What is shingles
Shingles (or "herpes zoster") is a blistering skin rash caused by a virus (the herpes zoster virus). When a person is first infected with the virus, it causes chickenpox. This virus lives in the nerves of the body where it usually remains dormant for many years. Often this causes no further problems, but in certain circumstances when the body's immunity may be reduced, the virus may become reactivated and the condition then develops. The illness usually starts with a tingling or burning sensation or frank pain on the skin of one side of the trunk, front and back in the area covered by the affected nerve. Between four and seven days later the rash appears.
The rash itself starts as a reddening of the skin in the area corresponding to the nerve distribution on the surface of the skin. Following this the blisters appear. They eventually burst to leave open raw wounds that can occasionally become infected. The rash frequently clears up within two to three weeks or more quickly if it is treated promptly. people of any age can acquire the infection and each year it is estimated that a quarter of a million people contract it. However, it does occur most commonly in middle aged or elderly people.
What causes the infection
The virus responsible for the infection is in fact the chickenpox virus which causes a common childhood virus infection in children. It is this which is responsible for the physical appearance of the rash. The virus remains dormant permanently in nerves in certain areas of the body and, in general, there are no further problems.
However, in some cases where, for instance, one is run down or is suffering from a prolonged illness, the body defences may become weakened thus allowing the dormant virus to become active again. When this happens the shingles infection appears.
What are the symptoms
Most cases occur after the age of 50 years and early on in the condition the pain can closely resemble other illnesses such as pleurisy, gall bladder pain or even angina. Therefore, it is important to seek help from your general practitioner as soon as possible.
The rash itself is typically a collection of small blisters which appear suddenly along a segment of the skin surface corresponding to the path that the nerve follows beneath the skin. Once the rash has broken out fresh crops will be seen over the next few days extending along the area of the skin. These crops of moist tiny blisters dry out within 48 hours to form scabs and after approximately three weeks the rash dries out and fades away.
After the blisters have healed the skin may remain slightly discoloured or scarred and the pain may persist over the site of the rash for many weeks.
Is the rash infectious
people do not "catch" shingles from each other as it is not spread through the air like other infections. When someone has shingles it can cause a chickenpox infection to occur in somebody who has never had this and who is therefore not immune to chickenpox. This means that if you have shingles you should avoid close contact with certain people:
- Babies and young children who have not had chickenpox
- pregnant women who have not had chickenpox and who can pass on the infection to the unborn child
- people with weakened immune systems such as cancer patients or AIDS patients and who can pick up these infections easily
Can shingles be treated
It is very important to seek help as early as possible in order to increase the chances of complete cure. Treatment will usually consist of a course of tablets, called Acyclovir or Famciclovir. These are designed to stop the spread of the virus, aid the rapid healing of the rash and alleviate the pain. It is important that the tablets are taken as prescribed and the course completed in order to be certain that the virus has been completely treated and eliminated.
There are a number of things that you as a patient can do to help relieve the skin irritation and soothe the rash.
- Keep the skin cool and dry. Ice cubes will help
- Avoid wearing nylon and instead use cotton clothes which will help the skin to breathe
- Calamine lotion will help cool and soothe the skin
- Try to avoid scratching the rash as this will increase the chances of infection developing
What are the complications of shingles
The most common and distressing complication is the persistent and severe pain called "post herpetic neuralgia". This is an intense persistent burning pain occurring in the same area as the rash and which may persist for weeks, months, or in some cases years after the disappearance of the rash. It is seen almost exclusively in the elderly. This pain can be accompanied by extreme sensitivity to direct contact, such as clothing, wind, or heat and cold.
The incidence is estimated at about 50% probability of developing the condition if you are 60 years old or more. It is much less common in the young. The cause of this pain is not understood but may be due to inflammation occurring in the nerves themselves. The pain usually resolves within two months in 50% of those affected and within twelve months in 70-80% of causes. It can, however persist for many years in a few cases, before disappearing completely.
Another complication can occur if shingles affects the eye. In these cases the shingles will cover part of the face and, because it may involve the nerve which travels to the eye, it can result in inflammation of the front of the eye. It is particularly important in these cases for the sufferer to seek early medical advice as they may need special treatment to the eye. This may be in the form of eye drops or ointment to limit the effect of the shingles on the eye.
Can the nerve pain (neuralgia) be treated
If diagnosed and treated early, there is a good chance of recovery. If there is a delay beyond three months, then the chances of full recovery are reduced. Do not delay seeking help.
There are a variety of possible treatments which, although not curing the pain, do make you feel better. These range from creams such as Calamine cream or one called Axsain, which is specifically designed for this purpose, to tablets called Amitriptyline. These are usually given to treat depression, but are also prescribed for this. Complementary treatments include aromatherapy and acupuncture. TENS treatment can also help. This involves the wearing of a special small device which delivers little pulses of electricity to the area affected by the pain. It works in the same way as when someone rubs part of the body which is in pain. The electrical pulses 'distract' the brain from the pain signals which are travelling along the nerves from the same part of the body.
Where can I get more information
Apart from contacting your own Gp the following organisations may be of help:
The Shingles Support Society (Affiliated to the Herpes Virus Association)
41 North Road
Helpline 020 7609 9061
The pain Research Institute
- ANDIMAN, R.M. et al. (1994) post herpetic neuralgia : the pain that lingers, patient Care , September 15, pp21-24
- BOWSHER, D. Shingles pain. Dealing with pain series : no. 1
- Liverpool, The pain Relief Foundation