Shingles is the common name for Herpes zoster, a viral infection that is caused by the virus that also causes chicken pox. Herpes zoster is a condition that can develop in anyone who has had chicken pox. The virus remains inactive (dormant), in certain nerve cells of the body, and when it reactivates it causes Herpes zoster. About 20% of those people who had chicken pox will get Herpes zoster. Most people get Herpes zoster only once.
It is not clear what makes the virus reactivate or “awaken.” A temporary weakness in immunity (the body's ability to fight infection) may cause the virus to multiply and move along nerve fibres toward the skin. Herpes zoster is most common in people over the age 50. Illness, trauma, and stress may also trigger Herpes zoster.
People with a weakened immunity caused by conditions such as leukemia, lymphoma, cancer, or AIDS are at a greater risk of developing Herpes zoster. Medical treatments like chemotherapy or radiation for cancer, drugs taken to prevent rejection of transplanted organs, and cortisone taken for a long time, can make someone susceptible.
WHAT ARE THE SYMPTOMS OF HERPES ZOSTER?
The first symptoms include itching, burning, extreme sensitivity, or tingling in one area and typically only involves the skin on one side of the body. This may be present for one to three days before a red rash appears at that site. There may also be a fever or headache. The rash becomes groups of blisters. The blisters generally last for 2-3 weeks. The blisters start out clear but then look yellow or bloody before they crust over (scab) and disappear.
WHERE DOES HERPES ZOSTER USUALLY APPEAR ON THE BODY?
Herpes zoster is most common on the trunk and buttocks, but it can also appear on the face, arms, and legs if the nerves in these areas are involved. In some cases the blisters can affect the eyes. In these cases extra care is required because they can cause permanent damage to the eyes. If Blisters develop on the tip of the nose it could indicate the eyes are being affected.
WHAT ARE THE COMPLICATIONS OF HERPES ZOSTER?
Post-herpetic neuralgia is itching, tingling, numbness, and pain which last long after the rash has cleared. Post-herpetic neuralgia can continue after the skin has healed, and can last for months and in some cases years. It is more common in older people. The use of medication in the early stages of Herpes zoster may help prevent this complication.
A bacterial infection of the blisters can occur and can delay healing. If pain and redness increase or reappear you should return to the dermatologist, because an antibiotic treatment may be necessary. An infection combined with Herpes zoster skin lesions can result in scarring if patients do not seek prompt treatment.
If Herpes zoster affects the eye it can lead to complications like scarring, glaucoma, and blindness unless the patient seeks early treatment.
HOW IS HERPES ZOSTER DIAGNOSED?
The diagnosis is based on the way the blisters look and a history of pain before the rash on one side of the body. Fluid from the blister is sometimes sent to the laboratory for special testing. Sometimes a skin biopsy is also performed.
IS THERE ANY REASON TO WORRY ABOUT A MORE SERIOUS DISEASE OR A POORLY FUNCTIONING IMMUNE SYSTEM IF SOMEONE HAS HERPES ZOSTER?
Most people with Herpes zoster are healthy. However, sick people or those with HIV are at risk. A chest x-ray or blood studies may be done.
IS HERPES ZOSTER CONTAGIOUS?
Herpes zoster is much less contagious than chicken pox. Persons with Herpes zoster can transmit the virus if blisters are broken. Newborns or those with decreased immunity are at the highest risk for contracting chicken pox from someone who has Herpes zoster. Hospitalization is rarely necessary for patients with Herpes zoster.
RISK OF SCARRING
Scarring typically occurs only after severe infections, especially in people who have weakened immune systems, elderly persons, or blisters that become infected.
WHAT ABOUT TREATMENT?
Herpes zoster typically clears in a few weeks and recurrences are rare. Cool compresses and pain relievers are helpful when drying the blisters. When Herpes zoster is diagnosed early, anti-viral drugs (e.g. Valacyclovir, Famciclovir, and Acyclovir) can be prescribed in order to decrease the viral shedding and the duration of skin lesions they are routinely prescribed for severe cases of Herpes zoster, cases with eye involvement, and for those with decreased immunity. The earlier treatment is started the better. In rare cases the drugs may cause stomach upset, light-headedness, or headache.
Post-herpetic neuralgia can be treated with pain relievers. Other oral medications including anti-depressants, anti-seizure medicines, and nerve stabilizers may also be of some benefit.
Corticosteroids, sometimes in combination with anti-viral drugs, are also used for severe infection, such as in the eyes, and to reduce severe pain. Nerve blocks can also help to control pain.
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