Shingles

What is Shingles?

Shingles, also known as herpes zoster, is a painful and blistering skin rash caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox. After a person recovers from chickenpox, the virus remains dormant in the nerve cells near the spinal cord and brain. Years later, under certain conditions, the virus can reactivate and travel along the nerves to the skin's surface, causing shingles.

Causes and Risk Factors for Shingles

Shingles can affect anyone who has previously had chickenpox. However, certain factors can increase the risk of developing shingles, including:

• Age: Shingles is more common in older adults, especially those over 50, as the immune system's ability to keep the virus dormant weakens with age.
• Weakened Immune System: Individuals with weakened immune systems due to conditions like HIV/AIDS, cancer, or medications that suppress the immune system are at a higher risk.
• Stress: Stress can sometimes weaken the immune system and trigger a shingles outbreak.
• Injury or Trauma: Physical trauma or injury to the affected nerve can sometimes trigger an outbreak in that area.
• Other Illnesses: Certain illnesses can weaken the immune system, making it easier for the virus to reactivate.
• Varicella Vaccine: People who have received the varicella (chickenpox) vaccine are less likely to develop shingles; if they do, the symptoms are often milder.

Symptoms of Shingles

Shingles typically follows a specific pattern of symptoms and stages:

• Prodromal Stage (Pre-Rash Stage): This is the initial phase of shingles and is characterised by symptoms that may occur before the rash develops. Common prodromal symptoms include:
• Pain: A burning, tingling, or stabbing pain on one side of the body or face, often preceding the rash by several days.
• Sensitivity: The affected area may become sensitive to touch or have an itching or numbing sensation.
• Fever: Some people may experience a low-grade fever, fatigue, and headache.
• Rash Stage: The rash is the hallmark symptom of shingles. It typically appears several days after the prodromal symptoms and follows a specific pattern:
• The rash often starts as a red patch or strip on one side of the body or face.
• It quickly develops into clusters of fluid-filled blisters.
• The blisters can break open, ooze, and form crusts.
• The rash is usually painful and can be very itchy.
• It follows the path of a nerve, so it is usually confined to one side of the body or face, often in a band-like pattern.
• Healing Stage: Throughout about 2 to 4 weeks, the blisters begin to dry up and form scabs. The pain and discomfort gradually subside during this stage. Once the scabs fall off, there may be some residual redness or discolouration at the site of the rash.

Types of Shingles

There is one main type of shingles caused by the varicella-zoster virus. However, shingles can affect different parts of the body, leading to variations in symptoms and complications. Some specific types of shingles include:

• Herpes Zoster Ophthalmicus: When shingles affects the eye area, it's known as herpes zoster ophthalmicus. This can be more serious and lead to eye complications if not promptly treated.
• Disseminated Shingles: In rare cases, the rash can spread to other parts of the body beyond the primary dermatome (area of skin supplied by a single nerve). Disseminated shingles can be more severe and is more common in people with weakened immune systems.
• Internal Shingles: Shingles can also affect internal organs, leading to herpes zoster encephalitis or herpes zoster meningitis, which involves brain or spinal cord inflammation.

While the primary symptom of shingles is a painful rash, the virus can also cause complications, including postherpetic neuralgia (persistent pain after the rash has cleared), bacterial skin infections, and, in rare cases, neurological complications.

Diagnosis of Shingles

Shingles is typically diagnosed based on the clinical presentation of symptoms, especially the characteristic rash and pain. A doctor can often identify shingles based on the physical examination. In some cases, additional tests may be performed to confirm the diagnosis or rule out other conditions. These tests may include:

• Visual Examination: doctors can often diagnose shingles by examining the rash and considering the pattern of blisters and the associated pain.
• Viral Culture: A swab of the rash or a sample of fluid from the blisters can be tested in a laboratory to confirm the presence of the varicella-zoster virus.
• Polymerase Chain Reaction (PCR) Testing: This molecular test can detect the virus's genetic material and is highly accurate in diagnosing shingles.

Treatment of Shingles

The treatment of shingles aims to alleviate symptoms, reduce pain, and prevent complications. It typically includes the following:

• Antiviral Medications: Antiviral drugs, such as acyclovir, valacyclovir, or famciclovir, are commonly prescribed to help reduce the severity and duration of the shingles outbreak. They are most effective when started within 72 hours of the rash's appearance.
• Pain Relief: Over-the-counter pain relievers like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended to manage the pain and discomfort associated with shingles.
• Topical Treatments: Some topical creams or ointments containing capsaicin or lidocaine can be applied to the rash to help alleviate pain and itching.
• Antiviral Eye Drops: In cases of herpes zoster ophthalmicus (shingles affecting the eye), antiviral eye drops may be prescribed, and an ophthalmologist should be consulted.
• Postherpetic Neuralgia (PHN) Treatment: If pain persists after the rash has healed, your doctor may recommend medications specifically for nerve pain, such as gabapentin or pregabalin.
• Preventive Measures: To prevent further complications and reduce the risk of postherpetic neuralgia, vaccination with the shingles vaccine (Shingrix) is recommended, especially for older adults.

What if Shingles is Untreated?

Untreated shingles can lead to various complications, including:

• Postherpetic Neuralgia (PHN): This is the most common complication of shingles. PHN is characterised by persistent, severe pain in the area where the shingles rash occurred. It can last for months or even years and may significantly affect the quality of life.
• Secondary Infections: Scratching the rash can lead to bacterial skin infections, which may require antibiotics for treatment.
• Eye Complications: Herpes zoster ophthalmicus can cause vision problems and, if left untreated, may result in permanent eye damage.
• Neurological Complications: In rare cases, shingles can lead to neurological complications such as encephalitis or meningitis, which can be life-threatening.

Seek medical attention promptly if you suspect you have shingles, as early treatment can help mitigate symptoms and reduce the risk of complications. If you experience severe or unusual symptoms, such as eye pain or neurological symptoms, it's especially important to consult a healthcare professional promptly to prevent potential complications.