Information About Shingles

Shingles, also known as herpes zoster, is a recurrence of the varicella-zoster virus (VZV), the same virus that causes chickenpox. Like some other herpetic conditions, VZV becomes latent in nerve cells after chickenpox clears and can remain inactive for years or even decades without an outbreak; as people age or their immune systems become weakened, VZV can recur as shingles, a condition characterized by what can be severe pain following the path of the nerve in which it was latent along with a rash along the same line.

Risk Factors

• It is not known exactly what causes a flareup at a given time in an individual; VZV is often latent for decades and then recurs. However, according to the Mayo Clinic, the two identifiable risk factors are advancing age, as most cases occur in people over the age of 60, and having a weakened immune system, as from a disease such as HIV or through medical treatment like chemotherapy or radiation.

Symptoms

• The most common symptoms of shingles are pain and skin rash on the buttocks or trunk of the body. Other areas, including the face and eyes can be involved; shingles in a facial nerve is called Ramsay Hunt syndrome, and the pain can be excruciating and lead to muscle damage.

  While everyone experiences pain during shingles, not everyone develops a rash. Shingles with no rash is a condition known as zoster sine herpete, while shingles with a very slight rash is known as zoster cum herpete minimo. These conditions can be difficult to diagnose because of the lack of a rash.

Treatment

• The most important element for the treatment of shingles is a combination of antiviral drugs (acyclovir, valacyclovir or famciclovir) and corticosteroids. This treatment reduces the pain of shingles and may reduce one's chances of developing postherpetic neuralgia, pain that lasts after the rash.

  Other treatments include either over-the-counter or prescription painkillers as well as topical treatments like calamine, which is used while blisters are active, and capsaicin cream, which is used after the blisters have started to heal, according to Seth John Stankus, MAJ, MC, et al.

Vaccination

• The Food and Drug Administration has approved the use of a vaccination against shingles, and the Centers for Disease Control and Prevention recommends its use in adults over the age of 60. Although the vaccine may not prevent an individual from developing an outbreak of shingles, it has been shown to reduce the duration and severity of symptoms and to reduce one's chances of developing postherpetic neuralgia.

PHN

• For some people, the pain of shingles does not go away at the same time as the rash clears up; this is a condition known as postherpetic neuralgia (PHN). PHN can be long-lasting and the pain difficult to relieve. A number of treatments are used, including the use of lowered-dose tricyclic antidepressants and anticonvulsants along with the continued use of corticosteroids. Narcotic painkillers, lidocaine patches, nerve blocks and electrode nerve stimulation are still other options for relieving the pain of PHN.