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Herpes Zoster - Shingles

Also known as shingles, is a viral infection caused by the same virus that causes chicken pox. Anyone who's had chicken pox can develop herpes zoster. The virus remains dormant or inactive in certain nerve root cells of the body and only when it reactivates does shingles occur. About 20 percent of those people who have had chicken pox will get shingles at some time during their lives. Fortunately, most people will get shingles only once.

It is not clear what prompts the virus to reactivate or "awaken" in healthy people. A temporary weakness in immunity (the body's ability to fight infection) may allow the virus to multiply and move along nerve fibers toward the skin. Although children can get shingles, it is more common in people over the age 50. Illness, trauma and stress may also trigger a shingles attack.

People with a weakened immunity for any reason are more prone to develop shingles. They are also more likely to have a serious form of it. Diseases that weaken immunity include cancers, such as leukemia or lymphoma, and AIDS. Some medical treatments including chemotherapy or radiation for cancer, drugs taken to prevent rejection of transplanted organs, and cortisone pills or injections taken for a long time for any reason, may also lower immunity.

What are the symptoms of Shingles?

The first symptom of shingles is burning pain, tingling or extreme sensitivity in one area of the skin usually limited to one side of the body. This may be present for one to three days before a red rash appears at that site. There may also be fever or headache.

The rash soon turns into groups of blisters that look a lot like chicken pox. The blisters generally last for two to three weeks. The blisters start out clear but then pus or dark blood collects in the blisters before they crust over (scab) and begin to disappear. T

he pain may last longer. It is unusual but possible to have pain without blisters or blisters without pain.

How severe is the pain?

The pain is often severe enough for the physician to prescribe painkillers.

Where does shingles usually appear on the body?

Shingles are most common on the trunk and buttocks. But it can also appear on the face, arms or legs if nerves in these areas are involved.

Great care is needed if the blisters involve the eye, because permanent eye damage can result. Blisters on the tip of the nose signal possible eye involvement. The dermatologist will usually refer the patient to an ophthalmologist (eye specialist) immediately.

What are the complications of Shingles?

Post-herpetic neuralgia is constant pain or periods of pain that can continue after the skin has healed. It can last for months or even years and is more common in older people. A bacterial infection of the blisters can occur, and can delay healing. If pain and redness increase or reappear, you should return to the dermatologist. Antibiotic treatment may be needed. Another complication is the spread of Shingles all over the body or to internal organs. This can also happen with chicken pox. It occurs rarely and most often in those with weakened immunity.

How is Shingles diagnosed?

The diagnosis is based on the way the blisters look and a history of pain before the rash on one side of the body. The dermatologist may scrape skin cells from a blister onto a glass slide for examination. The glass slide is then examined under a microscope for changes characteristic of zoster. If there is any doubt, blister fluid containing virus can be sent to the laboratory for special testing.

If someone has Shingles, is there any reason to worry about a more serious disease or a poorly functioning immune system?

The majority of people who develop Shingles are otherwise healthy; however, if you have other medical problems or could have been exposed to the AIDS virus, be sure to let your dermatologist know. This could affect treatment. Your doctor will ask questions about your medical history and may order tests, such as chest x-ray or blood studies, to be sure there are no other problems.

Is Shingles contagious?

The virus that causes Shingles can only be passed on to others who have not had chicken pox and then they will develop chicken pox, not Shingles. Shingles is much less contagious than chicken pox. Persons with Shingles can only transmit the virus if blisters are broken. Newborns or those with decreased immunity are at the highest risk for contracting chicken pox from someone who has Shingles. Patients with Shingles rarely require hospitalization.

Is there much scarring?

Scarring usually occurs only after more severe infections, such as in those with weakened immune systems, elderly persons or those whose blisters become infected.

What about treatment?

Shingles, usually clears on its own in a few weeks and seldom recurs. Pain relievers and cool compresses are helpful in drying the blisters.

If diagnosed early, oral anti-viral drugs can be prescribed to decrease both viral shedding and the duration of skin lesions. They are routinely prescribed for severe cases of Shingles - with eye involvement, for example - or for those with decreased immunity.

Corticosteroids, sometimes in combination with anti-viral drugs, also are used for severe infection, such as in the eyes, and to reduce severe pain. An ointment containing capsaicin, an extract of pepper, is helpful for some people.


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