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Shingles

Shingles is a painful, itchy skin rash that usually appears on your chest, but can also affect your trunk, back, legs or face. It is caused by varicella zoster virus, the same virus responsible for chickenpox. It is more common in the elderly and people with weakened immune systems. Treatment is works best within 2-3 days of the rash appearing. Vaccination with the shingles vaccine can reduce your risk of shingles and the long-term pain it can cause.
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Key points

  1. About 1 out of every 3 people will get shingles in their lifetime, with the risk rising to one in two for adults who live to 85 years old.      
  2. Shingles is caused by the same virus (varicella zoster) that causes chickenpox.
  3. See your doctor straight away (within 48 hours) if you think you have shingles.
  4. Complications include long-term pain after the rash has healed, and possible eye or ear damage if the rash is on your face.
  5. Antiviral medication can reduce the risk of complications.
  6. There is a vaccine to help prevent shingles.

What causes shingles?

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If you have been infected with the varicella zoster virus, you will most likely get chickenpox. Symptoms may be very mild or severe.
When you recover from chickenpox, the virus stays in your body – it 'hides out' in your spinal nerve cells and can lie dormant (inactive) for may years.

You develop shingles when this dormant virus is reactivated. This can happen if your immunity is lowered, such as by cancer treatment, HIV or ageing or other illnesses, such as rheumatoid arthritis and type 2 diabetes or during time of stress.

What are the symptoms of shingles?

Once the virus has been reactivated, it multiplies, spreads and causes pain along the path of the nerve that is infected, which may be on your chest, back, legs or face but on one side of your body only. The infection usually has 3 stages.

Stages of the illness Description
Stage 1 Pain that usually occurs 1 to 4 days before the rash appears. 
  • The pain is usually the first symptom of shingles.
  • It can appear as a tingling, itching or burning sensation, with stabbing pain every now and again.
  • You may also feel unwell with symptoms such as tiredness, fever and headache.
 Stage 2  A rash that lasts for about 7 to 10 days.
  • This may start off as your skin looking red (which is often missed) and you may notice a rash of small blisters over the next 3 to 4 days.
  • Because the blisters tend to follow nerve paths they’re usually in a line or ‘belt’ which is often from your back around to your tummy, and almost always on just one side.
  • The rash also may appear on one side of your face, neck or scalp.
  • The rash is usually painful, or very sensitive to touch. 
  • About 1 to 2 days after the rash, blisters may form, which then turn yellow, dry out and crust over.
You are infectious when your blisters burst. The virus can be spread by other people contacting the fluid from the blister.
 Stage 3 Resolution, which takes about 2 to 4 weeks.
  • Crusted lesions may be present for 2 to 4 weeks.
  • Healing may take longer with people who have weakened immune systems.
  • If the blisters have burst there may be scarring or changes in skin colour for some time after the rash has resolved.

How is shingles diagnosed?

To diagnose shingles, your doctor will ask you about your symptoms and also do an examination. Some people may have pain with no rash or rash with no pain. In such cases, a blood test may be needed to confirm the diagnosis.

See your doctor as soon as you think you may have shingles. This should be within 48– 72 hours of the rash first appearing, so you can be given antiviral medication to reduce the risk of complications. The earlier that antiviral medication is given, the more effective it is. If it is a holiday period, go to an after-hours clinic.

How is shingles treated?

The treatment for shingles helps to reduce the severity of the rash and its duration, and to manage the pain. There are a few things that you can do to ease your symptoms. Antiviral medicines help to fight the virus and other medications can be used to manage the pain.

What self-care can I do for shingles?

  • Keep the affected area clean and dry. Simple absorbent dressings can be used to cover the rash; this will help to prevent passing it on. Sticky (adhesive) dressings should not be used as they can slow healing and cause irritation. Antiseptics should not be used due to a lack of evidence that they are effective. A damp cool cloth on the affected area may relieve itchiness and pain.
  • Do not scratch the blisters – scratching can spread the virus and cause scarring. Calamine lotion is sometimes used to relieve the itch, but there is limited information on its effectiveness.
  • Avoid direct contact with other people, particularly immuno-compromised people, infants aged under one year and pregnant women.
  • It is possible to get shingles more than once.

Antiviral medications

Your doctor may prescribe an antiviral medication, such as valaciclovir or aciclovir, depending on your age, how long it has been since the rash started and how badly you are affected.
Antiviral medication can reduce the severity and the duration of pain associated with shingles. Antiviral treatment helps by slowing the multiplying virus. It’s best if it’s started within 3 days of the rash and is usually continued for 7 to 10 days, but it may be started up to 7 days after the rash first appears.

Medications for pain

Pain from shingles can happen during the infection (called acute pain), or may continue for months to years afterwards (called post-herpetic neuralgia).

Acute pain

The choice of pain relief will depend on the severity of the pain. For mild-to- moderate pain, paracetamol or a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen, is best. If this is not effective, or for moderate-to-severe pain, stronger pain relievers such as codeine, tramadol, morphine, tricyclic antidepressants and gabapentin may be used. Read more about pain relief medications.

Post-herpetic neuralgia (ongoing pain)

About 1 in every 3 people who have had shingles go on to have pain that lasts for months or years after the rash has gone. This is a type of nerve pain or neuropathic pain. The choice of pain relief will depend on the severity of the pain.

  • Generally, for mild pain, your doctor may prescribe capsaicin cream, where a small amount of cream is rubbed onto the painful area of your skin 3 to 4 times a day. It is only applied on healed skin and not on blisters as it can cause a painful burning feeling.
  • For moderate-to-severe pain, your doctor may prescribe pain relievers such as amitriptyline, nortriptyline or gabapentin. If this does not relieve your pain, then stronger pain relievers may be considered, but referral to a pain management specialist may also be needed.

How is shingles prevented?

In New Zealand, a vaccine called Zostavax is available for people over the age of 50. It reduces the risk of getting shingles and its complications — you may still get shingles but the symptoms are usually less severe and post-herpetic neuralgia is less likely. The vaccine may also be given after shingles to prevent it happening again. Currently the vaccine is not funded and you have to pay for it, but it will be funded from 1 April 2018 for people aged between 66 and 80 years old.

Learn more

The following links provide more information on shingles.

Shingles Ministry of Health, NZ, 2012
Shingles
 NIH Senior Health
Shingles (herpes zoster) DermNet NZ

References

  1. Zoster (herpes zoster/‌shingles) Immunisation Handbook 2017, NZ
  2. The diagnosis and management of herpes zoster and its complications BPAC, NZ, 2014


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Source: Health Navigator