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How Does A Person Get Shingles Rash

Varicella In Vaccinated Persons

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Breakthrough varicella on the abdomen of a vaccinated child.

Breakthrough varicella is infection with wild-type varicella-zoster virus occurring in a vaccinated person more than 42 days after varicella vaccination. Breakthrough varicella is usually mild. Patients typically are afebrile or have low fever and develop fewer than 50 skin lesions. They usually have a shorter illness compared to unvaccinated people who get varicella. The rash is more likely to be predominantly maculopapular rather than vesicular. However, 25% to 30% of people vaccinated with one dose who get breakthrough varicella will have clinical features similar to unvaccinated people with varicella.

Since the clinical features of breakthrough varicella are often mild, it can be difficult to make a diagnosis on clinical presentation alone. Laboratory testing is increasingly important for confirming varicella and appropriately managing the patients and their contacts. Breakthrough varicella occurs less frequently among those who have received two doses of vaccine compared with those who have received only one dose disease may be even milder among two-dose vaccine recipients, although the information about this is limited.

What Does It Mean To Let Shingles Run Its Course

This refers to the typical course a shingles rash takes, even with antiviral treatment:

  • A person may develop a tingling sensation or pain in a certain area on the skin, most commonly on the waistline. This may last for several days.
  • Next, a rash develops in the area. The skin turns red, with fluid-filled bumps . Its during this time that a shingles rash can spread the VZV to another person who hasnt had chickenpox or the chickenpox vaccine.
  • After 1 to 2 weeks, these fluid-filled bumps start to crust over. At this point, the rash can no longer spread to other people. It can then take 1 to 2 more weeks for the crusted areas to fully scab over and heal.
  • Managing People At High Risk For Severe Varicella

    Varicella-Zoster Immune GlobulinFor people exposed to varicella or herpes zoster who cannot receive varicella vaccine, varicella-zoster immune globulin can prevent varicella from developing or lessen the severity of the disease. Varicella-zoster immune globulin is recommended for people who cannot receive the vaccine and 1) who lack evidence of immunity to varicella, 2) whose exposure is likely to result in infection, and 3) are at high risk for severe varicella.

    The varicella-zoster immune globulin product licensed for use in the United States is VariZIG. VariZIG should be given as soon as possible after exposure to VZV it can be given within 10 days of exposure. For more information on the recommendations for VariZIG use, see the Morbidity and Mortality Weekly Report article on Updated Recommendations for Use of VariZIG United States, 2013. VariZIG is commercially available from a broad network of specialty distributors in the United States .

    Acyclovir TreatmentThe American Academy of Pediatrics recommends that certain groups at increased risk for moderate to severe varicella be considered for oral acyclovir or valacyclovir treatment. These high risk groups include:

    • Healthy people older than 12 years of age
    • People with chronic cutaneous or pulmonary disorders
    • People receiving long-term salicylate therapy
    • People receiving short, intermittent, or aerosolized courses of corticosteroids

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    Which Shingles Vaccine Is Best

    Eventually, your doctor will start mentioning the shingles vaccine which can help prevent shingles from developing, as well as reduce its severity if it does still develop. The shingles vaccine can also reduce your risk of postherpetic neuralgia, one of the most common complications of shingles.

    Because shingles becomes increasingly more common as a person ages, the shingles vaccine is currently recommended for people over the age of 50. There are two vaccine options, Shingrix and Zostavax, with Shingrix being the newer of the two vaccines and the preferred choice as it is more effective.

    When it comes to how the shingles vaccine works, Shingrix is a shot that requires two doses administered six months apart. There are temporary side of effects of this shingles vaccine that can be unpleasant, however. Shingles vaccine side effects typically dont last more than three days, but include:

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    Shingles can cause complications:

    • Postherpetic neuralgia is most common complication of shingles. It causes severe pain in the areas where you had the shingles rash. It usually gets better in a few weeks or months. But some people can have pain from PHN for many years, and it can interfere with daily life.
    • Vision loss can happen if shingles affects your eye. It may be temporary or permanent.
    • Hearing or balance problems are possible if you have shingles within or near your ear. You may also have weakness of the muscles on that side of your face. These problems can be temporary or permanent.

    Very rarely, shingles can also lead to pneumonia, brain inflammation , or death.

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    What Can Be Done To Prevent The Spread Of Shingles

    A vaccine for chickenpox is available and it is hoped that individuals immunized against chickenpox will be less likely to develop shingles in later life.

    The risk of spreading the virus that causes shingles is low if the rash is covered. People with shingles should keep the rash covered, not touch or scratch the rash, and wash their hands often to prevent the spread of shingles. Once the rash has developed crusts, the person is no longer contagious.

    Other Complications Of Shingles

    If the shingles rash appears around the eye or forehead, it can cause eye infections and temporary or permanent loss of vision. If the shingles virus attacks the ear, people may develop hearing or balance problems. In rare cases, the shingles virus may attack the brain or spinal cord. These complications can often be prevented by beginning treatment for shingles as soon as possible.

