Understanding Shingles

Shingles, also known as herpes zoster, is a viral infection caused by something known as the Varicella-zoster virus (VZV). This virus is the same virus that causes chickenpox. Although named “herpes zoster”, this infection should not be confused with the sexually transmitted infection known as “herpes” that is caused by the Herpes simplex virus (HSV).

What is Shingles?

Shingles is caused from a reactivation of latent (hidden) VZV. Usually, the first infection experienced by this virus is in the form of chickenpox. After recovering from chickenpox, the virus remains inactive in the body. When the body becomes stressed and/or the immune response weakens, the virus can become reactivated and causes a painful skin rash known as shingles. Shingles can affect any age group but is more commonly seen as we get older due to the weakening of our immune system. There is a greater risk of shingles in those that are immunocompromised, have autoimmune disorders, or are transplant patients.

Transmission

People with shingles can transmit the virus to people that have never had chickenpox. This transmission can cause chickenpox in those that come into contact with active lesions. Once the lesions crust over, they are considered non-infectious.

Symptoms

Shingles commonly appears as a painful rash that is usually limited to a general area on one side of the body. Prior to seeing the rash, some people can experience pain, tingling, itching, burning, or stabbing in the region where the rash will develop. The rash starts off with raised, red bumps and will develop into fluid-filled blisters in groups. Within a few days, pus will start to fill the blisters. During this period, the infection can be spread to those who have never had chickenpox. After approximately 7-10 days, the rash starts to dry and crust and that is when the infected person is no longer considered infectious. Other related symptoms can include fever, headache, chills, and/or fatigue.

Often times, the pain from shingles can outlast the actual infection. A common complication after a shingles infection is postherpetic neuralgia. This is pain that persists after the rash clears. About 10-15% of patients can develop this after they get shingles. Pain from postherpetic neuralgia can be significant and/or symptoms of numbness, tingling, itching, and sensitivity to touch can cause continued discomfort and annoyance for long periods of time. Postherpetic neuralgia can last anywhere from weeks, months, to even years in some individuals.

Symptoms of shingles can range in severity. Mild symptoms of shingles can be treated in the clinic; however, severe symptoms may result in a visit to the emergency room. Emergency treatment should be sought out in the event that a shingles rash develops on the face, especially near the eyes. Please consult your physician if you have further questions or concerns in regard to treatment of shingles.

Treatment

Shingles is usually treated with antivirals and pain medication. The sooner the medication is started, the more effective the treatment will be. Other treatments can be utilized for symptomatic relief like anti-itching ointment/cream or cool compresses.

There is no cure for shingles. Treatment provided can help reduce complications or shorten the length of healing, but once the virus is in the system it will remain there. Most people experience shingles only once, but it is possible for shingles to occur again.

Prevention

There is a shingles vaccine available that can help protect against shingles and complications of the disease. The CDC currently recommends adults 50 years and older to get the shingles vaccine. Currently, the recommended vaccine is Shingrix; a two-dose shingles vaccine that is given 2-6 months apart. This vaccine does not guarantee that you will not get shingles, but it lowers the risk of getting shingles and can reduce the severity of the disease in addition to lowering the chance of developing complications from shingles. Individuals that have gotten shingles in the past, received the Zostavax vaccine for prevention of shingles, or received the varicella (chickenpox) vaccine in the past are still encouraged to get Shingrix to prevent future outbreaks.

For more information regarding the shingles vaccine and to see if you are a candidate to receive the vaccine, please consult your physician. For further information or questions about shingles please talk with your healthcare provider.

Dr. Chau is a resident physician who sees patients of all ages and provides obstetrical services at Lone Star Family Health Center, a non-profit 501©3 Federally Qualified Health Center operating facilities in Conroe, Spring, Willis, Grangerland, and Huntsville, and serving as home to a fully integrated Family Medicine Residency Program to increase the number of Family Medicine physicians for Texas and our community.