Article

Shingles

Last reviewed: April 11, 2024

Shingles, a painful rash resulting from the reactivation of the varicella-zoster virus, can manifest anywhere on the body. However, it typically forms a single stripe of blisters along one side. This virus, which also causes chickenpox, lies dormant near the spinal cord and brain following a chickenpox infection, only to resurface as shingles later in life.

While shingles inflict significant pain, they are generally not life-threatening. Fortunately, vaccines exist to mitigate their effects, mainly when administered early on. However, postherpetic neuralgia can persist even after the blisters subside, prolonging the discomfort.

In the United States, approximately one million cases of shingles are diagnosed annually, with older individuals facing a higher risk; over half of cases occur in those aged 50 or older. Additionally, about one in ten individuals previously afflicted with chickenpox will eventually develop shingles.

Signs and symptoms

Before the rash appears, sensations like itching, pain, or tingling are often experienced in the affected area, sometimes several days in advance. While the rash typically emerges as a single stripe around the torso, it’s important to note that shingles can also affect facial regions, potentially leading to eye complications and vision loss. This is particularly concerning for individuals with weakened immune systems, where the rash may resemble that of chickenpox.

Advanced symptoms of shingles may include:

Causes

Shingles and chickenpox are caused by the varicella-zoster virus. Those with a history of chickenpox face an elevated risk of shingles when the virus reactivates within their system. However, why shingles develop in some individuals and not others remains unclear, though it frequently manifests in older individuals with compromised immunity.

Anyone previously afflicted with chickenpox is susceptible to developing shingles, but certain risk factors heighten the likelihood. The National Institute on Aging (NIA) identifies these factors as prior occurrences of shingles, undergoing chemotherapy or radiation therapy, having conditions that compromise the immune system like cancer or HIV, taking immune-suppressing medications such as steroids or those prescribed post-organ transplant, and being 60 years or older.

Transmission

Shingles and chickenpox are caused by the varicella-zoster virus (VZV). After recovering from chickenpox, the VZV virus remains dormant in the body, potentially reactivating later in life to cause shingles.

Typically, shingles occur once in a lifetime, though recurrence is possible. If someone with shingles comes into contact with individuals who have never had chickenpox or been vaccinated against it, the fluid from their rash blisters can transmit the VZV virus, resulting in chickenpox rather than shingles. These individuals may subsequently be susceptible to developing shingles in the future.

The likelihood of spreading the VZV virus is minimal if shingles and rash blisters are adequately covered. Transmission is improbable before the appearance of rash blisters or if direct contact with the patient is avoided. Those with chickenpox are more likely to spread the virus than those with shingles.

Complications

Even after the rash subsides, Postherpetic Neuralgia (PHN) can persist for an extended period in the areas affected by shingles. Individuals with PHN often endure severe and incapacitating pain that significantly disrupts their daily lives.

PHN affects approximately 10 to 18% of shingles sufferers, with the risk escalating with age. Older individuals afflicted with shingles face a heightened risk of developing PHN and may endure prolonged periods of excruciating pain compared to younger counterparts. Those under 40 years old typically do not experience PHN.

In addition to PHN, shingles can lead to severe eye complications, potentially causing vision impairment. Rarely, it may also result in other serious complications such as deafness, pneumonia, brain inflammation (encephalitis), or even death.

Prevention

Shingles can be effectively prevented through vaccination, particularly with the Shingrix vaccine in the United States.

Studies approved by the Food and Drug Administration (FDA) in 2017 demonstrate that Shingrix has protected against shingles for over five years. This nonliving vaccine consists of a virus component and is administered in two doses, spaced two to six months apart.

Shingrix is recommended and approved for individuals aged fifty and above and those who have previously received the Zostavax vaccine or had shingles. While Zostavax is no longer utilized in the United States, it remains available in other countries.

Common side effects of the shingles vaccine include pain, redness, tenderness, headaches, and swelling or itching at the injection site. Although the vaccine does not guarantee immunity from shingles, it can significantly reduce the severity and duration of the illness while lowering the risk of postherpetic neuralgia.

It’s important to note that the shingles vaccine does not treat individuals currently experiencing the disease but is a preventive measure. If shingles occur, seeking timely treatment from a healthcare professional is essential.

Treatment

Several antiviral medications, including famciclovir, acyclovir, and valacyclovir, are available to treat shingles and mitigate their severity and duration. These medications are most effective when initiated promptly at the onset of the disease. Individuals with shingles should quickly contact their healthcare provider to commence treatment.

Pain relief medications, whether prescribed by a healthcare professional or available over-the-counter, can help alleviate the discomfort associated with shingles. Additionally, calamine lotion, wet compresses, and colloidal oatmeal baths mixed with ground oatmeal can help relieve itching.

Works cited

Last reviewed and updated by on Apr 11, 2024

Dr. Jessica is a registered nurse and educator with 20 years of experience in critical care emergency nursing, specializing in patient care, education, and evidence-based practice. She holds multiple certifications and serves as a Patient Safety Coordinator.

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