Shingles is an infection of a nerve area caused by the varicella-zoster virus. We look at the causes, symptoms and treatment.
By Rita Ghelani
Concerned you might have shingles? Shingles is a painful blistering rash caused by a virus, and if you’ve ever had chickenpox, you may be at risk. The likelihood of experiencing a shingles outbreak increases with age, with about 1 in 5 people who have had chickenpox experiencing an attack of shingles later in life. Fortunately, you can take steps to ease the effects.
Our resident pharmacist Rita Ghelani looks at the symptoms, causes and treatments for this painful rash.
What is shingles?
Shingles, also known as herpes zoster, is caused by the reactivation of a latent varicella zoster virus infection. It is estimated that approximately one in four people will have at least one episode of shingles during their life.
A primary varicella zoster virus infection manifests as chickenpox. Following this initial infection, the varicella zoster virus enters the nerves and remains there as a dormant infection.
Shingles occurs when this dormant infection is reactivated, this may be many years after the initial chickenpox infection.
What causes shingles?
Most people get chickenpox in childhood, but once the spots have disappeared the varicella-zoster virus remains dormant (inactive) in the nervous system. This virus can be reactivated and cause shingles in later life.
It’s not known exactly why the shingles virus is reactivated at a later stage in life, but it is thought that having a lowered immunity can cause shingles.
The incidence and severity of shingles increases with age as immunity may decrease. Shingles is most common in people over 70 years old.
Lowered immunity can also result from the following:
➡️ Physical stress.
➡️ Emotional stress.
➡️ People with HIV and AIDS are more likely to get shingles, as their immune system is weak.
➡️ People who have recently had a bone marrow transplant, organ transplant or chemotherapy. These can all weaken the immune system.
What are the symptoms of shingles?
The main symptom of shingles is pain, followed by a rash that develops into itchy blisters which appear similar to the chickenpox spots.
The pain may be constant, dull, stabbing pain or a burning sensation. The intensity of the pain may vary from mild to severe. The area of skin affected may be tender.
In some cases, shingles may cause some early symptoms that develop a few days before the painful rash first appears. These early symptoms can include:
✔️ A headache.
✔️ Burning, tingling, numbness or itchiness of the skin in the affected area.
✔️ A feeling of being generally unwell.
Any part of the body can be affected by shingles, including the face and eyes, but the chest and tummy are the most common areas.
Shingles usually affects a specific area on one side of the body and doesn’t cross over the midline of the body – imaginary line running between your eyes down past the belly button.
New blisters may appear for up to seven days, these will dry out after a few days and appear flatter, yellowish in colour and form a scab.
💡 Shingles are usually diagnosed by examining the blister/rash and clinically assessment of the symptoms. There are usually no tests used to diagnosis shingles.
How is shingles treated?
Shingles can be treated with antiviral medicines such as aciclovir, famciclovir or valaciclovir. These medicines are usually prescribed for people over 50-years-old, with severe pain and extensive rash, or for people who have a suppressed immune system. Antiviral medicines will help you recover quicker and reduce the risk of getting complications associated with shingles.
If shingles has affected the eyes you may be given antiviral eye ointment.
Nerve pain is one of the most troublesome symptoms of shingles. This is usually treated with mild painkillers such as paracetamol, however if the pain is severe than strong painkillers such as codeine or morphine may be given.
The itchiness of a shingles rash can be treated with calamine lotion or aqueous calamine cream. You can also use cool compresses to help soothe the rash.
Is shingles contagious?
You cannot catch shingles from someone else who is infected. The rash develops when the dormant herpes zoster virus becomes active. However, if you have shingles you can pass on chickenpox to someone who has not previously been infected with chickenpox.
Shingles can be spread by direct contact with fluid from the small blistery rash, which are infectious as soon as the blisters develop and until they crust over. However, shingles are less contagious than chickenpox and the risk of spreading the Varicella zoster virus is low if the rash is covered.
Transmission of the virus only occurs through direct contact with the blisters, so if you do have shingles, always keep them covered before coming into contact with another person.
Shingles self-care tips
✔️ Try keeping the rash clean and dry – this will help reduce the risk of the rash becoming infected with bacteria.
✔️ Wear loose-fitting clothing.
✔️ Avoid using adhesive dressings such as plasters, as this may stop the blister from forming a scab. Use a non-adhesive dressing that doesn’t stick to the rash if you need to cover up the blisters. Covering up the blisters prevents passing the infection on to other people, ask your pharmacist for a suitable dressing.
✔️ Don’t rub creams on to the blisters, try dabbing calamine lotion or aqueous calamine cream on the area instead. This will have a soothing, cooling effect on the skin and will help relieve the itching.
✔️ For any weeping blisters try a cool compress (a cloth or a flannel cooled with tap water) to soothe the skin and keep the blister clean.
✔️ A bag of frozen peas wrapped in a towel also works well.
✔️ Do this several times a day for about 20 minutes each time. Shingles is contagious so make sure you don’t share towels or flannels.
How can I prevent shingles?
As the Herpes-Zoster virus is already inside the body, you can’t take any steps to avoid the virus, but you can boost your immune system by having a vaccine to help fight shingles.
Although most people fully recover from shingles, the risk of getting postherpetic pain, which can last for months and even years increases with age. Having a shingles vaccine can help you reduce the risk of developing shingles, as well as lessen the severity and duration of symptoms associated with shingles.
The shingles vaccine can be given to people aged over 50 at any time all year round. You can still have it if you have had shingles before, as long as it’s been over a year since you last had shingles. Speak to your doctor or pharmacist about getting a shingles vaccine.
What are the complications of shingles?
Complications of shingles may occur in people with a weakened immune system or in elderly people.
Postherpetic neuralgia is the most common complication of shingles. It is estimated that this affects 1 in 5 people over 50 who get shingles. Postherpetic neuralgia can cause severe nerve pain (neuralgia) and intense itching that persists after the rash and any other symptoms of shingles have gone.
The type of pain experienced by people with postherpetic neuralgia includes:
- Constant or intermittent burning, aching, throbbing, stabbing or shooting pain.
- Feeling pain from something that should not be painful, for example changes in temperature, the feeling of clothing moving on the skin. This is referred to allodynia.
- Becoming very sensitive to pain, known as hyperalgesia.
Postherpetic neuralgia is difficult to treat, it can take three to six months to resolve, it can also continue for a few years or be permanent. It can be treated with painkilling medicines such as co-codamol or strong painkillers that help with nerve pain. Your doctor may suggest trying amitriptyline, a tricyclic antidepressant that has been shown to help with nerve pain.
Other complications of shingles include eye problems, due to one of the eyes becoming affected by shingles, referred to as ophthalmic shingles. This can lead to some permanent loss of vision and should be referred to a specialist as soon as possible.
Net Doctor