�Diseases, Conditions and Injuries

Shingles

(Herpes Zoster)

En Espa�ol (Spanish Version)

Definition

Shingles is a painful infection of the nerves and skin caused by the varicella zoster virus. This is the same virus that causes chickenpox.

Causes

Shingles occurs in people who have already had chickenpox. It is considered a reactivation of the dormant varicella zoster virus. After causing the initial chickenpox infection, the virus does not leave the body. Instead, it settles in the nerve roots. Once reactivated, the virus travels along the nerve paths to the skin. There it produces the pain and rash.

Herpes Zoster Blisters

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Age: 50 or older
Compromised immune system, as in:
- People infected with HIV
- Patients with lymphoma or leukemia
Excessive fatigue
Physical or psychological stress
Radiation therapy

Shingles cannot be transmitted from one person to another. However, contact with a person who has shingles could lead to chickenpox in someone who has never had chickenpox and has not received the varicella vaccine.

Symptoms

Symptoms include:

Rash:
- Appears as a red, slightly raised band or patch often overlain with multiple small fluid-filled blisters
- Develops on one side of the body or the other, but does not cross the midline
- Blisters usually dry out and crust over within several days
- Most commonly affects the torso and face
In severe cases, the eyes may be affected, which can seriously threaten vision.
Pain on the skin at the site of the rash, which is usually severe
Tingling or itchiness on the skin, which may start a few days before the rash
Skin in the affected area that is unusually sensitive to touch
Fever
Headache
Tiredness

The rash usually disappears within three weeks, but the pain may linger. In some patients, however, the pain continues long after the rash has healed. This complication is called post-herpetic neuralgia (PHN). It refers to pain that is present in the affected area for months, or even years afterward. The pain of PHN is difficult to treat and can be very severe.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Usually the rash can be diagnosed by its appearance. Rarely, drawing fluid from the blisters and sending it to a lab is necessary to confirm the diagnosis.

Treatment

Like any viral condition, shingles cannot be cured.

Treatment includes:

Itch and Pain Relief

Relief for itching includes:

Calamine lotion
Wet compresses
Frequent oatmeal baths

Over-the-counter pain relievers include:

Acetaminophen (Tylenol)
Ibuprofen (Advil)
Naproxen (Aleve)

Prescription drugs may be given to help relieve pain that doesn't respond to over-the-counter remedies.

Oral Antiviral Drugs

Certain antiviral medications may help control shingles by hindering reproduction of the virus in the nerve cells. They include:

Acyclovir (Zovirax)
Famciclovir (Famvir)
Valacyclovir (Valtrex)

Antiviral therapy may shorten the course of an episode of shingles, but only if started within 48-72 hours after symptoms develop.

Relief for PHN

Tricyclic Antidepressants � medications that help some people with PHN pain. These drugs are typically prescribed in doses lower than those needed to treat depression. They include:

Amitriptyline
Nortriptyline
Doxepin

Lidoderm Patch � a transdermal form of lidocaine (a local anesthetic)

Transcutaneous Electrical Nerve Stimulation (TENS) � a device that generates low-level pulses of electrical current and applies it to the skin's surface. This causes a tingling sensation that offers some pain relief.

Nerve Blocks � these are injections near nerves that may be used to provide temporary pain relief (only used as a last resort)

Prevention

There is no proven way to prevent an outbreak of shingles, although avoiding undue stress and fatigue may help prevent an outbreak. Cases of shingles should theoretically diminish as more children avoid chickenpox by receiving the varicella vaccine.

RESOURCES:

VZV Research Foundation (for research on Varicella Zoster)
http://www.vzvfoundation.org

SOURCES:

"Management of herpes zoster and postherpetic neuralgia." American Family Physician, April 15, 2000.

The Merck Manual of Geriatrics (on-line edition). Merck and Co., 2000.

"Shingles: An Unwelcome Encore." FDA Consumer Magazine, May-June, 2001.

Triage Reviewed by EBSCO Medical Review Board in September 2005