Shingles is a common viral infection of the nerve roots that is caused by the varicella-zoster virus (herpes zoster), which is the same virus that causes chickenpox.
About one-third of the population will suffer from shingles pain at some point in their life, with adults over age 50 and people with a weakened immune system at the highest risk of getting shingles. However, children can also get shingles.
What Is Shingles?
After a person has chickenpox, the virus remains inactive in their body. During adulthood, the virus may reactivate, and cause an outbreak of shingles. Though shingles is common, researchers do not know what causes the virus to reactivate.
Once reactivated, the virus travels along a sensory nerve and develops into a painful, localized skin rash or small blisters. The rash occurs in the area of the affected nerve, usually with blisters, or fluid-filled sacs on top of reddish skin. This rash is what we call shingles.
The word “shingles” is from Latin and French words meaning “belt” or “girdle,” because the shingles rash usually appears in a single band on the body.
Most healthy people that develop shingles will experience symptoms for just a few weeks, and the condition is unlikely to return. In some cases, the symptoms may linger for a few months and can be more severe.
Related: Postherpetic Neuralgia
What Causes Shingles?
Shingles occur when the chickenpox virus reactivates. Anyone who had even a mild case of chickenpox can get shingles, including children. Although the reason for the reactivation of the virus is unclear, some medical professionals believe it may be due to lowered immunity to infections as we age.
Other factors that can increase the risk of developing shingles include:
- Certain diseases. Conditions that weaken the immune system, such as HIV/AIDS and cancer, can increase the risk of shingles.
- Cancer treatments. Radiation or chemotherapy can lower the body’s resistance to disease and can trigger shingles.
- Certain medications. Drugs designed to prevent rejection of transplanted organs can increase the risk of developing shingles — as can prolonged use of steroids, like prednisone.
- Stress and Fatigue. Chronic, daily stress and highly stressful life events can be a risk factor, especially if other factors are present, such as mood disorders or a poor diet, that can negatively affect the immune system.
What are the Symptoms of Shingles?
Two to four days before the shingles rash occurs there may be tingling or local pain in the area. Pain is usually the first sign of shingles. For some, the pain can be intense. In some cases, and depending on the location of the pain, shingles can be mistaken for problems with the heart, lungs, or kidneys. Furthermore, patients may also experience headaches, fever, dizziness, sensitivity to light, and flu-like symptoms without a fever. And, there are cases where some patients experience shingles pain without ever developing the rash.
As time progresses, tingling, itching, joint pain, swollen glands, and a burning pain often develops. The rash typically appears one to five days after the symptoms begin, starting with small, red spots that form blisters filled with fluid, and then scab over. If the blisters burst from scratching, the skin may scar after the rash subsides.
The shingles skin rash usually heals within two to four weeks; however, some people develop ongoing nerve pain that can last for months or years, a condition called postherpetic neuralgia.
The rash caused by shingles is more painful than itchy, with the pain and rash being the most obvious signs of shingles. The skin rash tends to be isolated to one side of the body, or in a particular location on the body. Shingles most commonly develops in the areas of the chest, stomach, spine, face, and mouth, but can appear other places on the body, even in multiple locations.
Besides the skin, many other organs can be affected by shingles, leading to severe complications. For example, shingles can affect the eyes, brain, heart, lungs, liver, pancreas, joints, intestinal tract, blood vessels, and more. Therefore, it’s very important to immediately seek a doctor’s care when symptoms of shingles first occur.
Stages of Shingles
Shingles tend to develop in stages.
Prodromal stage (before the rash appears)
- Pain, burning, tickling, tingling, and numbness occurs in the area around the affected nerves several days or weeks before a rash appears. The discomfort usually occurs on the chest or back, but it may occur on the belly, head, face, neck, an arm or a leg.
- Flu-like symptoms (usually without a fever), such as chills, stomachache, or diarrhea, may develop just before, or along with, the start of the rash.
- Swelling and tenderness of the lymph nodes may occur.
Active stage (rash and blisters appear)
- A band, strip, or small area of rash appears. It can appear anywhere on the body, but will generally appear on only one side of the body. Blisters will form. The fluid inside the blisters is clear at first but may become cloudy after 3 to 4 days. Some patients may not get a rash, or the rash may be mild.
- A rash may occur on the forehead, cheek, nose, and around one eye (herpes zoster ophthalmicus), which may threaten eyesight.
- Pain, described as “piercing needles in the skin,” may occur along with the skin rash.