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    Get Medical Care For Shingles Immediately

    If you have a blistering rash, you want to see a doctor as soon as possible. Should you have shingles, starting prescription medication within 2 to 3 days of developing the rash can dramatically:

    • Reduce your symptoms, such as pain

    • Lessen the amount of time you have shingles

    • Lower your risk of developing other health problems, such as a condition called postherpetic neuralgia, which is pain that can linger for months or years after the rash clears

    If youve had the rash for longer than 2 or 3 days, its still important to see a doctor. Shingles can lead to other health problems aside from long-lasting pain. For example, when the shingles rash develops on your face, it can affect your eyesight. Treatment can save your eyesight.

    A few people who get shingles develop pneumonia, hearing loss, or a disease that causes the brain to swell . Its important to find signs of these early, so that you can receive treatment.

    When you see your doctor, you may hear the medical term herpes zoster. This is the medical name for shingles.

    Get medical care immediately

    Getting medical treatment within 3 days of developing the shingles rash can greatly reduce your risk of developing long-lasting pain.

    Who Should Not Get Shingrix

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    You should not get Shingrix if you:

    • Have ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix.
    • Currently have shingles.
    • Currently are pregnant. Women who are pregnant should wait to get Shingrix.

    If you have a minor illness, such as a cold, you may get Shingrix. But if you have a moderate or severe illness, with or without fever, you should usually wait until you recover before getting the vaccine.

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    Will Shingles Go Away Without Treatment

    Shingles, or herpes zoster, is a painful rash caused by the varicella-zoster virus . This is the same virus that causes chickenpox.

    This virus remains dormant in a part of your nervous system called the dorsal root ganglion. It can be reactivated during times of stress or illness, or when the immune system is weakened by an autoimmune disease or cancer.

    The risk of developing shingles is relatively low for healthy young adults about 4 out of 1,000 people in the United States, according to the Centers for Disease Control and Prevention . Its much higher for those above age 60. Shingles affects about 1 out of 100 people in this older age group, the CDC says.

    Generally, a case of shingles rash resolves within 3 to 4 weeks. It can resolve without treatment, but antiviral treatment can shorten both the duration and severity of the rash.

    Where Does Shingles Come From

    When you have chickenpox as a child, your body fights off the varicella-zoster virus and the physical signs of chickenpox fade away, but the virus always remains in your body. In adulthood, sometimes the virus becomes active again. This time, the varicella-zoster virus makes its second appearance in the form of shingles.

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    When Should You Call For Help

    or seek immediate medical care if:

    • You have a new or higher fever.
    • You have a severe headache and a stiff neck.
    • You lose the ability to think clearly.
    • The rash spreads to your forehead, nose, eyes, or eyelids.
    • You have eye pain, or your vision gets worse.
    • You have new pain in your face, or you cannot move the muscles in your face.
    • Blisters spread to new parts of your body.

    Watch closely for changes in your health, and be sure to contact your doctor if:

    • The rash has not healed after 2 to 4 weeks.
    • You still have pain after the rash has healed.

    How Long Does Shingles Last

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    Most cases of shingles last three to five weeks.

    • The first sign is often burning or tingling pain sometimes it includes numbness or itching on one side of the body.
    • Somewhere between one and five days after the tingling or burning feeling on the skin, a red rash will appear.
    • A few days later, the rash will turn into fluid-filled blisters.
    • About one week to 10 days after that, the blisters dry up and crust over.
    • A couple of weeks later, the scabs clear up.

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    Preventing The Virus Spreading

    If you have the shingles rash, do not share towels or flannels, go swimming, or play contact sports. This will help prevent the virus being passed on to someone who has not had chickenpox.

    You should also avoid work or school if your rash is weeping and cannot be covered.

    Chickenpox can be particularly dangerous for certain groups of people. If you have shingles, avoid:

    • women who are pregnant and have not had chickenpox before as they could catch it from you, which may harm their unborn baby
    • people who have a weak immune system, such as someone with HIV or AIDS
    • babies less than one month old, unless it is your own baby, in which case your baby should have antibodies to protect them from the virus

    Once your blisters have dried and scabbed over, you are no longer contagious and will not need to avoid anyone.

    How To Avoid Spreading Shingles

    The varicella-zoster virus is typically less likely to be transmitted with shingles than with chickenpox. However, the varicella-zoster virus can be passed on from the time that your symptoms start until your rash and blisters have crusted dry.

