How Does It Occur
If you have had chickenpox, you are at risk for later developing shingles. After you recover from chickenpox, the chickenpox virus stays in your body. It moves to the roots of your nerve cells and becomes inactive . Later, if the virus becomes active again, shingles is the name given to the symptoms it causes.
What exactly causes the virus to become active is not known. A weakened immune system seems to allow reactivation of the virus. This may occur with normal aging, immune-suppressing medicines, or another illness, or after major surgery. It can also happen as a complication of cancer or AIDS or treatment of these illnesses. Chronic use of steroid drugs may trigger shingles. The virus may also become active again after the skin is injured or sunburned. Emotional stress seems to be a common trigger as well.
Focus On Prevention Doctors Say
Prevention is the best way to avoid a shingles episode.
There is a vaccine that prevents the onset of shingles in people exposed to chickenpox. The CDC recommends that people age 60 and older get one dose of the vaccine. Vaccines are readily available at a doctors office and drug stores. In 2011, the Food and Drug Administration extended the vaccine use for people aged 50 to 59.
Wigand-Bolling said the vaccine reduces the incidence of shingles by 51% and the neuralgia associated with shingles by 67%. The doctor said the vaccine is injected and once vaccinated a person is protected for life.
Unless contraindicated because of pregnancy or being an organ transplant recipient or on chemotherapy, everyone over age 50 should be vaccinated, Wigand-Bolling said. I would recommend getting vaccinated to patients who may not have had chicken pox, or those who dont remember having chicken pox.
More than 90% of those identified in the study at increased risk of stroke and heart attack after a shingles episode hadn’t been vaccinated for shingles. The people in the study who had the vaccine still got shingles, it’s worth noting.
Key Points About Shingles
- Shingles is a common viral infection of the nerves. It causes a painful rash or small blisters on an area of skin.
- Shingles is caused when the chickenpox virus is reactivated.
- It is more common in people with weakened immune systems, and in people over the age of 50.
- Shingles starts with skin sensitivity, tingling, itching, and/or pain followed by rash that looks like small, red spots that turn into blisters.
- The rash is typically affects just one area on one side of the body or face.
- Treatment that is started as soon as possible helps reduce the severity of the disease.
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Is It Possible To Avoid Shingles
Most people get shingles only once, but it is possible to get it two or more times.
Anyone who has had chickenpox can get shingles later in life. There is a shingles vaccine that may help prevent shingles, or make it less painful. The vaccine is recommended for adults ages 60 and older, even if theyve previous had shingles.
For children and adults who never had chickenpox, there is a vaccine that can help avoid getting the virus that causes both chickenpox and shingles.
For anyone who has never had chickenpox and has not received the chickenpox vaccine, it is best to avoid contact with people who have shingles or chickenpox. Fluid from shingles blisters is contagious and can cause chickenpox, but not shingles.
What Causes Postherpetic Neuralgia
Postherpetic neuralgia results from damage to nerve fibers during shingles infection. The nerve fibers at the skin in the affected area send exaggerated pain signals to your brain. Postherpetic neuralgia means nerve pain after herpes. Shingles is also called herpes zoster.
Shingles is caused by the varicella-zoster virus, the virus that causes chickenpox. Once youve had chickenpox, the virus remains in your body for your entire life, but is dormant or silent for years. When the virus becomes reactivated, it causes shingles. A certain percentage of people who get shingles develop PHN.
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Lasting Pain After Shingles
Pain that continues for a long time after a shingles rash has disappeared is called post-herpetic neuralgia. This is the most common complication of shingles. Its still not clear how it can be prevented or what the best treatment is.
Shingles typically causes a rash accompanied by pain in the affected area. The pain normally goes away when the rash goes away. This usually happens after two to four weeks. Pain that continues for longer is referred to as post-herpetic neuralgia. The word “post-herpetic” means “post-herpes” because the pain arises after infection by the herpes zoster virus. In very rare cases pain can come back after a shingles infection, even if it had already gone away and the rash has disappeared.
The main symptom of post-herpetic neuralgia is pain in the nerves . The skin is often overly sensitive and itchy as well. This can make it difficult or painful to wash yourself, turn over in bed, or hug someone. The pain and itching can be very severe and might keep you from sleeping.
Postsurgical Occurrence Of Shingles
Drazin et al8 have reported a 41-year-old man with a history of right arm varicella-mediated vesicular skin eruptions, who presented with continuing right arm pain, burning, and numbness in a C6 dermatomal distribution 10 days after a C5-C6 anterior cervical discectomy and fusion. He was started on acyclovir and sent home. On outpatient follow-up, his rash had resolved, though his pain continued. He then began taking a neuromodulating agent for chronic pain.
