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Introduction to shingles

Shingles (also known as herpes zoster) refers to the infection caused due to reactivation of a virus called Varicella zoster. Initially, this virus would have caused chicken pox in the same individual before entering into a dormant stage in the body. These viruses spread in the body through the blood during the initial infection and reside in the collection of nerve cells (referred to as ganglia) in the body. Once reactivated, the Varicella zoster virus results in shingles, which is characterized by formation of small, fluid filled eruptions (blisters) on the skin that may be painful. Although noted at any age, shingles is common in adults above the age of 50 years and rare in children below 15 years. In some cases, individuals who are affected by shingles may develop a condition known as postherpetic neuralgia several years after being infected by shingles.1

Signs and Symptoms of shingles

As discussed earlier, shingles is characterized by formation of blisters that may be painful. These blisters are typically noted along the path of the nerve endings on the skin. Such blisters are often noted in the trunk region and may be observed around the trunk region like a belt. Other regions may also be affected. The initial stage of shingles is characterized by increased sensation to touch, numbness, burning or itchy sensation in the affected area. This stage may last for about 2 days to 3 weeks following which the blisters begin to form. The associated pain may at times be severe enough to cause sleeplessness. The clear blisters may become reddish eventually and then begin to harden over a period of 7–10 days. These harden skin tissues eventually fall off leaving behind a scar or areas of darkened skin.1,2

Causes of shingles

The exact cause of reactivation of the Varicella zoster virus is not known. Various factors that may alter an individual’s immune system may play a role in the reactivation. Following an initial infection, the virus causes chicken pox and then resides in the ganglia. When reactivated, the virus travels along the nerves that carry the sensation of pain resulting in skin eruptions and pain along the path of the nerve.1,2

Diagnosis of shingles

The diagnosis is often confirmed based on the signs and symptoms observed. The doctor may perform a skin biopsy at times if any other condition is suspected.

Treatment of shingles

There is no cure for the viral infection once an individual is infected. However, the severity of the condition and its complications can be prevented effectively when early therapy is initiated. The treatment of shingles involves administration of antiviral drugs known as acyclovir, valacyclovir and famciclovir. If the antiviral drugs are administered within 72 h after onset of rash, they are known to speed up the healing process and also decrease the duration of pain. These drugs are advised to be taken 3–5 times a day for about 7 days. Some of the over-the-counter painkillers such as ibuprofen or acetaminophen may be required to relieve the pain associated with it. At times, the doctor may also advise corticosteroids to relieve the inflammation. Some smoothening lotions such as calamine lotions may also be helpful in reducing the itchiness.1,3,4

Complications of shingles   

Over half of the individuals affected with shingles may develop complications of the eye that is characterized by inflammation of the eyelids, conjunctivitis and at times may affect the movement of the eyes. Rarely in severe cases, wherein there is widespread involvement of the nerves shingles may be mortal.1

Prevention of shingles

The occurrence of shingles cannot be prevented, as the exact factor that triggers reactivation is not known. However, the occurrence of chicken pox can be prevented by vaccinating children and adults, who have not been affected with chicken pox. Progression of shingles to postherpetic neuralgia may be prevented in certain instances with appropriate treatment of shingles.

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Written by: Saptakee sengupta
Date last updated: April 13, 2015