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Shingles: Settling The Score

Medically reviewed by C. Fookes, BPharm. Last updated on Mar 16, 2018.

1. Shingles Caused By Reactivation of the Chickenpox Virus

Shingles is a viral illness caused by the Herpes Zoster virus. This virus is the same virus that causes chickenpox, and shingles is a result of this virus reactivating in your body.

Technically, you are never cured of chickenpox. Even though your body recovers, the virus stays in your body hidden in the roots of your nerves near your spinal cord.

Many years later, something triggers the release of this virus and it spreads down your nerves, causing visible and painful symptoms on your skin. Risk factors for shingles include:

  • Older age - over 50% of all cases of shingles occur in people aged over 60
  • A weakened immune system - conditions such as HIV or cancer, autoimmune diseases such as multiple sclerosis or rheumatoid arthritis, or certain medications (such as prednisone, azathioprine) can all compromise your immune system, increasing your risk of developing shingles
  • Recent surgery.
Some people also develop shingles for no obvious reason at all.

2. Shingles Symptoms: Painful, Itchy Rash On One Side Of Your Body

The most noticeable symptom of shingles is a painful, itchy, red rash with fluid-filled blisters. Most people get a tingling or itchy feeling in the area a few days before the rash appears. It takes about 7 to 10 days for the blisters to scab over and about 2 to 4 weeks for the rash to fully heal. Commonly, the rash occurs as a single stripe around one side of your face or body.

A rash that occurs near the eyes is considered very serious as it could affect your vision. In addition to a rash, other symptoms can include fever, a headache, chills or a sore stomach. See a doctor immediately if you suspect you have shingles as treatment is usually more effective if you are diagnosed early.

3. Shingles Treatment: Antivirals

Several antiviral medicines are available to treat shingles. These include:

These medicines help shorten the length and severity of the illness and work best when started within 48 hours of the rash appearing, but can still be used up to 72 hours later.

Pain-relieving medications (such as acetaminophen, NSAIDs) can lessen sharp pains caused by shingles. Topical anesthetics - available as creams, gels, sprays or patches - numb the skin and decrease pain. Certain anticonvulsants or antidepressants are effective at dulling down nerve pain. Wet compresses, calamine lotion, or soothing colloidal oatmeal baths help reduce itching and may also offer relief.

4. Shingles Treatment: Helping You To Recover

If you think you may have shingles, see a doctor as soon as you can. Antiviral medicine is much more effective if taken within 48 to 72 hours of the onset of the rash; the sooner the better.

The following may also help ease shingles symptoms:

  • Wear loose-fitting, soft, comfortable cotton clothes and keep the rash covered especially while it is in the blister stage. As well as protecting your sores from further damage, this will also help reduce spreading the virus to others
  • Avoid touching or scratching the rash as this could lead to a secondary bacterial infection
  • Take a cool bath or apply a cool wet cloth or an ice pack wrapped in a towel to the rash.

If you have shingles take extra care to avoid contact with pregnant women, newborns, or people who are particularly unwell until all your blisters have crusted over and healed. These people are particularly vulnerable to infection and have a high risk of developing chickenpox as a result of contact with you.

5. Shingles Is Contagious: Avoid Spreading The Virus To Others

If you have shingles it is best to keep the rash covered until it has crusted over and forms a scab.

Shingles can be contagious in certain circumstances. People who have never had chickenpox or aren't vaccinated against chickenpox and come into contact with fluid from shingles blisters may get chickenpox (not shingles). Those who have only had one dose of the chickenpox vaccine are at a higher risk too. Even people fully vaccinated against both chickenpox and shingles are not guaranteed 100% protection from someone with shingles; however, if they do catch the virus, their symptoms are much more likely to be mild.

The herpes zoster virus can harm a developing baby if the mother is exposed late in pregnancy. People whose immune systems are weakened - such as those with cancer, HIV, or taking certain medications - have a higher risk of developing a more severe form of the disease.

6. Postherpetic Neuralgia: Persistent Nerve Pain After Shingles

Most people fully recover from shingles, with no long-lasting effects. Unfortunately some people are not so lucky.

Postherpetic neuralgia (PHN) is the term used to describe nerve pain that continues long after the rash has healed. PHN is more common in people over the age of 60. The risk of PHN can be reduced by taking antivirals during the illness.

For people who already have PHN, creams such as Capzasin-HP or Zostrix may help relieve the pain, although they should not be applied to broken skin or open blisters.

ZTLido is a patch that contains lidocaine that is placed directly on the area affected by PHN. Lidocaine is an anesthetic that numbs the area, relieving pain, and each patch lasts approximately 12 hours.

Oral medicines like gabapentin (Gralise, Neurontin), pregabalin (Lyrica) are another treatment that may be considered. See your doctor if you are suffering from PHN.

7. Herpes Zoster Ophthalmicus And Other Complications Of Shingles

Unfortunately, almost a quarter of people with shingles experience reactivation of the virus in the part of the trigeminal nerve that supplies the eye.

Herpes zoster ophthalmicus usually presents with a rash that affects the eyelid and the skin surrounding the eye. A small number of people also develop conjunctivitis, keratitis (inflammation of the cornea), uveitis (inflammation of the middle part of the eye), and ocular cranial-nerve palsies (paralysis). Long-term consequences of these effects include persistent eye inflammation, loss of vision, and debilitating pain.

Shingles can also cause hearing loss if it affects the ear or Bell's palsy if it affects a facial nerve. Shingles rashes can also become infected with bacteria and require antibiotics. Keep fingernails short and cover the rash to lessen the risk of scratching.

8. Herpes Zoster Vaccinations: Zostavax and Shingrix

The easiest way to prevent reactivation of the herpes zoster virus is to get vaccinated. Two vaccines are available: Zostavax and Shingrix.

Shingrix was approved by the FDA in October 2017, and is preferred by the CDC because it is much more effective than Zostavax, preventing shingles in about 90 percent of people. Zostavax is only about 50 percent effective. Two doses of Shingrix are required, with a gap of two to six months between shots. Zostavax is given as a single shot in the upper arm. Shingrix is slightly more expensive at $280 for the two shots compared to $223 for Zostavax; however, most insurance plans cover the cost of vaccination. Side effects from the vaccines are typically mild, with some people developing redness or tenderness at the injection site or a slight chickenpox-like rash soon after vaccination.

The CDC recommends Shingrix for everybody over the age of 50, even those people who have received Zostavax previously; however, the vaccine may be contraindicated in people with certain conditions.

Finished: Shingles: Settling The Score

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Sources

  • Shingles. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/shingles/multimedia/shingles/flh-20078300
  • About Shingles (Herpes Zoster) CDC http://www.cdc.gov/shingles/about/
  • Shingles Vaccination: What Everyone Should Know. CDC http://www.cdc.gov/vaccines/vpd-vac/shingles/vacc-need-know.htm
  • Shaikh S, Ta C. Evaluation and Management of Herpes Zoster Ophthalmicus. Am Fam Physician. 2002 Nov 1;66(9):1723-1730.
  • New Shingles Vaccine, Shingrix, Approved by FDA. Drugs.com News https://www.drugs.com/news/new-shingles-vaccine-shingrix-approved-fda-67506.html

Further information

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