Koda et al10 have reported a 74-year-old man who was seen for left-sided sciatic pain with MRI evidence of spinal stenosis at the L4-L5 spine level. Initially there were no skin lesions. Decompression surgery was performed because conservative therapy failed to relieve his symptoms. At that time, he complained of a skin rash involving his left foot. A vesicular rash and erythema were observed on the dorsal and plantar surfaces of his great toe and lateral malleolus. He was diagnosed with herpes zoster in the left fifth lumbar spinal nerve area based on clinical findings, including the characteristics of the pain and vesicular rash and erythema in the fifth lumbar spinal dermatome. He was treated with famciclovir and NSAIDS. After 1 week of medication, the skin rash resolved and pain relief was obtained.
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How Can I Prevent The Spread Of The Shingles Virus
The virus can be passed to a person who has never had chickenpox. This usually happens if the other person comes in contact with your open sores. This person may get chickenpox, but not shingles. You are contagious until your blisters scab over. Stay away from people who have not had chickenpox or the chickenpox vaccine. Avoid pregnant women, newborns, and people with weak immune systems. They have a higher risk of infection.
- Wash your hands often. Wash your hands several times each day. Wash after you use the bathroom, change a child’s diaper, and before you prepare or eat food. Use soap and water every time. Rub your soapy hands together, lacing your fingers. Wash the front and back of your hands, and in between your fingers. Use the fingers of one hand to scrub under the fingernails of the other hand. Wash for at least 20 seconds. Rinse with warm, running water for several seconds. Then dry your hands with a clean towel or paper towel. Use hand sanitizer that contains alcohol if soap and water are not available. Do not touch your eyes, nose, or mouth without washing your hands first.
- Cover a sneeze or cough. Use a tissue that covers your mouth and nose. Throw the tissue away in a trash can right away. Use the bend of your arm if a tissue is not available. Wash your hands well with soap and water or use a hand sanitizer.
Shingles Linked To Stroke Heart Attack
Not only do shingles flare-ups hurt, research says they can increase your short-term risk of heart attack and stroke following the virus outbreak.
Shingles was found to raise the risk of stroke by 35% and the risk of heart attack by nearly 60%, according to a study of more than half a million people. The risk of stroke was highest in those under age 40.
Its been known for a while now that zoster causes stroke, said Dr. Gwen Wigand-Bolling, an internist at . The inflammation it creates causes heart attack and stroke, and shingles causes increased blood clotting in the arteries, she added.
The risks of both stroke and heart attack were highest in the first year after the onset of shingles and decreases with time, researchers said.
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What Is Postherpetic Neuralgia
In some instances, people whove had shingles may experience postherpetic neuralgia , in which pain persists well after the blisters go away. This happens because the shingles-damaged nerves continue to send pain signals to the brain.
There are several factors that can lead to postherpetic neuralgia. Anything that depresses immunity can increase your risk, says Dr. Oaklander.
She adds: The severity of postherpetic neuralgia gradually eases over time in everyone, but the rate of resolution can vary. As you get older, your postherpetic neuralgia typically lasts longer and longer. Senior citizens, who are the most at risk for zoster, have substantial risk of postherpetic neuralgia lasting over a year, and sometimes for the rest of their lives.
If you have a lot of pain before the rash, it puts you at much higher risk for postherpetic neuralgia, adds Joseph Safdieh, MD, professor of neurology at Weill Cornell Medicine in New York City.
- Personality disorder
Is Shingles Contagious
You cannot get shingles from someone else. However, if you have never had chickenpox, you may get chickenpox from close contact with someone who has shingles because the blisters contain chickenpox virus.
If you have shingles, make sure that anyone who has not had chickenpox or the chickenpox shot does not come into contact with your blisters until the blisters are completely dry. Once your blisters are crusted over, they are no longer contagious.
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S Of The Shingles Rash
If you have a rash of blisters on your skin or a rash that looks like any shown below, see your doctor immediately for a diagnosis. If you have shingles, its important to get treatment, preferably within 2 to 3 days.
If youve had the rash for longer than 2 to 3 days, its still important to see your doctor.
A typical shingles rash
Doctors often refer to this rash as the shingles band because it looks like a band that appears on one area of your body, as shown here.
A rash on one side of the body
A key that you have shingles is that the rash only develops on one side of your body.
Close-up of a shingles rash
The shingles rash often causes a cluster of tiny blisters. You may notice that the skin beneath the blisters is red and inflamed, as shown here.
The rash will also feel painful.
Blistering shingles rash on a man’s chest
Although the rash can begin in one area, you may notice that a few scattered blisters develop in other areas, as shown here.
Shingles rash on the palm of a man’s hand
While shingles tends to develop on your body or face, it can appear anywhere on your skin.
How Can I Take Care Of Myself
- Take a pain-relief medicine such as acetaminophen. Take other medicine as prescribed by your healthcare provider.
- Put cool, moist washcloths on the rash.
- Rest in bed during the early stages if you have fever and other symptoms.
- Try not to let clothing or bed linens rub against the rash and irritate it.
