By Dr Ananya Mandal, MD
Shingles is a medically termed herpes zoster. The name derives from the Latin term for belt. This is because Shingles generally results in a belt shaped rash. (6)
Shingles is characterized by this blistering and severely painful rash that occurs due to the varicella-zoster virus or the virus responsible for chickenpox.
Once an individual gets chickenpox, the virus remains inactive or dormant within certain nerves in the body. Years later this virus may reactivate to lead to Shingles or herpes zoster. This reactivation attack is usually not repeated.
Causes of Shingles
Shingles is caused by the reactivation of the varicella zoster virus which caused chicken pox in the patient, usually many years earlier.
The virus passes down a nerve to the skin where it causes the symptomatic blistering rash.
It is not known why exactly why the viral reactivation is triggered, although it has been associated with several different bodily events, mainly involving a weakened immune system. (4)
When does Shingles occur?
Shingles occur when there is a lowering in the immunity or the individual. This could be due to:
- old age
- having chicken pox as an infant
- weakened immune system due to medicines like steroids or disease like other viral infections
- infections with HIV/AIDS etc.
- receiving an organ or bone marrow transplant
Shingles tends to occur in people over the age of 50, and it is particularly common in those over the age of 80 – affecting around 11 in every 1000 people each year. (3)
An adult or child who has not had chicken pox earlier may get chickenpox rather than shingles if they come in contact with a patient with shingles rash.
Symptoms of Singles
The condition is characterized by one-sided burning, tingling or numbing pain.
The pain appears before as blistering rash. The individual blisters break to coalesce together to form a raw ulcerated area.
This gets dry and forms crusts over 2 to 3 weeks. Rarely there may be scarring.
The typical area of the rash is on the side of the torso - from the spine to the front of the abdomen or chest. The rash may also appear over face, forehead, eyes, mouth, and ears.
Facial shingles is called Ramsay Hunt Syndrome.
There may also be abdominal pain, fever, chills, drooping eyelids, difficulty in facial muscle movement etc.
Diagnosis of Shingles
Diagnosis is usually made by clinical examination and history of previous chicken pox infection.
Normally, tests are not needed to diagnose Shingles, for the symptoms are sufficient.
A patient may, however, be referred to a specialist if any of the following apply:
- the doctor is unsure of the diagnosis
- the patient is at risk of developing complications
- the patients pain or rash isn’t responding to medication
- the condition is affecting the patient’s ability to control their bladder or bowel
- the doctor is concerned that the eyes are being affected by Shingles (5)
Treatment of Shingles
For treatment, medicine that fights the virus called antivirals are prescribed.
The medications need to be started within 24 hours of feeling pain or burning.
Cold compresses, soothing lotions, pain relievers etc. are prescribed for local pain.
How long does Shingles last?
The condition usually resolves within 2 to 3 weeks and rarely recurs.
Sometimes the nerve pain may persist. This is called Post herpetic neuralgia.
Sometimes shingles can leave a person blind or deaf or paralyzed. The ulcers might also get infected secondarily with bacteria leading to further complications.
Chicken pox is transmitted if a person comes in contact with shingles.
Vaccination especially for the vulnerable like older people and pregnant women may be needed.
A herpes zoster vaccine is available. It is different than the chickenpox vaccine.
Older patients should routinely receive the herpes zoster vaccine. (1, 2)
Incidence of Shingles
The National Health and Nutrition Examination Survey (NHANES 1999-2004) finds that 98% of adults between ages 20 and 49 years in the United States have serologic evidence of varicella infection and are at risk for herpes zoster.
Each year there are an estimated one million cases of herpes zoster in the United States. (2)
According to the NHS, in the UK around 3 in every 1000 people have Shingles every year. (3)
Edited by April Cashin-Garbutt, BA Hons (Cantab)