- Blisters may break open, ooze, and crust over in about five days. The rash heals in about 2 to 4 weeks, although some scars may remain.
Postherpetic neuralgia (chronic pain stage)
- Postherpetic neuralgia (PHN) is the most common complication of shingles. It lasts for at least 30 days and may continue for months or years. Symptoms include:
- Aching, burning, stabbing pain in the area of the earlier shingles rash.
- Persistent pain that may linger for years.
- Extreme sensitivity to touch.
- The pain associated with PHN most commonly affects the forehead or chest. This pain may make it difficult for the person to eat, sleep, and do daily activities. It may also lead to depression.
Shingles may be confused with other conditions with similar symptoms. The rash from shingles may be mistaken for an infection from herpes simplex virus (HSV), poison oak or ivy, impetigo, or scabies. The pain from PHN can feel like appendicitis, a heart attack, ulcers, or migraine headaches.
How is Shingles Diagnosed?
A diagnosis of shingles is typically based on a physical exam and history, specifically, if the patient has ever had chickenpox. Also, a tissue scraping or culture of the blisters may help confirm the diagnosis. Shingles can be confused with herpes simplex, dermatitis herpetiformis (a chronic blistering skin condition), impetigo (a bacterial infection of the skin), and skin reactions.
If there is a reason to suspect the rash is shingles, antiviral treatment may begin immediately. Early treatment can help shorten the length of the illness and prevent complications, such as postherpetic neuralgia.
How is Shingles Treated?
There is no cure for shingles, but treatment may shorten the length of illness and prevent complications.
As soon as the patient is diagnosed with shingles, the doctor will probably start treatment with antiviral medicines. If treatment begins within the first three days of seeing the shingles rash, there is less chance of complications, such as postherpetic neuralgia.
The most common treatments for shingles include:
- Antiviral medicines to reduce the pain and the duration of shingles.
- Over-the-counter pain medicines to help reduce pain during an attack.
- Topical antibiotics to stop infection of the blisters.
- Over-the-counter (OTC) antihistamines (e.g., Benadryl) and topical creams (e.g., Lidocaine cream) can help relieve the itching.
In severe cases, the use of corticosteroids, along with antiviral medicines, may help. However, corticosteroids are not often prescribed, since some studies show taking a corticosteroid along with an antiviral medicine doesn’t help any more than just taking an antiviral medicine by itself.
If pain persists for more than a month after the shingles rash heals, the patient may have postherpetic neuralgia (PHN), the most common complication of shingles. PHN can cause pain for months or years. It affects about 10-15% of people who had shingles.
Lifestyle and Home Remedies
Taking a cold bath or using cool, wet compresses on your blisters may help relieve the itching and pain. And, if possible, reducing stress can be helpful.
What are the Complications of Shingles?
Most patients will suffer from the typical symptoms of shingles. In some cases, shingles can lead to long-term pain or affect internal organs. Not everyone will have complications from shingles; however, some of the complications that can develop include:
- Postherpetic neuralgia. For some people, shingles pain continues long after the blisters have cleared. This condition is known as postherpetic neuralgia, and it occurs when damaged nerve fibers send confused and exaggerated messages of pain from the skin to the brain.
- Vision loss. Shingles in or around an eye (ophthalmic shingles) can cause painful eye infections that, in some cases, can cause immediate or delayed vision impairment.
- Neurological problems. Depending on which nerves are affected, shingles can cause inflammation of the brain (encephalitis), facial paralysis, and hearing or balance problems.
- Skin infections. If shingles blisters aren’t properly treated, bacterial skin infections may develop.
- Other organs. Several other organs can be affected by shingles, including the heart, lungs, liver, pancreas, joints, intestinal tract, blood vessels, and more.
- Ramsay Hunt Syndrome. A complication of shingles infections inside or near the ear can cause weakness of the muscles on the affected side of the face, as well as hearing and balance problems.
- Pneumonia. Although infrequent, shingles can cause inflammation of the tissue of the lungs, resulting in viral pneumonia. This condition usually improves along with the symptoms on the skin. Some patients may experience fever and persistent breathing problems for weeks after the rash clears.
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 (Zostavax) is recommended for adults ages 60 and older, even if they’ve previous had shingles.
For children and adults who never had chickenpox, there is a vaccine (Varicella) 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.
Novus Spine & Pain Center
Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating shingles pain. By using a comprehensive approach and cutting edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.