- You develop worsening pain or fever.
- You develop a severe headache, stiff neck, hearing loss, or changes in your ability to think.
- The blisters show signs of bacterial infection, such as increasing pain or redness, or milky yellow drainage from the blister sites.
- The blisters are close to the eyes or you have pain in your eyes or trouble seeing.
- You have trouble walking.
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How Is It Treated
It is best to start treatment as soon as possible after you notice the rash. See your healthcare provider to discuss treatment with antiviral medicine, such as acyclovir. This medicine is most effective if you start taking it within the first 3 days of the rash. Antiviral medicine may speed your recovery and lessen the chance that the pain will last for a long time.
Your provider may also recommend or prescribe:
- medicine for pain
- antibacterial salves or lotions to help prevent bacterial infection of the blisters
Seek Treatment Right Away
Many people have the mistaken impression that, like poison ivy, shingles is a nuisance rash that fades on its own. But in fact a shingles rash should alert people, especially in middle or old age, to seek immediate medical help, says Dr. Oaklander.
Rapid treatment with one of three antiviral drugs, acyclovir , valacyclovir , or famciclovir , can shorten a shingles attack and reduce the risk of serious damage, such as:
- Long-term pain. Pain that lingers in the area of a healed shingles rash is called postherpetic neuralgia. This often-disabling pain can last several months to a year.
- Prolonged itching. Many people are left with an itchy area from their shingles, which can be as disabling as chronic pain. It is most common on the head or neck.
- Damage to vision and hearing. Pain and rash near an eye can cause permanent eye damage and requires an urgent ophthalmological exam. When the nerve to the ear is affected, it can permanently damage hearing or balance.
- Strokes and heart attacks. A PLOS Medicinestudy that tracked about 67,000 people ages 65 and older who were newly diagnosed with shingles found that stroke risk more than doubled in the first week after the shingles diagnosis. The same study reported an increased risk for heart attacks in the three months after shingles, but the additional risk dissipated after six months.
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Clinical Facts Of Shingles
Drazin et al8 report clinical facts about shingles in a literature search, stating that postsurgical occurrence of varicella zoster virus-mediated radiculitis is rare and is reported in 1 report to occur 2 days to 10 months after surgery or steroid injection, and 2 to 7 days afterward in another. Surgical manipulation of nerve roots has been seen in the development of shingles or herpes radiculitis in dermatomal distribution of the same manipulated nerve roots or those in adjacent levels. Patients have seen resolution of symptoms attributable to herpes ranging from days to 1 year, with complete to partial resolution of symptoms. Cervical spinal dermatomal involvement in zoster outbreaks may reach 15%. Trunk involvement, including 1 to 3 separate dermatomes of the thoracic or lumbar spine, makes up 60% of spinal involvement. Disc herniation is an independent risk factor for primary activation or reactivation of varicella zoster virus leading to herpes zoster. Zoster may be detected through serum or cerebrospinal fluid polymerase chain reaction DNA analysis in an acute idiopathic setting.
How Is Internal Shingles Treated
Even though shingles is a virus, this is a case where there are antiviral medications available by prescription. Thats why its important to see your doctor right away if you suspect you have shingles. Early treatment may reduce the risk of complications, like PHN. Serious complications require hospitalization.
Common antiviral medications for shingles include:
Depending on the location and severity of the shingles infection, steroids may also help. Anti-inflammatory medications like ibuprofen and pain-relieving medication such as acetaminophen or other prescription pain medication can help in easing pain experienced from shingles.
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What Are The Treatments For Shingles
There is no cure for shingles. Antiviral medicines may help to make the attack shorter and less severe. They may also help prevent PHN. The medicines are most effective if you can take them within 3 days after the rash appears. So if you think you might have shingles, contact your health care provider as soon as possible.
Pain relievers may also help with the pain. A cool washcloth, calamine lotion, and oatmeal baths may help relieve some of the itching.
What Are The Complications Of Shingles
Symptoms of shingles usually dont last longer than 3 to 5 weeks. However, complications can happen. The main complications that can result from shingles include:
- Postherpetic neuralgia . The most common complication of shingles is called postherpetic neuralgia . This continuous, chronic pain lasts even after the skin lesions have healed. The pain may be severe in the area where the blisters were present. The affected skin may be very sensitive to heat and cold. If you had severe pain during the active rash or have impaired senses, you are at increased risk for PHN. The elderly are also at greater risk. Early treatment of shingles may prevent PHN. Pain relievers and steroid treatment may be used to treat the pain and inflammation. Other treatments include antiviral drugs, antidepressants, anticonvulsants, and topical agents.
- Bacterial infection. A bacterial infection of the skin where the rash happens is another complication. Rarely, infections can lead to more problems, such as tissue death and scarring. When an infection happens near or on the eyes, a corneal infection can happen. This can lead to temporary or permanent blindness.
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