Shingles: Postherpetic Neuralgias Stubborn Mother
PHN is triggered by shingles which is triggered by chicken pox. Some think of shingles as adult chicken pox and while its true both shingles and chicken pox are caused by varicella-zoster virusa common infection of the nervesthats pretty much where the similarity ends.
If you had chicken pox as a kid the varicella-zoster virus has been residing in your body ever since. It didnt leave when your chicken pox resolved. Instead, it took up residence and remained a low-maintenance tenant until either age, a weakened immune system, stress, or some sort of cruel combination transformed the varicella-zoster virus into the herpes virus causing shinglesa much more demanding occupant.
Shingles typically starts with a variety of sensationsburning, tingling, and itching. Within days a blistery rash appears, usually on one side of the body typically around the torso, and the sensations may get more severe and painful. Within weeks the rash disappears and with it, those sensations.
Facial Pain And Eye Damage
Between 10% and 15% of the time, shingles affects the trigeminal gangliona triple-branched nerve that provides sensation to structures in the face. The medical term for head or facial pain due to shingles is “painful trigeminal neuropathy attributed to herpes zoster.”
Specifically, the trigeminal ganglion involves the eye the cheek and the mandibular branch . Of these, the ophthalmic branch is the one most commonly affected by herpes zoster.
According to the American Academy of Ophthalmology , 25% of the 300,000 to 500,000 cases of shingles that occur each year are herpes zoster ophthalmicus .
HZO can affect any part of the eye, from the optic nerve to the conjunctiva . Without antiviral treatment, almost half of people who have shingles near the eye will experience eye damage or even lose an eye, so it’s vital to see an ophthalmologist immediately.
How Is Shingles Diagnosed
Your healthcare provider will do a complete physical exam and ask about your medical history, specifically about whether you have ever had chickenpox.
Your healthcare provider will likely know right away that it is shingles based on the unique rash. The rash usually appears one area on one side of the body or face. It appears as red spots, small fluid- or pus-filled vesicles, or scabs.
The healthcare provider may also take skin scrapings for testing.
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Appearance Of The Shingles Rash
The eruptive stage of shingles begins a few days later. This is when a rash appears.
The skin in the area of the prodromal pain caused by shingles will often be sensitive to the touch and reddish in appearance. As these symptoms get worse, it may begin to feel like a sunburn.
Within three to five days of the initial pain, a few tiny pimple-like spots appear and quickly multiply into clusters, forming a rash that feels prickly to the touch.
From there, sometimes within hours, the pimples develop into water-filled blisters, or vesicles, that then consolidate into larger blisters. Often, redness and swelling accompany the rash.
The shingles rash looks very much like the chickenpox rash, with a key difference: Chickenpox blisters are widely scattered over the entire body. With shingles, the rash almost always occupies a finite strip of skin.
Ultimately, the pain of shingles may get so excruciating that simply grazing the skin with clothing can set off what feels like an electric shock.
Prevent Shingles With Vaccination
The Centers for Disease Control and Prevention recommends that almost all people ages 60 and older be vaccinated against shingles, whether or not they had chicken pox in their youth or have had shingles before, says Dr. Oaklander.
The vaccination that prevents chickenpox in children was used to develop a similar vaccine that protects against shingles. It reduces the risk of getting shingles by about half, and shingles rashes that still develop are slightly less likely to cause postherpetic pain, or other serious complications, says Dr. Oaklander.
People with especially weak immune systems, such as those with cancer or anyone undergoing immunosuppressive treatments, should avoid Zostavax since the vaccine contains a weakened form of the live virus. Because Zostavax has only been available since 2006, it is still not yet clear if a single vaccination offers lifelong protection, but at this time, no booster is recommended.
A new shingles vaccine called HZ/su also may be helpful for older adults. A study published in The New England Journal of Medicine found that the vaccine was 97.2% effective among those ages 50 and older, and 97.9% effective for those ages 70 and older. And since HZ/su is not made from a live, weakened virus, it is safe to give to people with weak immune systems. This vaccine still needs to undergo further testing before it can be submitted for FDA approval, which may happen as early as this year.
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What Is The Outlook For People With Recurring Shingles
Shingles usually clears up within two to six weeks.
In a small number of cases, the pain can remain once the rash has healed. This is called postherpetic neuralgia . Up to 2 percent of people who get shingles have PHN for five years or more. The risk increases with age.
Recurring shingles isnt preventable. You can reduce your risk by getting the shingles vaccine, even after youve had shingles.
A showed that people who had the shingles vaccine had 51 percent fewer cases of shingles. For people 50-59 years old, the shingles vaccine reduced the risk of shingles by 69.8 percent.
People who received the shingles vaccine generally had less severe cases of shingles. They also had
Why Does The Pain Persist In Some People
The symptoms of PHN can last for several months in some people. Shingles causes inflammation of the nerve. Pain can be expected whilst the rash and inflammation occur. However, it is not clear why some people continue to have pain when the inflammation has gone. It is thought that some scar tissue next to the nerve, or in the nearby part of the spinal cord, may be a factor. This may cause pain messages to be sent to the brain.
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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.
Is There A Way To Prevent Shingles
Fortunately, a vaccine is available for older adults that can prevent shingles and reduce the incidence of postherpetic neuralgia. The Zostavaxshingles vaccine was approved in 2006. In 2017, the U.S. Food and Drug Administration approved a newer vaccine, Shingrix, as the preferred vaccine. The older Zostavax is a live vaccine given as a single injection, and the newer Shingrix is a nonliving vaccine. The newer Shingrix vaccine is given in two doses two to six months apart. Shingles vaccination is recommended for use in people over 60 years of age.
