Shingles is a painful, itchy skin rash, that usually appears on the chest, but can also affect the trunk, back, legs or face.
- Shingles, usually occurs in people aged over 50 years. and is four times more common in those over 70 years of age.
- It is caused by the same virus (varicella zoster) that causes chickenpox.
- See your doctor straight away (within 48 hours) if you think you have shingles.
- Complications include prolonged pain after the rash has healed, and possible eye damage if the rash is on the face.
- Antiviral medication can reduce the risk of complications
- There is a vaccine to help prevent shingles.
To get shingles, you will first have been infected with the varicella zoster virus, which causes chickenpox. The varicella zoster virus is also known as ‘herpes zoster virus’ or ‘human herpes virus type 3’.
The varicella zoster virus can be spread through coughing and sneezing. On first becoming infected, you are likely to develop chickenpox (nine out of 10 people have had this). However, when you recover from chickenpox the virus remains in your body - it 'hides out' in your spinal nerve cells and can lie dormant (inactive) for decades.
You develop shingles if this dormant virus is reactivated. This can happen if your immunity is lowered for any reason, and ageing is one factor that causes lowered immunity. Other illnesses or stress that lower your immunity can also bring on shingles.
Once the virus has been reactivated, it multiplies, spreads and causes pain along the path of the nerve that is infected.
- Shingles typically begins with pain and itching.
- Within 2 to 3 days red patches start to form on the skin in the painful area, and the pain may worsen or become a deep aching or burning.
- If you are under 50 years of age, shingles pain is often not too severe, but if you are older it can be extremely painful.
- The rash then develops into a 'belt' of small blisters, usually on only one side. The blisters tend to join and crust over in about 7 to 10 days.
- The area of the rash depends on which nerve supply the virus has been 'hiding out' in.
- Untreated, the rash usually lasts two to five weeks, and it may leave some scarring.
- You remain infectious until all of the rash has scabbed over.
- You may also experience headaches and fever.
Diagnosis of shingles is made using your history combined with a clinical examination.
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. If it is a holiday period, go to an after hours clinic.
Your doctor may prescribe an antiviral medication, depending on your age, how long since the rash started and how badly you are affected. Your doctor will also decide what strength of pain relief is suitable for you as an individual - this depends on what other health conditions you may have.
Antiviral treatment can reduce the severity of shingles, help heal the rash and reduce risk of complications developing. Antiviral treatment helps by slowing the multiplying virus. To work, it needs to be started within 3 days of the appearance of the rash.
Possible complications include:
- Additional infections around the rash, which might need antibiotic treatment.
- Involvement of the eye, mouth or tongue (you will be referred to a specialist for treatment).
- Scarring can occur as white areas with lost pigment and feeling.
- Muscle weakness occurs in about 5% of people with shingles. It happens because the nerve supplying the muscle has also been inflamed by the virus. It occurs more often on the face than on the body, but most people with muscle weakness recover completely or near completely.
- Post-herpetic neuralgia (PHN) is pain lasting over 4 weeks from the start of the rash, and persisting even though the rash has healed. It happens because the infection has inflamed and possibly damaged the nerve as well as the skin. This causes your pain senses to become disorganised and overexcitable while the nerves are repaired. The chance of lasting pain increases the older you are. The pain improves with time, but can be difficult to treat while it lasts. Your doctor can determine the best form of pain relief for you - this may be paracetamol, analgesic or an analgesic gel to use on the healed areas. If the pain does not go away, your doctor can advise what other types of treatments can be tried.
- Take medications as prescribed - this reduces the severity of shingles and the risk of lasting problems.
- If you cannot sleep, try constructing a support to keep the weight of your bedding off of your body.
- Keep the rash dry (you can still bathe or shower).
- Stay at home until your rash has healed.
- When the rash has healed and the crust has fallen off (not before) you can use a moisturiser, or a vitamin E cream, which may help prevent scarring.
- After the shingles, avoid exposing the area to sunlight.
- If you have lasting pain, wear loose-fitting clothes made of natural fibres and seek help from your doctor early on.
Shingles is contagious. This means you can pass the chickenpox virus onto someone else who is not immune to chickenpox if that person comes in contact with weeping shingles blisters. Therefore avoid close contact with pregnant women and young children.
There is a vaccine to help prevent shingles or reduce its severity. It may also help prevent or reduce ongoing pain after shingles (post-herpetic neuralgia).
- The vaccine is for use in people over the age of 50.
- It is not funded in NZ so you need to pay for it. The vaccine costs about $200 plus a doctor or nurse's fee.
- Talk to your doctor.
Shingles NIH Senior Health
Shingles: causes, symptoms, treatment, vaccination Southern Cross Healthcare Group NZ
Shingles (herpes zoster) DermNet NZ
Source: Health Navigator