Zoster, more commonly known as shingles, is a viral infection that produces a painful rash. It is caused by the same virus responsible for chickenpox, which remains inactive in the body after the initial illness and can reemerge years later. While not life-threatening, the pain can be intense, and prompt medical care helps manage its duration and severity.
The Virus Behind Shingles
After a chickenpox infection, the varicella-zoster virus (VZV) is not eliminated but enters a dormant state. It resides in nerve tissue near the spinal cord and brain, where it can remain inactive indefinitely.
The virus can reactivate years or decades later, traveling along nerve pathways to the skin, causing shingles. The trigger for this reactivation is not fully understood but is strongly linked to a decrease in immunity. A primary risk factor is advancing age, with individuals over 50 being more susceptible.
Conditions that compromise the immune system, such as HIV/AIDS and certain cancers, also increase the risk of VZV reactivation. The use of immunosuppressive medications, like steroids or drugs taken after an organ transplant, can also weaken the body’s defenses.
Signs and Symptoms of a Zoster Infection
The symptoms of a zoster infection appear in stages and affect a small section on one side of the body. The initial phase begins one to five days before any visible rash. During this time, individuals may experience localized sensations of pain, burning, tingling, or itching in a specific area.
Following the initial symptoms, the rash emerges as a single stripe of fluid-filled blisters that wraps around either the left or right side of the torso. The rash can also manifest on one side of the neck or face. The blisters eventually break open and form crusts, a process that takes 7 to 10 days.
In addition to localized rash and pain, some people experience more general, systemic symptoms. These can include fever, chills, headache, and fatigue.
Medical Treatment for Zoster
There is no cure for shingles, but prompt medical intervention can manage the condition. Prescription antiviral medications like acyclovir, valacyclovir, and famciclovir work to reduce the severity of the illness and speed healing. For the best results, these medications should be started within 72 hours of the rash’s first appearance.
Managing the severe pain associated with the infection is another focus of treatment. Over-the-counter pain relievers can provide relief for milder cases. For more intense pain, a healthcare provider might prescribe medications like anticonvulsants or certain antidepressants that calm nerve pain. Topical treatments can also be used to soothe the skin.
Applying cool compresses to the affected area can help ease discomfort, and calamine lotion can relieve itching. Seeking timely medical treatment helps manage immediate symptoms and lowers the risk of developing postherpetic neuralgia, a long-term complication where nerve pain persists after the rash has cleared.
Zoster Prevention and Transmission
A person with shingles cannot transmit the condition to another person. However, the varicella-zoster virus (VZV) can be spread from an active shingles rash to someone who has never had chickenpox or the chickenpox vaccine. This transmission occurs through direct contact with the fluid from the shingles blisters.
If a non-immune person is exposed to VZV this way, they will develop chickenpox, not shingles. A person with shingles is no longer contagious once the blisters have crusted over. Covering the rash helps prevent spreading the virus to others.
The most effective method of preventing zoster is vaccination. The shingles vaccine, Shingrix, is recommended for adults 50 and older and is administered in two doses. It is highly effective in preventing shingles and also reduces the risk of developing postherpetic neuralgia.