Could It Be Shingles
If youre an older adult and experiencing a blistery rash, the most likely answer is that youve got , a.k.a. herpes zoster, which affects one in three people in their lifetime, according to the CDC. Shingles is whats known as a reactivation virus that usually affects older adults, says Dr. Jones Lopez. Basically, once youve had chickenpox, the varicella zoster virus stays in your body. After the initial infection, the virus goes into dormant state for potentially decades, he says. Much later in life, when your immunity goes down, it can reactivate as shingles.
Unlike a chickenpox rash, the shingles rash is usually confined to a specific area of the body and appears in a single band, rather than spreading indiscriminately. It typically happens somewhere on the chest or back, says Dr. Jones-Lopez, although the head and other parts of the body can sometimes be affected. The key thing that distinguishes the shingles rash is that it doesnt cross the midline. If it spreads across your body, its not shingles. For example, if youve got a rash on left side of your face but another on the right side of your back, you can probably rule out this illness.
In addition to a rash , you may have some pain, itching, or tingling on your skin. You may also have flu-like symptoms . Like chickenpox, shingles rashes may itchbut they are mostly known for causing pain.
Varicella In Vaccinated Persons
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.
Prevention Of Herpes Zoster
Because the risk of serious complications from herpes zoster is more likely in older people, those aged over 60 years might consider the zoster vaccine, which can reduce the incidence of herpes zoster by half. In people who do get herpes zoster despite being vaccinated, the symptoms are usually less severe, and post-herpetic neuralgia is less likely to develop. In New Zealand, the zoster vaccine will be funded from 1 April 2018 for people aged between 66 and 80 years old.
Herpes zoster vaccination is contraindicated in immunosuppressed patients due to the risk of it causing disseminated herpes zoster infection.
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How Is Postherpetic Neuralgia Treated
Treatments include lotions or creams and/or other medications not specifically used for pain, such as antidepressants or drugs for epilepsy. Regular pain relievers are not usually effective for this type of pain.
If your pain doesnt lessen, you might try therapies like nerve blocks or steroid injections near the area where the nerves exit the spine. Your provider might suggest an implantable nerve stimulator device for severe, ongoing pain that hasnt responded to other treatments.
Treatment Of Herpes Zoster
, an ophthalmologist should be consulted. For treatment of otic herpes zoster Treatment Herpes zoster oticus is an uncommon manifestation of herpes zoster that affects the 8th cranial nerve ganglia and the geniculate ganglion of the 7th cranial nerve. Herpes zoster … read more , an otolaryngologist should be consulted.
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Signs And Symptoms Of Shingles
Symptoms of shingles include:
- Hypersensitive area of the skin where the rash is preparing to break out that may itch or feel tingly
- Rash that appears on the trunk of the body
- Blisters that appear in clusters
- Mild itching or discomfort from mild to intense pain
- Vesicles turn yellow and begin to dry and crust over
The rash that develops from shingles typically heals in two to four weeks, often leaving pigment changes and pitted scarring.
Herpes Simplex And Zoster
Nelson LS LEE, Ian CT TSE
Herpes simplex virus is a DNA virus, belonging to the family Herpesviridae. Sequence homology between HSV types 1 and 2 is about 50%. Serologic assays of antibody can differentiate between the two by using type specific antigens, such as the gG1 and gG2 proteins. Upon primary infection, the virus establishes latency in neuronal cells of ganglia. Reactivation is frequent especially in the first year after infection. The mechanism of reactivation may be through alteration in viral proteins that are responsible for maintaining latency. UV light, trauma, immunosuppression and stress have been cited as factors causing reactivation. As cell-mediated immunity is essential to the containment of infection, it is understandable why HSV infection is particularly important in HIV disease.
Varicella zoster virus is also a herpesvirus. As such it shares structural characteristics with HSV. Furthermore, the virus causes similar histopathologic features, e.g. intranuclear inclusions and multinucleated giant cells. VZV causes two major syndromes: varicella and zoster .
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What Should I Do About An Exposure To Varicella
If you have been in contact with someone with chickenpox or shingles, or if you have a rash-associated illness that might be chickenpox or shingles, discuss your situation with your healthcare provider. Blood tests may be done to see if you have become infected with the virus or have had the disease in the past. If you are pregnant and not immune and have been exposed to chickenpox or shingles, call your healthcare provider immediately. Your provider may choose to treat you with a medication called varicella-zoster immune globulin , but in order for this medication to be most helpful, it needs to be given as soon as possible after your exposure to varicella.
What Are The Clinical Features Of Herpes Zoster
Herpes zoster is characterised by dermatomaldistribution, that is the blisters are confined to the cutaneous distribution of one or two adjacent sensory nerves. This is usually unilateral, with a sharp cut-off at the anterior and posterior midlines.