Antiviral medications, including acyclovir and valacyclovir , when administered early enough in the course of the disease, can decrease the severity and duration of the outbreak, reduce the risk of eye damage if the eyes are involved, and reduce the likelihood of developing postherpetic neuralgia. It is recommended that antiviral drugs be given within 72 hours of the onset of symptoms for the best outcome.
Pain medications can also be effective in controlling shingles pain. These may be applied to the skin, like the capsaicin topical patch or lidocaine . Oral medications that can help with pain control in people with shingles include tricyclic antidepressants such as amitriptyline and certain antiseizure medications such as gabapentin .
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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.
Can I Give Shingles To Others
No one can catch shingles from you. But the virus can be spread to a person who has never had chickenpox. The virus lives in the blisters that shingles causes. It can be spread until the blisters are completely healed. If you have blisters that have not crusted over yet, you should stay away from:
- Anyone who has never had chickenpox
- Babies under 12 months old
- Very sick people
Tell your doctor if you live with children who have not had chickenpox. They may need to be vaccinated.
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How Common Is Postherpetic Neuralgia
Varicella-zoster virus causes both chickenpox and shingles. About 99% of Americans over age 40 have had chickenpox. About one in three people in the U.S. develop shingles in their lifetime. Some 10 to 18% of people who get shingles will develop postherpetic neuralgia. Postherpetic neuralgia is the most common complication of shingles.
When To Seek Medical Advice
Shingles is not usually serious, but you should see your GP as soon as possible if you recognise the symptoms. Early treatment may help reduce the severity of your symptoms and the risk of developing complications.
You should also see your GP if you are pregnant or have a weakened immune system and you think you have been exposed to someone with chickenpox or shingles and havent had chickenpox before.
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Condition Can Be Prevented With The Shingles Vaccine
Shingles is a painful condition that can develop many years after a person contracts chickenpox. The virus that causes chickenpox, varicella zoster, quietly remains inactive in the nervous system after a person recovers from chickenpox. In certain patients, the varicella zoster virus becomes active again in later life , causing the pain, rash, and blisters of shingles. People most likely to develop shingles are those with a weak immune system, often from a chronic disease or drug therapy. Common causes of weakened immunity include emotional or physical stress, traumatic injuries, cancer, autoimmune disease, HIV/AIDS, and treatments such as chemotherapy, steroids, and radiation therapy.
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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.
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Where A Shingles Rash Forms
A shingles rash typically occurs on the face, neck, or chest, on just one side of the body.
The affected area of skin is called a dermatome, a region supplied by the sensory fibers of a specific spinal nerve. Outbreaks can involve two adjacent dermatomes, but rarely two non-adjacent dermatomes.
The exception may be in people whose immune systems are severely comprised, such as those with advanced HIV infection. They’re often at risk of disseminated shingles , shingles of the eyes or internal organs, and a recurrence of shingles within six months.
How To Prevent Transmission
You cant catch shingles, and you cant give shingles to someone else. But you can give others chickenpox.
After you have chickenpox, the varicella-zoster virus stays dormant in your body. If this virus reactivates, shingles occurs. Its possible to transmit this virus to others who arent immune while the shingles rash is still active. You are contagious to others until all areas of the rash are dried up and crusted over.
To catch the varicella-zoster virus from you, a person has to have direct contact with your rash blisters.
You can help prevent your transmission of the varicella-zoster virus by:
- keeping the rash loosely covered
- practicing frequent handwashing
- avoiding contact with people who may not have had chickenpox or who havent been vaccinated against chickenpox
Last medically reviewed on August 24, 2017
- Cohen KR, et al. . Presentation and management of herpes zoster in the geriatric population.
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Shingles Symptoms Before Rash
Shingles develops in two stages. The first is called the prodromal period.
Shingles is a reactivation of the varicella virus, which is what causes chickenpox. After an initial infection, the virus lays dormant in the body. Once reactivated, which can happen years down the line, shingles results.
Often, the earliest signs this is occurring are similar to what you’d expect at the start of any infection. These symptoms sometimes occur at times when you’re feeling stressed or run down. They are also systemic, meaning they affect the whole body.
You may assume you’re just overtired or coming down with a cold when you actually have shingles.
What Are The Symptoms
The first sign of shingles is often burning, sharp pain, tingling, or numbness in your skin on one side of your body or face. The most common site is the back or upper abdomen. You may have severe itching or aching. You also may feel tired and ill with fever, chills, headache, and upset stomach or belly pain.
One to 14 days after you start feeling pain, you will notice a rash of small blisters on reddened skin. Within a few days after they appear, the blisters will turn yellow, then dry and crust over. Over the next 2 weeks the crusts drop off, and the skin continues to heal over the next several days to weeks.
Because shingles usually follows nerve paths, the blisters are usually found in a line, often extending from the back or side around to the belly. The blisters are almost always on just one side of the body. Shingles usually doesn’t cross the midline of the body. The rash also may appear on one side of your face or scalp. The painful rash may be in the area of your ear or eye. When shingles occurs on the head or scalp, symptoms can include headaches and weakness of one side of the face, which causes that side of the face to look droopy. The symptoms usually go away eventually, but it may take many months.
In some cases the pain can last for weeks, months, or years, long after the rash heals. This is called postherpetic neuralgia.
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Who Should Get The Shingrix Vaccine
The Shringrix vaccine is recommended in healthy adults age 50 and older. There is no maximum age. You should get the vaccine even if:
- Youve had shingles.
- Youre not sure if youd had chickenpox .
- Youve already had the Zostavax vaccine. This vaccine for shingles is no longer available in the U.S. Ask your healthcare provider about the best time to get the Shingrix vaccine.
If you currently have shingles, you need to wait until the shingles rash has gone away. Talk with your provider about the proper time to begin vaccination with Shingrix.
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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