Angela Payumo, MD
INTERNIST

Dr Payumo’s medical practical has taken her around the globe, from the Philippines to Haiti, to various cities in the US. She hails from a family of physicians and has been practicing herself since 2011. Dr. Payumo appreciates the sense of family and community that she sees and feels in Hawaii, and with CloudWell Health she hopes to provide greater healthcare access to the Hawaiian people, and to anyone in immediate need.

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Shingles Herpes Zoster

Shingles are a viral infection of the skin that causes a painful rash. The varicella-zoster virus triggers the condition by infecting a nerve below the surface of the skin. Prescription for shingles comprises antivirals and steroid medications.

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Shingles Herpes Zoster

What are shingles?

Shingles resemble chickenpox because it erupts in a painful blister-like rash. However, unlike chickenpox, shingles confines to one area of the body. Pain manifests before the appearance of a rash and may even continue to be there for a few days after the rash is gone completely.

Symptoms

Usually, only areas of skin supplied by the affected nerves present symptoms of the condition. In people with particularly weak immune systems, shingles may present on both sides of the body.

The most common symptoms of the condition are pain and rash.

Most often, the nerves that are affected are those that supply to the skin on the chest and tummy. It also sometimes affects nerves the upper face as well.

Symptoms include the following. For instance:

  • Pain is localized.
  • It can occur anywhere in your body.
  • Severity can be mild to very severe.
  • Pain can be gnawing pain, burning or dull and constant.
  • Sometimes, you may experience sharp stabbing pains that don’t last long.
  • There is tenderness in the affected area.
  • Typically, you would experience pain first and the rash after two days.
  • Red itchy fluid-filled patches quickly develop.
  • It may resemble chickenpox but is not spread all over the body.
  • Scabs fade away after the blisters dry up. There may be slight scarring left behind on the skin.
  • Typically, the duration of a single episode of shingles lasts between 2-4 weeks.
  • In rare cases, you may experience pain but no rash develops or you develop a rash but feel no pain.
  • Occasionally you may feel unwell and run a temperature for a few days.

Are shingles contagious?

A person suffering from shingles cannot pass on shingles to others. But those persons who’ve not had chickenpox before can contract chickenpox from a person who has shingles. People who have had chickenpox before are immune to the virus. Shingles are considered contagious until the blisters have scabbed and become dry. Dressing over the blisters will minimize the chance of spreading it to others. You can continue going to work or attend school so long as you feel well and blisters are covered by a dressing or layers of clothes.

Extra care to keep away from people with shingles must be taken by the following. For instance:

  • Those who are pregnant and have not have chickenpox before.
  • Those who have a weak or compromised immune system

Can other people catch it?

You only get shingles from a reactivation of your own chickenpox infection in the past.

A person suffering from shingles cannot pass on shingles to others. But those persons who’ve not had chickenpox before are likely to contract chickenpox from the person who has shingles. Persons who have had chickenpox before are immune to the virus.

So, you cannot ‘catch’ shingles.

How common is it?

The varicella-zoster virus causes both Shingles and Chickenpox. Shingles, also called herpes zoster, develops in people who have had chickenpox in the past. Herpes zoster is not the same as genital herpes, which results from herpes simplex virus.

While it can happen to people belonging to any age group, it is more likely to occur in people who are older than 50 years. About 25% of all people have shingles during their lifetime. It is also very rare to get shingles more than once in your lifetime, but such cases have been reported too.

Causes of shingles

The virus that causes chickenpox in people does not completely go away and remains dormant in the nerve roots near your spinal cord. It is unclear why, after many years since chickenpox, the virus may multiply again and travel along the nerve to the skin surface and manifest as shingles. Often shingles do not have a proper trigger source and seem to occur randomly. An illness or stressful times may sometimes trigger the onset. Among older people, the weaker immune system may sometimes be responsible for it by allowing the inactive virus to get active and multiply resulting in shingles. People who have AIDS or those who undergo treatments involving chemotherapy or steroids have weak immune systems.

Treatment

The treatment plan aims at:

  • Providing pain relief and easing discomfort.
  • Preventing complications of the condition from developing.

General measures:

  • Wear loose-fitting clothes made of cotton.
  • Cooling the affected area by using icepacks, bath, or wet dressings.
  • A dry dressing to cover the blisters will help minimize pain caused by friction with clothes.
  • Emollients or moisturizing creams can help relieve an itch. (like calamine lotion).

Painkillers for shingles

Tylenol or Advil may provide relief from pain and inflammation.

Antiviral medicines for shingles

Prescription for shingles includes acyclovir, famciclovir, and valaciclovir, which are antiviral medicines that will not kill the virus completely but work by stopping the virus from multiplying. They are most effective if you take them within 72 hours of the appearance of the rash.

Antiviral medicines for treating shingles is advised:

  • Among the elderly or those who are 50 or older than they may develop complications from shingles.
  • Shingles have spread to the eye or ear if you have poor immunity if shingles affect neck/ arm/ leg or genitals if your pain is excruciating or you develop a severe rash. Typically, an antiviral course of treatment lasts 7 days.

Steroid medication for shingles

Prescription for shingles sometimes also include steroids. Sometimes, steroid tablets such as prednisolone can be prescribed for a short duration besides antiviral medicines. They help in reducing swelling and pain relief. This prescription for shingles also helps the rash heal faster.

Are there any tests for shingles?

No, shingles diagnosis does not require testing. The shingles rash has a unique pattern and presents with a typical set of symptoms.

Should I see a doctor?

Yes. Seek medical attention as soon as you spot the rash. Your doctor will tell you if you need a prescription for shingles or not.

Because the pain can be very severe, doctors may prescribe stronger medicines than those available over the counter.

What complications are there from shingles?

Complications are very rare, but they include:

  • Postherpetic neuralgia (PHN)–This is a condition where the nerve pain continues to trouble the person even after the rash is completely gone.
  • Skin infection–The skin around the rash comes tender and inflamed because of a bacterial infection. In such cases, you may need a course of antibiotics.
  • Eye problems–In rare cases, shingles of the eye can occur. If left untreated, the inflammation could even cause loss of vision. Seek medical help if you find it troubling your vision or makes your eye itchy.
  • Weakness–Occasionally, the affected nerve controls a motor function and not sensory. This could lead to weakness in the muscles affected by the nerve.
  • Various other rare complications–These are rare. The infection may spread to the brain or spread throughout the body as opposed to confining the rash to the area where the nerve supplies the skin. People with severely compromised immune systems are likely to develop complications.

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