Shingles

Shingles, also called zoster or herpes zoster, is a viral infection that affects the nerves. It typically produces a painful rash with blisters that can be dangerous in some people. The varicella zoster virus that causes chickenpox is the same one that causes shingles.

Shingles, also called zoster or herpes zoster, is a viral infection that affects the nerves. It typically produces a painful rash with blisters that can be dangerous in some people. The varicella zoster virus that causes chickenpox is the same one that causes shingles.

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What Is It?

Shingles is caused by the same virus that causes chickenpox. Even if you had chickenpox as a child—the CDC estimates that 90% of adults over 40 have had chickenpox (whether they remember it or not)—the virus can remain dormant in your body for many years, then become reactivated, either due to a lowered immunity from infections that come with age or a weakened immune system due to medical treatments or a disease. It's important to note that the shingles rash itself can be debilitating and painful, and it can also result in long-lasting nerve pain once the rash itself has cleared. 

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Types

Varicella zoster is the name of the virus that causes chickenpox. And, while it's a type of herpes virus, it's not the same virus that causes cold sores or genital herpes. (Herpes simplex 1, which is transmitted orally, causes cold sores and may cause genital herpes. Herpes simplex 2 is a sexually transmitted infection that causes genital herpes.)

The way you can develop shingles after you've had chickenpox is that the varicella zoster virus enters the bloodstream, infecting the nerves. The virus can remain dormant, essentially asleep, for years, or it can reawaken, traveling from nerve fibers to the skin surface above—and that's when shingles symptoms can begin to arise.

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Symptoms

Shingles are first accompanied with pain, typically on one side of the face or torso. Next, red blister-like bumps appear in on your chest, waist, neck, back or buttocks. These bumps can feel intensely painful, like an itching, burning, stabbing sensation on either the left or right side of your torso and may be accompanied by a headache and a low fever.

Afterwards, the bumps turn into fluid-filled blisters that appear in a belt-like path of the nerve that the virus is affecting. The big concern: Shingles blisters on your face or in your eyes. This is much more dangerous at this can cause lasting damage to your eyes and requires immediate treatment.

If you do have a shingles outbreak, it's imperative to know that this is contagious. In fact, you can pass the virus to anyone who hasn't had chickenpox if that person has direct contact with your shingles sores. Interestingly, if a person who has not had chickenpox becomes infected, he or she will develop chickenpox, not shingles. A safe bet: Avoid anyone with a weakened immune system, pregnant women, and newborns until your shingles blisters dry up and scab over.

Common symptoms of shingles include:

  • Burning, stabbing, or tingling pain
  • Itching
  • Skin sensitivity
  • Fever
  • Chills
  • Headache
  • Fatigue
  • Nausea
  • Red rash
  • Fluid-filled blisters
  • Skin that looks burned

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Causes

Scientists don't know exactly why some people develop shingles and others don't, but there are some common risk factors that may factor into who develops it. For example, shingles tends to flare up in those people who have weakened immune systems, including HIV and cancer patients, and organ transplant patients who take immune-suppressing medications to prevent organ rejection. Stress or trauma may also play a role in getting shingles. In addition, shingles is known to be age-related, since it mostly affects older adults, especially those people who are between the ages of 60 to 80 years old.

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Diagnosis

If you think you have shingles, head to your doctor immediately, especially if it's on your face or near your eyes as this can cause lasting damage to your eyes. Most cases of shingles are diagnosed based on physical signs and symptoms. The tipoff is the distinctive, band-like rash that most people develop. It's usually accompanied by itching, tingling, or pain in an area of the body affected by a previous bout of chickenbox.

However, in people with weak immune systems, shingles cannot be diagnosed by signs and symptoms alone. In rare instances, a person may have shingles with pain and itching but no rash. If this is the case, additional testing may be required to pinpoint the exact cause, including a scraping of skin cells and/or a blood test for varicella zoster virus DNA. High levels may indicate an active infection.

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Treatment

Once you're diagnosed with shingles, you will be treated with oral antiviral medicines, which you will take for seven to 10 days. The sooner you start treatment, the better off you will be. Prescription antiviral medicines, including acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex), aren't cures for shingles, but these drugs can weaken the virus, reduce pain, expedite healing, and stave off complications. Antiviral medicines are less effective when taken three or more days after a shingles rash has appeared, so early diagnosis is important.

Your healthcare provider might also prescribe over-the-counter or prescription pain-relief medicines and topical ointments to numb the pain. Other remedies such as cool compresses, applying Vaseline or Calamine lotion to the rash, wearing loose, cotton clothes, and taking oatmeal or baking soda baths can also be helpful.

It's important to note that this is not the time to watch your symptoms develop and wait for the rash to run its course. Although most cases of shingles resolve in two to six weeks, the risk of longer-term complications rises with age, weakened immunity, and delayed or lack of treatment. If you think you have shingles, it's important to get diagnosed right away. You can see a general practitioner, family medicine physician, internist, dermatologist, or neurologist for an evaluation.

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Prevention

To best prevent shingles, all adults over 50 should get Shingrix, the shingles vaccine approved by the FDA in 2017 for adults who are 50 and older. The vaccine is a two-part series, with the second dose given two to six months after the first.

Be sure to get the Shingrix shot—the approved choice that has been found to be over 90% effective, according to the CDC—even if you had Zostavax, the older shingles vaccine. You should also get it if you already had shingles or don't know if you had chickenpox as a child. (If you aren't sure, your doctor can test your blood for immunity to the virus.) Current evidence suggests the vaccine provides five years of protection against shingles in adults 60 and older. In addition, the Shingrix vaccine is the only way to both protect against getting shingles as well as developing postherpetic neuralgia (PHN), a painful, chronic condition that's the most common complication that stem from shingles and can last for months.

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