Shingles, or herpes zoster, is a painful viral infection caused by the varicella-zoster virus, the same virus responsible for chickenpox. It manifests as a blistering rash. While not life-threatening, shingles can be very painful.
What Causes Shingles and Who is At Risk
Shingles develops from the reactivation of the varicella-zoster virus, which lies dormant in nerve cells after a person has recovered from chickenpox. The virus can remain inactive for many years before reactivating, often correlating with a weakening immune system.
Aging is a primary risk factor, with individuals over 50 having a significantly higher likelihood of developing shingles. The immune system naturally declines with age, making it less effective at keeping the dormant virus in check. People over 60 are also more prone to experiencing severe complications.
A weakened immune system, regardless of age, also increases the risk of reactivation. This can result from certain medical conditions or medications that suppress the immune system.
Recognizing Shingles Symptoms
The onset of shingles often begins with early signs preceding the characteristic rash. Individuals may experience pain, burning, tingling, or itching in a specific skin area where the rash will eventually appear. This sensation can occur several days before any visible skin changes.
A few days later, the distinctive rash typically emerges as a single stripe of blisters on one side of the body or face. The rash commonly forms around the chest and abdomen, but can appear anywhere. These red bumps quickly evolve into fluid-filled blisters that crust over within 7 to 10 days. The blisters then dry out and scab over, usually clearing within two to four weeks. Other general symptoms can include fever, headache, chills, and an upset stomach.
Treating and Managing Shingles
While there is no cure for shingles, early antiviral medications can help manage the infection and reduce complications. Medications such as acyclovir, valacyclovir, and famciclovir are commonly prescribed. These antivirals are most effective when started within 72 hours of the rash appearing to shorten the duration and severity of the illness.
Pain management is an important aspect of shingles treatment. Over-the-counter pain relievers like acetaminophen or ibuprofen can alleviate milder discomfort. For more severe pain, healthcare providers may prescribe stronger medications, including certain anticonvulsants or tricyclic antidepressants for nerve pain. Topical treatments, such as lidocaine creams, gels, or patches, can also provide localized pain relief.
Home care strategies can further aid in symptom management and promote healing. Keep the rash clean and dry to reduce the risk of secondary bacterial infections. Applying cool compresses or taking cool baths with colloidal oatmeal can help soothe itching and discomfort. Wear loose-fitting clothing and avoid scratching blisters to prevent scarring and infection. If symptoms worsen or new concerns arise, prompt medical attention is recommended.
Preventing Shingles
Vaccination stands as the most effective method for preventing shingles and its potential complications. The recombinant zoster vaccine (RZV), known as Shingrix, is currently recommended. This vaccine is given as a two-dose series, with the second dose typically administered two to six months after the first.
The Centers for Disease Control and Prevention (CDC) recommends Shingrix for healthy adults aged 50 years and older. It is also advised for adults aged 19 and older who have weakened immune systems due to disease or therapy. Shingrix provides strong protection, showing over 90% effectiveness in preventing shingles in adults 50 and older.
Even individuals who have previously had shingles or received an older shingles vaccine (Zostavax, which is no longer available in the U.S.) are advised to get Shingrix. The vaccine helps prevent future occurrences and reduces the risk of long-term nerve pain. Common side effects are generally mild and temporary, including soreness, redness, or swelling at the injection site, as well as headache or fatigue.
Potential Complications
While most people recover from shingles without lasting issues, some may experience complications. The most common and significant complication is postherpetic neuralgia (PHN), which involves persistent nerve pain in the area where the rash occurred, even after the blisters have healed. PHN can last for months or even years and can be debilitating.
Less common but serious complications can arise, particularly if shingles affects certain areas of the body. If the rash occurs in or around the eye (ocular shingles), it can lead to painful eye infections and potentially vision loss. Shingles can also cause neurological problems, such as facial paralysis, or issues with hearing and balance. In rare instances, more widespread complications like brain inflammation or pneumonia can occur. Prompt medical attention is important if any of these specific symptoms develop.