Shingles is often a misunderstood condition, with most people unaware that the viral infection is part of the herpes family virus. Still, the condition is different from herpes and cold sores and is more closely related to chickenpox.
Once exposed, shingles can lie dormant in the body for years, and if you’re a healthy person, you may never experience an outbreak. But for the many people that do experience a shingles outbreak, there are methods for treating the infection quickly and effectively. Here’s all you need to know about the virus.
What are Shingles?
Although shingles are part of the herpes virus family, they are not the same viruses that cause genital herpes and cold sores. Shingles are a painful infection of an individual nerve and the skin surface that is supplied by the nerve. Shingles are caused by the varicella zoster virus, which is the same virus that causes chickenpox.
Similar to Chickenpox
It is not possible to have shingles if you have never been exposed to chickenpox or the varicella virus that causes it. Once exposed, the virus can lay dormant for years and most adults with the dormant virus never experience an outbreak of shingles. In some people, the shingles virus may reactivate many times and it’s most common in people over 50.
There are around one million cases of shingles each year in the United States, with one in three people developing shingles during their lifetimes. Approximately one-half of shingles cases affect people of at least 60 years of age, although they can affect anyone. The varicella zoster virus, which is responsible for chickenpox and shingles, can be spread by direct contact with fluid from the small blistery rash that occurs with shingles.
Becoming Infected with Shingles
When a person is infected with shingles, they will experience a tingling of the skin, burning, and numbness. This usually occurs on one side of the body and after two to three days, clusters of small, pus-filled blisters will appear. The rash and blisters normally continue to appear for three to five days, and they will be surrounded by red skin.
Are Shingles Contagious?
It is during this time that the person is highly contagious. If another person is in direct contact with the blisters, they can get sick. It’s important to note that transmission only occurs through direct contact with blisters and it can cause chickenpox in someone who has never been infected with the virus. However, during the time before blisters appear, there is no risk of viral transmission.
If shingles blisters are broken and scabbed, or if they are covered well, they are not contagious. There are ways to prevent transmission which include covering the rash and avoiding touching it, practicing good hygiene by frequently washing hands, and avoiding coming into contact with people after blisters have formed.
People to Avoid if You Have Shingles
The people to avoid coming into contact with are pregnant women who have never had chickenpox or received the shot for it, infants born early or of low birth weight, children who have not yet had the vaccination, or people with weakened immune systems; for example, people with HIV, leukemia, or those receiving cancer treatment. A person with a weakened immune system might also be someone who is on immunosuppressive medications or those who have had an organ transplant.
How is the Infection Spread?
Shingles itself is not spread from one person to another, but the herpes zoster virus which causes chicken pox and then shingles, can. Despite what some people believe, the infection cannot be spread through sneezing, coughing, or casual contact, unless it involves the rash. As for the first signs of shingles, there are some noticeable symptoms.
One of the symptoms of shingles is a one-sided stripe of blisters wrapping around the side of the body, torso, or face. The person will also experience a widespread rash, a rash in the eye, pain which is intense at times, and fluid-filled blisters that scab within 10 days and resolve within two to four weeks. Other signs are a headache, fever, chills, an upset stomach, itching, tiredness, and a sensitivity to light.
People who are affected will experience pain, itching, or tingling at the site of the rash about one to five days before the shingles outbreak occurs. In some cases, a rash or pain may not even be present, which makes diagnosing the infection difficult. Shingles are most commonly diagnosed by a physical exam, where a sample of the virus may be obtained and tested.
Unfortunately, there is no way to completely eliminate the shingles virus from the body, but there are ways to ease its symptoms. Although the virus cannot be cured, medical treatment is available including the use of medications like acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir). These antiviral drugs can reduce the severity of the symptoms and aim to shorten the life and duration of the illness.
Different Treatment Options
The first step is to keep the rash dry and clean to reduce the risk of further infection. It’s advised to wear loose-fitting clothing for comfort and to avoid rubbing antibiotic creams or adhesive dressings to the area as they can slow down the healing problems. If the rash needs to be covered in a cream, a non-adherent one is advised to prevent aggravating the skin.
Medications such as topical capsaicin, calamine lotion, wet compresses and colloidal oatmeal baths are a few treatment options. These products can soothe and relieve the itching caused by shingles. Antihistamines can sometimes help prevent itching at night, but a doctor may prescribe painkillers if the pain is severe.
Relieving the Symptoms
Neurontin, or gabapentin, a drug used to treat nerve pain, may be prescribed, as well as elavil or the antidepressant amitriptyline. A doctor may also suggest mood-altering medications, or epidural injected corticosteroids and local anesthetics. The only way that living with a shingles rash is bearable is by taking steps to relieve the symptoms.
Shingles typically resolve within two to four weeks and most young and healthy individuals can expect to make a full recovery. But in severe cases, approximately one to four percent of people who develop shingles will require hospitalizations, with 30 percent of those people having impaired immune systems. The statistics show that there are about 96 deaths per year related to the varicella zoster virus.
Complications of Shingles
If left untreated, shingles can cause severe complications. These include eye infections, loss of vision, nerve problems such as brain swelling, facial paralysis, hearing problems and problems with balance, skin infections, and more rarely, pneumonia. Postherpetic neuralgia (PHN) — prolonged pain — can also occur. PHN can take the form of pain in the location of the rash and blisters after they have gone away, which can be severe.
Vaccines can prevent both chicken pox and the shingles and it is commonly administered to children. In the U.S., immunization with the chickenpox vaccine is recommended and given once between the age of 12 and 15 months and again between four and six years old. The Centers for Disease Control and Prevention also recommends the Zostavax vaccine for people ages 60 years and above, since this age group has the highest risk of getting shingles and of experiencing a complication.
Vaccination in Children and Adults
Ever since vaccination started in children, the number of shingles outbreaks has decreased dramatically. While most healthy individuals are recommended to receive the vaccine, some people are not the best candidates. These people include anyone with a weakened immune system, women who are or might be pregnant, and anyone who has ever had a severe allergic reaction to gelatin, the antibiotic neomycin, or any other component of shingles vaccine.
Since shingles is known as herpes zoster, like any herpes virus, shingles hides in the nervous system and can remain there indefinitely. However, shingles can lie dormant for many years, until under the right conditions, the herpes zoster virus can reactivate. This means it will essentially wake up from hibernation and travel down nerve fibers to cause a new active infection.
Triggers of Shingles
It most causes, it’s unclear why the varicella zoster virus begins multiplying to cause shingles in the first place, but one suggestion is that shingles occurs when something weakens the immune system. Possible triggers causing the virus to reactivate include older age, stress or trauma, some diseases including cancers, HIV, or AIDS, cancer treatments, and medications, especially immunosuppressive drugs, used by patients after an organ transplant.