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What is shingles/herpes zoster?
Shingles or herpes zoster is an infection which is characterized by a painful blistering skin rash.
The rash usually affects one side of the body, i.e. the torso and/or one side of the face. It appears in a band formation and therefore the name ‘shingles’, which is Latin for ‘belt’. Shingles is caused by the same virus that causes chickenpox, called the varicella-zoster virus.
The initial warning symptoms appear one to five days before the rash appears. You will feel the warning signs on the location where the rash will appear. These initial symptoms include itching, pain, burning, pricking and stabbing sensation, followed by high fever, chills and muscle pain. The tell-tale rash appears soon after.
If you experience any of these symptoms you need to contact your family physician or a general practitioner without delay.
How does shingles/herpes zoster occur?
When a person (usually children) gets infected by the varicella-zoster virus, he/she develops chickenpox. After the chickenpox heals, the virus remains in a dormant state in the nerve roots or the dorsal root ganglia, which contains the cell bodies of sensory neurons. Years later, this virus may wake up to cause an outbreak of shingles or herpes zoster.
Although the reason for its waking up is not certain, experts believe a variety of conditions can lead to its activation such as
- normal ageing
- weakening of the immune system
- stress and anxiety
Healthy people and young children too are not exempt from the risk. In fact, anyone who has had chickenpox is at a high risk of developing herpes zoster or shingles.
Appearance of the Blistering Rash
The distinctive feature of this illness is the rash that appears on one side of the body. The rash is accompanied by a pricking and sometimes stabbing pain. It erupts into clusters of small red patches that develop into blisters.
Within 7 - 10 days the blisters break open and a fluid comes out. During this period, if anyone who never had chickenpox before, accidentally touches the oozing blisters of the patient, he/she will develop chickenpox.
Once the fluid comes out, the rash slowly begins to dry and crust. The rash disappears completely after two to four weeks. When the blisters scab and dry, the virus cannot spread anymore.
Because herpes zoster affects the nerve cells in the body, it is very common for the rash to appear in the formation of a band on one side of the body along the path of a nerve.
In some people, the rash may spread to the eyes, and occur inside the eyelids. This can be extremely painful, with the person experiencing stabbing pains in the eye, constant eye watering, sensitivity to light, and blurry vision.
The symptoms in the eyes usually vanish within three to five weeks.
A person with shingles cannot transmit shingles to another person. Though, he can transmit chickenpox to a person, who has never had chickenpox before.
Post-Herpetic Neuralgia (PHN)
Around 20% of the people who suffer from shingles may develop a condition known as post-herpetic neuralgia. This occurs when the proper functioning of a nerve is disrupted due to the damage caused to it by shingles. It is commonly believed that shingles causes scar tissue to develop around the nerve, which when inadvertently pressed, causes pain signals to go to the brain.
Experts, however, are not clear as to why some people go on to develop PHN.
The person suffering from PHN will experience a sudden throbbing, burning, shooting, or even a stabbing pain along the damaged nerve for months, or even years, after the rash has healed.
In some cases, the pain may be continuous for a few months after the rash has healed, however, if the condition runs into years, the person will experience paroxysms of pain along the nerve.
Who is prone to shingles/herpes zoster?
You are at an increased risk of shingles if you:
- have had chickenpox as a child
- are above 50 years of age. The risk increases with age, no matter how healthy you are
- a weak immune system
- are experiencing any stress or trauma
- are suffering from any illnesses such as diabetes, HIV, cancer
- are taking any medications that affect the immune system such as steroids
- are taking treatments for certain ailments such as cancer
- are recuperating from any illness, be it even a cold, or flu
- have erratic sleeping patterns
- are suffering from malnutrition
What are the symptoms of shingles/herpes zoster? How is shingles/herpes zoster diagnosed?
The most common symptoms of shingles include:
- a dull constant pain which can be mild or severe, or an intermittently shooting pain in the affected area
- soreness, burning sensation, itching, or numbness in the affected area
- exhaustion
- fatigue
- sensitivity to light
- fever
- headache
- the appearance of a painful, itchy and red rash on one side of the body and sometimes in and around the eyes
- a sensation of pins and needles piercing through in the areas of the rash
- throbbing pain in the eye with burning sensation and irritation
- soreness and redness in and around the eye
- extreme sensitivity to light
- constant eye watering
- blurred vision
Diagnosis
Your general physician can immediately diagnose shingles based on the symptoms.
If the diagnosis is not clear, the doctor may ask you to undertake lab tests, which usually involves scraping a part of your blisters formed from the rash, and testing it in the lab.
What are the complications of shingles/herpes zoster?
Shingles is a self-limiting condition which disappears within three weeks. However, in people with very low immunity, it may take a serious turn. Delaying, or not undertaking medical treatment can cause serious complications which include:
- Postherpetic Neuralgia - which is nerve pain caused by the damage to nerves by the varicella-zoster virus. The stabbing pain can remain for months and even for years in patients.
- Eye Complications - which can occur if the rash spreads to the eyes. Swelling of the cornea may occur which can leave permanent scars. Shingles in the eye can also cause the retina to swell, or increase pressure in the eye which can lead to glaucoma and eventually loss of vision.
- Skin Infections - may occur if the area affected by the rash is not kept clean, which can lead to scarring.
- Neurological Complications - can ensue if the shingles affects the nerves in the brain. The neurological complications include Guillain-Barre Syndrome, Ramsay Hunt Syndrome, Bell’s palsy, encephalitis, meningitis, and even stroke anytime in the year following the illness.
- Disseminated Herpes Zoster- is when the virus spreads to other organs. People with compromised immune systems ( those suffering from cancer, HIV/AIDS), are at a risk of Disseminated Herpes Zoster. This can be life-threatening especially if it affects the lungs.
What is the treatment for shingles/herpes zoster?
Though there is no known cure or for that matter treatment for shingles, your general physician may prescribe antiviral medicines, which will reduce the pain and duration of shingles. He may also prescribe some topical antibiotics to apply on the rashes which will reduce the stinging and prevent infection.