The clinical presentation of herpes zoster depends on the age and health of the patient and which dermatome is affected.
The first sign of herpes zoster is usually localised pain without tenderness or any visible skin change. It may be severe, relating to one or more sensory nerves. The pain may be just in one spot, or it may spread out. The patient may feel quite unwell with fever and headache. The lymph nodes draining the affected area are often enlarged and tender.
Within one to three days of the onset of pain, a blistering rash appears in the painful area of skin. It starts as a crop of red papules. New lesions continue to erupt for several days within the distribution of the affected nerve, each blistering or becoming pustular then crusting over.
The chest , neck , forehead and lumbar/sacral sensory nerve supply regions are most commonly affected at all ages. The frequency of ophthalmic herpes zoster increases with age. Herpes zoster occasionally causes blisters inside the mouth or ears, and can also affect the genital area. Sometimes there is pain without rashherpes zoster “sine eruptione”or rash without pain, most often in children.
Herpes zoster
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Why Doesnt Having Chickenpox Earlier In Life Provide Immunity Against Having Shingles Later
After having chickenpox, your body doesnt rid your system of the virus. Instead, the virus stays in a portion of the spinal nerve root called the dorsal root ganglion. In most people, the virus simply stays there quietly and doesnt cause problems. Scientists arent always sure why the virus gets active again, but they know stress can be a cause.
Difference Between Chickenpox And Herpes
As mentioned earlier in the article, chickenpox is a contagious sickness caused by the varicella-zoster virus. Herpes can refer to multiple things. Its the common name used for a sexually transmitted disease and for an infection of the lips spread through localized contact. Herpes can also refer to herpes-zoster, a virus that causes shingles.
The sexually transmitted herpes is known as genital herpes and is caused by the herpes simplex virus. Its characterized by uncomfortable, raised spots on the genitalia. If left untreated, genital herpes can cause even worse health complications. Herpes simplex also causes an infection on the mouth which is identified by a single, raised mouth sore. Herpes-zoster is a virus that causes shingles, which are characterized by painful rashes on one side of the body.
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What Can I Do If I Have An Attack Of Shingles
Shingles can be a painful and very uncomfortable condition, but there are a number of things you can do to make yourself more comfortable. These include:
- Taking paracetamol for the pain
- Applying a cold compress to affected areas
- Keeping the rash clean and dry to reduce infection
- Avoiding antibiotic cream.
If you think you are experiencing symptoms of shingles, the best thing to do is to go and see your doctor. It is important to get shingles diagnosed as soon as possible, as early treatment with antiviral medicine can help lessen an attack, but this needs to be taken within the first few days of any visible symptoms.
How Long Does A Shingles Outbreak Last
It can take three to five weeks from the time you begin to feel symptoms until the rash totally disappears.
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Varicella In Unvaccinated Persons
The rash is generalized and pruritic. It progresses rapidly from macular to papular to vesicular lesions before crusting. Lesions are typically present in all stages of development at the same time. The rash usually appears first on the chest, back, and face, then spreads over the entire body. The lesions are usually most concentrated on the chest and back. Symptoms typically last 4 to 7 days.
In healthy children, varicella is generally mild, with an itchy rash, malaise, and temperature up to 102°F for 2 to 3 days. Infants, adolescents, adults, pregnant women, and immunocompromised people are at risk for more severe disease and have a higher incidence of complications. Recovery from primary varicella infection usually provides immunity for life. In otherwise healthy people, a second occurrence of varicella is uncommon. Second occurrence of varicella may be more likely to occur in people who are immunocompromised. As with other viral infections, re-exposure to natural varicella may lead to re-infection that boosts antibody titers without causing illness or detectable viremia.
NEW: To learn more about how to promptly recognize and diagnose varicella, check out this Varicella Clinical Diagnosis Fact Sheet in Englishpdf icon and Spanishpdf icon.
Characteristic pancorporeal varicella lesions in an unvaccinated person.
An infographic that helps identify breakthrough varicella
Are There Natural Ways To Boost Your Immune System To Help Lessen The Chances Of Developing Shingles
Stress is a risk factor for developing shingles, so limiting your stress can be helpful. Try meditation, yoga or other relaxation methods.
Other things you can do include:
- Eat a healthy diet.
- Aim for seven to nine hours of sleep each night.
- Dont smoke or use tobacco products.
These are all tips for an overall healthy lifestyle, not just for reducing your chance of getting shingles.
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Differences Between Herpes And Shingles
Categorized under Disease | Differences Between Herpes And Shingles
Herpes vs Shingles
Herpes and shingles are two different types of diseases both have different symptoms and both have distinct modes of transmission. Their only similarity is that they are both caused by the family of the herpes virus. Herpes is said to be caused by the herpes simplex virus , while shingles is said to be caused by the varicella-zoster virus, the same virus that causes chicken pox.