    If you have shingles and are otherwise healthy, you can still go out in public or to work. But be sure to follow these tips:

    • Keep the shingles rash clean and covered. This can help prevent other people from coming into contact with your blisters.
    • Wash your hands often. Also, try not to touch the blisters.
    • Avoid being around pregnant people. The varicella-zoster virus can cause serious health risks for both pregnant people and their babies. Risks include pneumonia and permanent damage to the unborn child. If you find you have shingles after spending time with someone whos pregnant, let them know at once so they can ask their OB-GYN for advice. Be especially careful to avoid pregnant people who havent had chickenpox or the vaccine for it.
    • Avoid other at-risk people. Stay away from premature babies, infants with low birth weights, and children who havent yet had chickenpox or its vaccine. Also, avoid people with weakened immune systems. These include people living with HIV, organ transplant recipients, and people taking immunosuppressant medications or having chemotherapy.

    Doctors recommend the chickenpox vaccine for children. Preventing chickenpox will also prevent shingles.

    You can get the vaccine

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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.

    How To Treat Shingles

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    If you have ever had chickenpox, or been vaccinated for it, you are at risk for getting shingles a painful, blistering rash. This is because after the chickenpox clears, the virus stays in the body. If the virus reactivates, or wakes up, you could get shingles.

    Although shingles is much less contagious and itchy than chickenpox, it tends to cause more pain. In addition, although the shingles rash usually clears in a few weeks, some people can experience pain, numbness, itching and tingling that can last months or even years.

    According to dermatologists from the American Academy of Dermatology , common signs and symptoms of shingles include:

    • An area of skin that burns, itches, tingles or feels very sensitive: This usually occurs in a small area on one side of the body and lasts one to three days.
    • A rash that begins as red spots and quickly turns into groups of clear, painful blisters: These may turn yellow or bloody before they scab over and heal.
    • Flu-like symptoms: A fever or headache may occur with the rash.
    • Pain: Sometimes, the pain is bad enough for a doctor to prescribe medication. The pain tends to lessen once the blisters heal, which can take two to three weeks.

    To help relieve shingles pain and discomfort, the Academy recommends the following tips:

  • Cool the rash with ice packs, cool wet cloths, or cool baths.
  • Cover the rash with loose, non-stick, sterile bandages.
  • Wear loose, cotton clothing around the body parts that hurt.
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    Nosocomial Transmission Of Vzv

    Nosocomial transmission of VZV is well-recognized and can be life threatening to certain groups of patients. Reports of nosocomial transmission are uncommon in the United States since introduction of varicella vaccine.

    Patients, healthcare providers, and visitors with varicella or herpes zoster can spread VZV to susceptible patients and healthcare providers in hospitals, long-term-care facilities, and other healthcare settings. In healthcare settings, transmissions have been attributed to delays in the diagnosis or reporting of varicella and herpes zoster and failures to implement control measures promptly.

    Although all susceptible patients in healthcare settings are at risk for severe varicella and complications, certain patients without evidence of immunity are at increased risk:

    • Premature infants born to susceptible mothers
    • Infants born at less than 28 weeks gestation or who weigh 1000 grams, regardless of maternal immune status
    • Immunocompromised people, including those who are undergoing immunosuppressive therapy, have malignant disease, or are immunodeficient

    Impact Of The Varicella Vaccination Program

    Varicella used to be very common in the United States. In the early 1990s, an average of 4 million people got varicella, 10,500 to 13,000 were hospitalized, and 100 to 150 died each year.

    Varicella vaccine became available in the United States in 1995. Each year, more than 3.5 million cases of varicella, 9,000 hospitalizations, and 100 deaths are prevented by varicella vaccination in the United States.

    Highlights from Our Data

  • The rate of herpes zoster in United States among children has been declining since the routine varicella vaccination program began. National administrative data showed that herpes zoster rates in people aged 0-17 declined 17% during 1993-2013.
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    What Problems Can Happen

    Most cases of shingles heal on their own, with or without treatment, and won’t lead to any other problems. In rare cases, shingles can lead to complications, including:

    • Ongoing pain : Damaged nerve fibers in the skin send confused messages to the brain, leading to pain. Pain can go on for a long time after the shingles rash is gone. This is the most common shingles complication.
    • Vision problems: Shingles near or in an eye can lead to vision loss.
    • Skin infections: A shingles rash can become infected with bacteria, leading to impetigo or cellulitis.
    • Nervous system problems: Shingles on the face can involve different nerves that connect to the brain. This can lead to nerve-related problems such as facial paralysis, hearing problems, and problems with balance. In very rare cases, shingles can lead to encephalitis .

    Know The Bathing Dos And Donts

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    Using the right water temperature while bathing or showering can make a big difference in how your skin feels and heals. Ideally, you should bathe with cool or lukewarm water and avoid very hot water.

    You can also apply a cool, wet compress to the rash and blisters. The AAD recommends you soak a clean washcloth in cold water and place the cloth on top of the affected area several times a day. Leave it on for 5 to 10 minutes.

    You should avoid rubbing washcloths, sponges, or exfoliants on the area.

    You can also add colloidal oatmeal or cornstarch to your baths to provide some much-needed itch relief. Just be sure to dry your skin gently after getting out of the bath. Then, follow up with a layer of calamine lotion to soothe your skin, or keep it dry and cover with a bandage if its still weeping.

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