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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Shingles (Herpes Zoster)
What is shingles?
Shingles is an infection caused by the same virus that
causes chickenpox. This virus is called varicella zoster.
Varicella refers to chickenpox and zoster to shingles. You
cannot develop shingles unless you have had a previous
infection of chickenpox (usually as a child).
Shingles is also called herpes zoster, because the varicella
virus is in the larger herpes family of viruses.
Shingles is most common in people over 60 years of age, but
can occur in young people as well.
How does it occur?
After you recover from chickenpox, the chickenpox virus is
not destroyed, but goes back to the roots of your nerve
cells (near the spinal cord) and becomes dormant, or
inactive. Later, when the chickenpox virus is reactivated,
the symptoms are called shingles.
What causes the reactivation of the virus is not known. A
weakened immune system seems to allow reactivation of the
virus. This may occur with immune-suppressing medications,
with another illness, or after major surgery. It is also
seen as a complication of cancer or AIDS. Advancing age,
chronic use of cortisone-type drugs, and the stress of major
surgery may trigger shingles. The virus may also become
active again after trauma to the skin from injury or
sunburn. Emotional stress seems to be a common trigger as
well.
What are the symptoms?
The first sign of shingles is often burning, sharp pain,
tingling, or numbness in or under your skin on one side of
your body or face. The most common site is the back or
upper abdomen. You may have severe itching or aching rather
than pain. You also may feel tired and ill with fever,
chills, headache, and upset stomach.
After several days, you will notice a rash of small, clear,
fluid-filled blisters on reddened skin. Within 3 days after
they appear, the blisters will turn yellow, then dry and
crust over. Over the next 2 weeks the crusts will drop off,
sometimes leaving small, pitted scars.
Because they tend to follow nerve paths, the blisters are
usually found in a line, often extending from the back or
flank around to the abdomen, just on one side. Shingles
usually doesn't cross the midline of the body. The word
shingles comes from the Latin word for belt or girdle. The
rash also may appear on one side of your face. Some people
have painful eye inflammations and infections.
Is shingles contagious?
A person with shingles can transmit chickenpox to a person
who has never had the virus. There are virus particles in
the blister fluid.
Shingles is much less contagious than chickenpox because
chickenpox can be spread through the air, whereas spread of
shingles occurs only with direct contact or indirect contact
(for example, a washcloth) with the blister fluid.
If you have shingles, avoid contact with infants, children,
pregnant women, and adults who have never had chickenpox
until your blisters are completely dry.
How is shingles diagnosed?
Your doctor will diagnose shingles based on the history of
your symptoms and the appearance of the blisters on one side
of your body. Your doctor may order lab tests to look for
the virus in fluid from a blister.
What is the treatment?
The shingles virus has to run its natural course, but you
can get some relief by:
- applying cool compresses
- taking acetaminophen or other mild pain relievers.
Your doctor also may prescribe:
- stronger painkillers for more serious discomfort
- antibacterial salves or lotions to control skin infection
- capsaicin cream for pain
- acyclovir, an antiviral drug, to speed recovery and
lessen chance of prolonged symptoms from nerve
inflammation
- corticosteroids, for people over 50.
New antiviral drugs have become available for treating
shingles. The goal is to shorten the course of painful
symptoms, minimize blister formation, and speed healing. To
be most effective, these medicines should be started as
early as possible.
Another approved use of antiviral drugs is to prevent
postherpetic neuralgia. This is a condition of persistent
numbness or tingling or pain along the course of the
affected nerve that may last for months or even years after
the shingles rash. This problem is most likely to occur
after a shingles outbreak in a person over 50. The medicine
is prescribed at the time the shingles is diagnosed and must
be taken for 7 days.
How long will the effects last?
The rash from shingles will heal in 1 to 2 weeks and the
pain or irritation will usually disappear within 3 to
5 weeks. However, if the virus damages a nerve, you may
have pain, numbness, or tingling long after the rash is
healed.
Rare effects of shingles include headaches and paralysis of
one side of the face (droopy face). Even if you have a
severe case, however, your symptoms will all eventually go
away, although it may take months or years.
How can I take care of myself?
You should rest in bed during the early stages if you have
fever and other symptoms. Your rash may be irritated by
contact with clothing or bed linen.
What can be done to prevent shingles?
A vaccine to prevent chickenpox is now available. You also
can protect your immune system and lessen your chances of
getting shingles by keeping your stress under control.
When should I call my doctor?
You should see your doctor for the initial diagnosis and for
age-appropriate treatment. After your initial visit, you
should contact your doctor if:
- You develop worsening pain or fever.
- There are signs of bacterial infection of the blisters
(for example, increasing pain, redness, or milky-yellow
drainage from the blister sites).
- The blisters are close to the eyes.
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