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Shingles

Definition

Shingles (herpes zoster) is a painful, blistering skin rash. It is caused by the varicella-zoster virus. This is the virus that also causes chickenpox.

Alternative Names

Herpes zoster

Causes, incidence, and risk factors

After you get chickenpox, the virus remains inactive (becomes dormant) in certain nerves in the body. Shingles occurs after the virus becomes active again in these nerves after many years.

The reason the virus suddenly becomes active again is not clear. Often only one attack occurs.

Shingles can develop in any age group. You are more likely to develop the condition if:

  • You are older than 60
  • You had chickenpox before age 1
  • Your immune system is weakened by medications or disease

If an adult or child has direct contact with the shingles rash and did not have chickenpox as a child or the chickenpox vaccine, they can develop chickenpox, not shingles.

Symptoms

The first symptom is usually pain, tingling, or burning that occurs on one side of the body. The pain and burning may be severe and are usually present before any rash appears.

Red patches on the skin, followed by small blisters, form in most people:

  • The blisters break, forming small sores that begin to dry and form crusts. The crusts fall off in 2 to 3 weeks. Scarring is rare.
  • The rash usually involves a narrow area from the spine around to the front of the abdomen or chest.
  • The rash may involve the face, eyes, mouth, and ears.
Signs and tests

Your health care provider can make the diagnosis by looking at your skin and asking about your medical history.

Tests are rarely needed, but may include taking a skin sample to see if the skin is infected with the virus.

Blood tests may show an increase in white blood cells and antibodies to the chickenpox virus. But the tests cannot confirm that the rash is due to shingles.

Treatment

Your health care provider may prescribe a medicine that fights the virus, called an antiviral drug. This drug helps reduce pain, prevent complications, and shorten the course of the disease.

The medicines should be started within 72 hours of when you first feel pain or burning. It is best to start taking them before the blisters appear. The medicines are usually given in pill form. Some people may need to receive the medicine through a vein (by IV).

Strong anti-inflammatory medicines called corticosteroids, such as prednisone, may be used to reduce swelling and pain. These medicines do not work in all patients.

Other medicines may include:

  • Antihistamines to reduce itching (taken by mouth or applied to the skin)
  • Pain medicines
  • Zostrix, a cream containing capsaicin (an extract of pepper) to reduce pain

Follow your health care provider's instructions about how to care for yourself at home.

Other measures may include:

  • Caring for your skin by applying cool, wet compresses to reduce pain, and taking soothing baths.
  • Resting in bed until the fever goes down

Stay away from people while your sores are oozing to avoid infecting those who have never had chickenpox -- especially pregnant women.

Expectations (prognosis)

Herpes zoster usually clears in 2 to 3 weeks and rarely returns. If the virus affects the nerves that control movement (the motor nerves), you may have temporary or permanent weakness or paralysis.

Sometimes the pain in the area where the shingles occurred may last from months to years. This pain is called postherpetic neuralgia.

It occurs when the nerves have been damaged after an outbreak of shingles. Pain ranges from mild to very severe. Postherpetic neuralgia is more likely to occur in persons over age 60. 

Possible Complications

Complications may include:

  • Another attack of shingles
  • Bacterial skin infections
  • Blindness (if shingles occurs in the eye)
  • Deafness
  • Infection, including encephalitis of sepsis (blood infection) in persons with a weakened immune system
  • Ramsay Hunt syndrome if shingles affects the nerves of the face/ear
Calling your health care provider

Call your health care provider if you have symptoms of shingles, particularly if you have a weakened immune system or if your symptoms persist or worsen. Shingles that affects the eye may lead to permanent blindness if you do not receive emergency medical care.

Prevention

Do not touch the rash and blisters on persons with shingles or chickenpox if you have never had chickenpox or the chickenpox vaccine.

A herpes zoster vaccine is available. It is different than the chickenpox vaccine. Older adults who receive the herpes zoster vaccine are less likely to have complications from shingles.

 
References

Cohen J. Varicella-zoster virus (chickenpox, shingles). In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa.: Elsevier Saunders; 2011:chap 383.

Habif TP.Clinical Dermatology. 5th ed. St. Louis, MO: Elsevier Mosby; 2009:chap 12.

Herpes zoster (shingles) on the back
A classical pattern for shingles. The infection follows a nerve root from the spine, along a rib, to the front of the chest. The area innervated by the nerve is called a "dermatome".
Adult dermatome
Understanding the nerve distribution along the dermatomes is helpful in determining how certain diseases, such as shingles and some other neurological conditions, target one area of the body. The letter-number combinations show the relationship between each area and its corresponding sensory nerve. The vertebrae are classified as C for cervical, T for thoracic, L for lumbar, and S for sacral. The trigeminal nerve is the fifth cranial nerve, represented by V.
Shingles
Shingles, or herpes zoster, is caused by the same virus that causes chickenpox. The virus can lie dormant in the body for many years and re-emerge as shingles. Shingles appear as a painful rash. It consists of red patches of skin with small blisters (vesicles) that look very similar to early chickenpox. Shingles usually clears in 2 to 3 weeks and rarely recurs.
Herpes zoster (shingles) - close-up of lesion
A close-up picture of herpes zoster skin lesions. Four small blisters are shown with redness around them. These vesicles will break, crust over, scab, and finally heal.
Herpes zoster (shingles) on the neck and cheek
This is a picture of herpes zoster (shingles) on the neck and cheek. Shingles are caused by the same virus that causes chickenpox. Outbreaks of shingles often follow the distribution of nerves in the skin. This distribution pattern is called a dermatome (see the "dermatomes" picture).
Herpes zoster (shingles) on the hand
Shingles occurs more commonly on the chest and back, but can involve the arms and legs. The small blisters on this person's hand represent involvement of the dermatome innervated by the 7th cervical nerve. (See the Dermatomes picture.)
Herpes zoster (shingles), disseminated
Herpes zoster (shingles) normally occurs in a limited area that follows a dermatome (see the "dermatome" picture). In individuals with damaged immune systems, herpes zoster may be widespread (disseminated), causing serious illness. Herpes zoster is caused by the same virus that causes chickenpox.

Review Date: 6/6/2013
Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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