially in older individuals. Ingestion of antiviral drugs during a bout of shingles may reduce the risk of getting post-herpetic neuralgia in individuals above 50 years of age.
Where do shingles appear on the body?
Most commonly, blisters will appear on one side of body, the buttocks and genitalia, or the face in the distribution of the nerve(s) supplying the area. If the blisters involve the eye region, permanent eye damage can result and your doctor will refer you immediately to an eye specialist.
What are the complications of shingles?
- Post-herpetic neuralgia - a condition in which either constant or episodic pain persists for a long time after the skin has healed.
- Infection of the blisters by bacteria – this can lead to delayed healing of the skin. Antibiotics are needed in these instances.
- Rarely, high fever and spread of the disease all over the body in very ill persons.
How do I know I have shingles?
This is by the appearance of the blisters and pain on one side of the body. To be certain, your doctor may do a special test called Tzanck smear in which scrapings from the blister are put on a slide and examined under the microscope for “giant cells”.
Is shingles contagious?
Shingles is much less contagious than chicken pox. People with shingles can spread the virus if blisters are broken and a susceptible person (someone who has never had chicken pox or who is already ill) is close by. The main people at risk are babies or those who are already ill, e.g from cancers or AIDS.
Is there much scarring?
Scarring occurs in those who have more severe infections, elderly people, those whose blisters become infected, those who used toxic home-remedies, those who treated their rashes with burning or scalding them, or those who have used chemicals to treat themselves.
How is shingles treated?
Shingles usually resolves spontaneously in a few weeks and seldom recurs. Treatment consists of painkillers, as well as cool compresses to help in drying the blisters. Anti-viral medications, e.g acyclovir, are usually given for severe cases of shingles, those with eye involvement or those who are very ill. If taken within the first few days of the attack, acyclovir can shortened the duration of the attack. Post-herpetic neuralgia can be treated with topical painkillers such as lignocaine gel or capsaicin; or simple analgesics such as paracetamol. In severe, persistent post-herpetic neuralgia, tricyclic antidepressants can be used to relieve the pain. See your doctor early for shingles.
Fig.1 Herpes Zoster (Shingles) - red patches and blisters appear in a band on one side of the body.
Fig.2 If herpes zoster affects the region around the eye, the eye itself may also be affected
DEDICATED TO EXCELLENCE IN DERMATOLOGY
By National Skin Centre (Singapore)
Copyright (C) 1995 - National Skin Centre (Singapore)