Shingles

What is "shingles"?
Shingles, medically termed Herpes zoster, is a skin rash caused by the same virus that causes chickenpox.  The virus responsible for these conditions is called Varicella zoster.  After an individual has chickenpox, this virus lives in the nerves and is never fully cleared from the body.  Under certain circumstances, such as emotional stress, immune deficiency (from AIDS or chemotherapy) or with cancer, the virus re-activates causing shingles.  In most cases, however, a cause for the reactivation of the virus is never found.  The herpes virus that causes shingles and chickenpox is not the same as the herpes virus that causes genital herpes (which can be sexually transmitted) and herpes mouth sores.

How do shingles start and progress?
Before a rash is visible, the patient may notice several days to a week of burning pain and sensitive skin.  Shingles start as small blisters on a red base, with new blisters continuing to form for 3-5 days.  The blisters follow the path of individual nerves that comes out of the spinal cord (called dermatomal pattern).  The entire path of the nerve may be involved or there may be areas with blisters and areas without blisters.  Generally, only one nerve level is involved. In a rare case, more than one nerve will be involved.  Eventually, the blisters pop and the area starts to ooze.  The area will then crust over and heal.  The whole process may take 3-4 weeks from start to finish.  On occasion, the pain will be present but the blisters may never appear.  This can be a very confusing cause of local pain.

Are shingles contagious?
Yes.  Shingles can be spread from an affected person to children or adults who have not had chickenpox.  Instead of developing shingles, these people develop chickenpox.  Once they have had chickenpox, people cannot catch shingles (or contract the virus) from someone else.  Once infected, however, persons have the potential to develop shingles later in life.

Shingles are contagious, to persons that have not previously had chickenpox, as long as there are new blisters forming and old blisters healing. Once all of the blisters are crusted over, the virus can no longer be spread.

What is the treatment for shingles?  Should I visit my health care provider?
There are several effective treatments for shingles.  Drugs that fight viruses (antivirals), such as acyclovir (Zovirax) or famciclovir (Famvir) can reduce the duration of the rash if started early (within 48 hours of the appearance of the rash).  The addition of steroids may also limit the length of time that a patient has pain with shingles.  However, the benefit of both of these drugs is limited.

In addition to antiviral medication, pain medications may be needed for symptom control.  The affected area should be kept covered and dry.  However, bathing is permitted and the area can be cleansed with soap and water.  An aluminum acetate solution (Burow's or Domeboro's solution, available at your pharmacy) can be used to help dry up the blisters and oozing.

What are the complications of shingles?
Generally, shingles heal well and problems are few.  However, on occasion, the blisters can become infected with a bacteria causing cellulitis, a bacterial infection of the skin.  If this occurs, the area will become reddened, warm, firm, and tender.  You might notice red streaks forming around the wound.  If you notice any of these symptoms, contact your health care professional.  Antibiotics can be used to treat these complications.

A more worrisome complication occurs when shingles affect the face, specifically the forehead and nose.  In these cases, it is possible, although not likely, that shingles can affect the eye leading to loss of vision.  If you have shingles on your forehead or nose, your eyes should be evaluated by a health care professional.

What is postherpetic neuralgia and what can be done for it?
Postherpetic neuralgia is localized pain in the area of involvement of shingles that persists beyond one month.

The most common complication of shingles is postherpetic neuralgia.  This occurs when the pain associated with shingles persists beyond one month, even after the rash is gone.  The pain can be severe and debilitating and occurs primarily in persons over the age of 50.  There is some evidence that treating shingles with steroids and antiviral agents can reduce the duration and occurrence of postherpetic neuralgia.  However, the decrease is minimal.

The pain of postherpetic neuralgia can be reduced by a number of medications.  Tricyclic antidepressant medications [amitriptyline (Elavil) and others], as well as anti-seizure medications [gabapentin (Neurontin), carbamazipine (Tegretol)], have been used to relieve the pain associated with herpetic neuralgia.  Finally, capsaicin cream (Zostrix), a derivative of hot chili peppers, can be used topically on the area after all the blisters have healed, to reduce the pain.  Acupuncture and electric nerve stimulation through the skin can be helpful for some patients.  Lidocaine pain patches can also be helpful in relieving nerve pains.  These options are best discussed with your health care provider.