Shingles

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VOL 113 / NO 6 / JUNE 2003 / POSTGRADUATE MEDICINE

It started as a tingly, itchy feeling on one side of your back, where a painful rash broke out a few days later. Your doctor tells you that you have shingles, an infection that affects up to 1 million people in the United States each year.

What is shingles?
Shingles, which is also called herpes zoster (her-peez zäs-ter), occurs in some people who have had chickenpox. The virus that causes chickenpox, varicella (var-ih-sel-a) zoster, stays in the body's nerve tissue and can become active again--usually many years later. It travels down a nerve and breaks out on the skin in a rash that looks like chickenpox. The bandlike appearance of the rash led to the name shingles, which comes from cingulum, the Latin word for girdle or belt.

No one knows what reactivates the chickenpox virus, but some experts think it may be age or stress. Most people recover from shingles and never have it again; only about 4% go on to have another episode.

Who gets shingles?
About 2 of every 10 people have shingles at some time in their life. This condition usually occurs after age 50, but it can affect younger people--particularly if their immune system has already been weakened by such things as HIV infection, cancer, chemotherapy, or radiation therapy.

What are the symptoms of shingles?
The first symptom usually is a burning sensation, numbness, itchiness, or stabbing pain, typically affecting the trunk or face--but only on one side of the body. A fever and a general overall feeling of weakness may also be present. After a few days, a rash begins as clusters of small bumps that become clear, fluid-filled blisters. Later, the blisters fill with cloudy fluid, break open, and begin to crust. Some people experience only mild itchiness; others have extreme and intense pain. After the scabs from the blisters fall off within a few days to a few weeks, the pain fades, and most people have no complications.

However, some people who have shingles on their face may experience temporary or permanent problems with hearing or vision, or both. Others may have temporary paralysis of the face, problems with sleep, anxiety, depression, or an inflammation of the brain called encephalitis (en-sef-ah-lie-tis). People who scratch their rash may get an infection, which can lead to scarring.

Shingles can be especially serious in people with a weak immune system, in whom the virus can spread to the internal organs and affect the lungs and brain. Other people have painful aftereffects known as postherpetic neuralgia (post-her-pet-ik nu-ral-ja). This condition, which is more likely to occur in older people, may last for months or years. It can cause the skin to be so sensitive that wearing clothing is very painful.

Is shingles contagious?
It is possible for a person who has never had chickenpox to get chickenpox (but not shingles) from someone with shingles.

How is shingles diagnosed?
Before the rash appears, it can be easy to mistake shingles for other conditions (for example, kidney stones, appendicitis, or heart attack), depending on the nerve that is affected. Once the rash breaks out, doctors can tell shingles apart from chickenpox by the pattern of the rash. If the diagnosis is still in doubt, laboratory tests can confirm it.

How is shingles treated?
If started within 48 hours of the first symptoms, antiviral drugs such as acyclovir, valacyclovir hydrochloride, or famciclovir may shorten a shingles attack, make it less painful, and lessen the chance of postherpetic neuralgia. Pain relievers and cold compresses may also be helpful. If post-herpetic neuralgia develops, some people may benefit from steroids, antidepressants, anticonvulsants, nerve blocks, or creams or ointments applied to the skin. Others may respond to relaxation exercises such as biofeedback or a technique called transcutaneous electrical nerve stimulation (TENS), in which small amounts of electric current are sent to the affected nerve.

Current research is focusing on development of a vaccine to prevent shingles.

For further information:

National Chronic Pain Outreach Association
PO Box 274
Millboro, VA 24460
540-862-9437
http://www.chronicpain.org

National Foundation for the Treatment of Pain
1330 Skyline Dr, #21
Monterey, CA 93940
831-655-8812
http://www.paincare.org

National Institute of Neurological Disorders and Stroke
National Institutes of Health Neurological Institute
PO Box 5801
Bethesda, MD 20824
800-352-9424
http://www.ninds.nih.gov/health_and_medical/disorders/shingles.doc.shtml

VZV Research Foundation
40 E 72nd St
New York, NY 10021
800-472-8478
http://www.vzvfoundation.org

This information is not a substitute for medical treatment.

Please send technical questions related to the Web site to Ann Harste