Herpes is usually passed to others through intimate sexual contact. Oftentimes, it is referred to as a sexually transmitted infection or STI. There are two types of the herpes simplex virus: type 1 and type 2. Both of these types are contagious and can be passed on easily from one person to the other by direct contact even if the symptoms of herpes do not show up, it is still highly possible for someone to pass the condition on to a sexual partner. It is a chronic condition, meaning the virus will remain in your body and if triggered, it can be active again.
Summary
Who Is At Risk For Shingles
Anyone who has had chickenpox is at risk for getting shingles. But this risk goes up as you get older shingles is most common in people over age 50.
People with weakened immune systems are at higher risk of getting shingles. This includes those who:
- Have certain cancers
- Take immunosuppressive drugs after an organ transplant
Your immune system may be weaker when you have an infection or are stressed. This can raise your risk of shingles.
It is rare, but possible, to get shingles more than once.
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How Is Chickenpox Spread
Chickenpox is spread through direct contact with an infected individual as well as airborne droplets. Varicella-zoster is the virus that causes chickenpox. It takes about 14 to 16 days before someone starts showing symptoms of chickenpox after coming into contact with varicella-zoster.
Unvaccinated individuals living in crowded areas are especially at risk for spreading and contracting chickenpox. Individuals with a weakened immune system and those who live in poorly sanitized areas without access to clean and nutritious food are also at risk of contracting chickenpox as well as other communicable diseases.
Clinical Management Of Zoster And Varicella
Acute management of zoster lesions involves pain management with analgesics, local treatment and specific antivirals.
Antivirals
In general higher doses of antivirals are required for zoster than HSV infections and should be started within 72 hours of rash onset. Similar to treatment of HSV, antivirals for VZV reduce viral shedding and duration of disease. They may also reduce the risk of postherpetic neuralgia. Acyclovir, valacyclovir and famciclovir are the preferred first line drugs. Treatment is continued for 7-10 days or until lesions have crusted. Although no comparative trials have been performed, acyclovir is considered inferior because of its relatively poor bioavailability and more frequent dosing.
The comparative doses of the commonly used antivirals against zoster are listed in Box 25.4. Most HIV infected patients with localised zoster require only oral treatment as an outpatient. However, cutaneous dissemination and visceral involvement require intravenous acyclovir for treatment.
Acyclovir resistant zoster
Resistant zoster, generally presenting as persistent lesions refractory to treatment, is usually due to deficient or altered thymidine kinase. Cross resistance among the first line antivirals is expected. In this case, IV foscarnet at 40 mg/kg q8h may be effective.
Varicella
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Who Should Be Vaccinated With Shingrix
The Shingrix vaccine is recommended for those 50 years of age and older who are in good health.
You should get the Shingrix vaccine even if:
- Youve had shingles already.
- Youve been previously vaccinated with Zostavax . If youve been vaccinated with Zostavax, wait at least eight weeks before getting vaccinated with Shingrix.
- You dont know for sure if youve ever had chickenpox.
Ask your healthcare provider, who knows your entire health history if getting this vaccine is right for you.
Conventional Treatment And Prevention
Standard treatment for herpes virus infections is antiviral medication. The main antiviral medications used for both shingles and herpes are acyclovir, famciclovir , and valacyclovir .10,64,72 All three medications can be taken orally, reduce pain, and speed healing of the lesions however, famciclovir and valacyclovir areoften preferred because they require less frequent dosing than acyclovir.72
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Chickenpox Is A Type Of Herpes
But like many people who view chickenpox as just a normal part of growing up, they may not realize that recovering from the disease doesn’t mean the virus is gone, or that they’re immune from a future problem.
In fact, chickenpox technically known as the varicella zoster virus is a type of herpes virus that, just like its close relative herpes simplex, becomes a lifelong resident in the body.
And like its other cousin, genital herpes, varicella may be silent for many years, hiding out inside nerve cells and can reactivate later, wreaking havoc in the form of the excruciating skin disorder, shingles.
Progesterone Hormonal Contraception And Herpes Infection In Women
A number of studies have shown that multiple aspects of immunity in the female genital tract are controlled by sex hormones, and hormones influence susceptibility to several sexually transmitted diseases, including HSV infection.
Evidence from animal studies has shown that treatment with female sex hormones had a significant impact on rates of HSV-2 transmission. Treatment with estradiol was found to confer some protection against vaginal HSV-2 infection in a mouse model, whereas progesterone was found to exacerbateviral infection and contributed to extensive inflammation.146-148 This may be because progesterone induces a diestrus-like state, during which mice are most susceptible to HSV-2 infection.149
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