Herpes Zoster: Shingles
American Academy of Dermatology
Whether your skin needs medical, surgical or cosmetic treatment, trust the expert care of a board certified dermatologist.
Shingles is a painful skin rash that often blisters. Your dermatologist may call it herpes zoster or zoster.
Anyone who had had chickenpox can get shingles. The virus that causes chickenpox, the varicella-zoster virus, stays in the body. This virus always causes chickenpox first. When chickenpox clears, this virus travels to nerve cells where it lies dormant (asleep). If something reactivates or wakes up the virus, the person gets shingles.
It is not clear what reactivates or wakes up the virus. A weakened immune system seems to play a role. The immune system naturally weakens with age. About half the people who get shingles are 60 years of age or older.
People also are more likely to get shingles after an illness, serious injury or stressful event. All can weaken the immune system. Other things that weaken the immune system include having HIV or AIDS, taking medicine to prevent the body from rejecting a transplanted organ and undergoing chemotherapy or radiation treatments. All these seem to increase the risk of getting shingles.
Genes also may play a role. Having a close blood relative who has had shingles seems to increase the risk. People do not catch shingles from their relatives but they may inherit genes that increase their risk.
You can not catch shingles from someone who has shingles but you can catch chickenpox if you have not had chickenpox or the vaccine. To catch the virus, you have to touch fluid from a broken shingles blister. This makes shingles much less contagious than chickenpox.
Signs and symptoms
If you get shingles, you may have symptoms before the rash appears. A bit of skin may burn, itch or tingle. Sometimes, a patch of skin feels extremely sensitive. This sensation usually develops in one area and affects only one side of the body. This may last for one to five days before the rash appears. During this time, some people also have flu-like symptoms. These include chills, fever, headache and feeling tired and run down.
When the rash appears, it usually forms on one side of the face or body. This rash tends to be more painful but less itchy than chickenpox. The shingles rash can last from two to four weeks. The blisters clear, scabs form. These scabs eventually heal.
Complications can occur
Shingles often clears within a few weeks. If a complication occurs, the complication can last for months or even years. Possible complications include:
This complication is the most common and develops after shingles clears. Post-herpetic neuralgia (PHN) can cause pain, numbness, itching and tingling. These can be severe. For example, a light touch can cause intense pain. Other symptoms of PHN include feeling tired and run down, poor appetite and trouble sleeping. People over 60 years of age are most likely to develop this complication.
Shingles can affect the eye. When it does, it is called ocular shingles or herpes zoster ophthalmicus. The eyes can become very sensitive to light. Vision can be blurry. Some people feel as if they have a foreign object in their eye.
Without treatment for shingles, this complication can lead to glaucoma, scarring and even blindness. People who have shingles in the eye also have a higher risk for a stroke.
Anyone who develops shingles in or near an eye should see a doctor immediately to prevent possible loss of eyesight and other problems.
Warning signs of a skin infection are lasting pain and redness. If either occurs, see you dermatologist. You may need an antibiotic. Without prompt treatment, a skin infection can cause scars.
Treatment can prevent complications
Although shingles usually clears on its own in a few weeks, dermatologists strongly recommend treatment. Early treatment lessens the risk of developing complications and reduces the amount of time shingles last. To treat shingles, your dermatologist may prescribe:
If you see your dermatologist or another doctor within 72 hours of getting the rash, you can get an antiviral medicine. This medicine can lessen pain, severity and the amount of time you have shingles. Antiviral medicines include famciclovir, valacycovir and acyclovir.
Your dermatologist may recommend other treatment as well. Cool wet cloths can relieve pain and itching. Pain relievers can help ease the discomfort. To reduce swelling and ease pain, your dermatologist may prescribe corticosteroid pills. These can be taken along with an antiviral medicine. This treatment is not appropriate for everyone.
If the pain is severe, prescription painkillers or a nerve block can help control the pain. A nerve block is an injection (shot) that contains anesthetic to numb the area. It also may contain a corticosteroid to reduce swelling and pain.
After the rash clears, other medicine may be prescribed to treat the pain. These include anti-depressants, anesthetic creams and patches and anti-seizure medicines.
Shingles vaccine recommended
If you are 60 years of age or older and have had chickenpox, your dermatologist may recommend that you get the shingles vaccine. The U.S. Food and Drug Administration (FDA) has approved this vaccine for people 60 years of age and older. Studies show that in people 60 and older, this vaccine lowers the risk of getting shingles by about 50%. Getting the vaccine also reduces the risk of developing complications.
This vaccine was approved for people 60 and older because the studies did not produce enough information to determine the risks and benefits of giving this vaccine to people younger than 60.
Before getting this vaccine, be sure to tell your doctor about all medicines that you take and allergies and other medical conditions you have, including skin diseases such as eczema. This vaccine contains a bit of the varcella-zoster virus so it is not recommended fro everyone.
The shingles vaccine does not prevent chickenpox. Another vaccine is available to prevent chickenpox.
A dermatologist is a medical doctor who specializes in treating the medical, surgical and cosmetic conditions of the skin, hair and nails. To learn more about herpes zoster, visit http://www.aad.org or call toll free (888) 462 DERM (3376) to find a dermatologist in your area.
To learn more
Contact the American Academy of Dermatology (AAD) which represents almost all dermatologists in the U.S. and has more than 17,000 members worldwide. Most of the Academy’s members are board-certified in dermatology, which means they have completed a three-year residency and passed a rigorous two-part test administered by the American Board of Dermatology.
Log on to the academy’s website at http://www.aad.org and can:
*Locate a dermatologist in your area.
*Read information on a wide variety of skin conditions.
*Get advice about skin cancer prevention and detection and other ways to care for your skin.
*Learn about the latest dermatologic procedures and how to make informed decisions about having those procedures.
Disclaimer: This information was taken directly from a pamphlet provided by the American Academy of Dermatology. Please call the above numbers or email the Academy for more information.