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Shingles

Caused by a viral infection with the same virus that causes chickenpox (the varicella-zoster virus) shingles is manifesting as a painful rash. It usually appears on a part or another of the torso, under the form of a stripe of painful blisters. The infection is not life-threatening, but it is extremely uncomfortable. The only preventive solution is vaccination, while the discomfort experienced by the patient can be diminished by an early treatment. The infection is quite spread in the world, yearly, only in the USA, 1000 new cases being diagnosed. The rates at which this infection is appearing are also concerning, about 1 in three people being at risk to develop the infection at least once in their lifetime. Because the varicella-zoster virus is remaining in the nerve cells after the chickenpox infection is cured, it can reactivate at any time in the future. However, people in the fifties are more prone to experience shingles than younger ones are. A common opinion is that those with a weak immune system are at risk of developing it. Observation has proven that this painful rash usually lasts about two weeks, but in certain cases, it can lead to complications. The most common complication that results from shingles is postherpetic neuralgia, which is manifesting as a continuous nerve pain in the affected area.

 

Shingles Overview & Facts

Shingles is caused by a reactivation of the varicella-zoster virus. The virus is initially causing chickenpox, but once it is cured, the virus does not disappear, it only deactivates and remains in the nerve cells. At a point in time, in many people, the virus will reactivate, and will cause shingles, a painful strip of blisters on a part or another of the sufferer’s torso. Nevertheless, the infection can manifest in any other part of the body, but this is the most common localization. The way in which the virus reactivates is not completely understood. However, specialists have identified some shingles risk factors that may lead to shingles.

• Old age;
• Poor immune system;
• A chickenpox infection before the age of 18 months.

Exposure to the virus in the blisters is very likely to lead to a chickenpox infection, but not shingles itself. When the infection appears, it responds well to antiviral drugs. For instance, acyclovir will diminish the symptoms within 72 hours from the infection’s debut.  Because it is caused by the reactivation of a very common virus, specialists approximate that about a third of the globe’s population will have the infection at one point in their lifetime.

 

Shingles Symptoms & Diagnosis

Shingles symptoms and signs on the torso

Some of the most common early symptoms of shingles are a high fever, headache and malaise. Unluckily, these symptoms are very common in multiple infections, and the re-activation of the virus remains unidentified until cutaneous signs appear. Shortly after the debut of the fever and headache, there appears a sensation of burning pain and itchiness, paresthesia and hyperesthesia. In the affected area, the pain intensity can vary from mild to extreme. Many individuals need opioid drugs in order to calm their pain. The shingles symptoms in children are oftentimes mild, children rarely experiencing pain with their infection. However, the symptoms seem to worsen with age, increasing in intensity.  The infection can manifest in various areas of the body, the most common being the torso. However, shingles can appear on the face and hands as well. The eyes can also be affected by shingles in some cases, case in which the pain and discomfort experienced is considerably higher. Initial symptoms of shingles can be:

• Small blisters in the pattern of a belt, usually located on the torso;
• Burning sensation in the area, pins-and-needles sensation, numbing, throbbing in the area.
• Throughout the cutaneous manifestation, the patient will remain with a malaise sensation, as well as fever and headache.

Shingles signs and symptoms on the face

As previously mentioned, shingles may occur on the face and eye area. Because the trigeminal nerve is the most active in the case of the patients with facial shingles, and from it, the ophthalmic branch, many experience shingles on the face as a result of the migration of the virus from the nerve cells to the surface of the skin. The appearance of the rash on the ophthalmic area bears the name of zoster ophthalmicus. The symptoms of zoster ophthalmicus may manifest to the forehead, upper eyelid, and eye orbit. The pain is acuter than in other localizations. Common symptoms of this type of shingles is:

• Optic nerve palsies;
• Conjunctivitis;
• Uveitis;

This, oftentimes translates into chronic inflammation, debilitating pain and loss of vision.

Shingles oticus is another type of shingles, with a different localization, on the ear. This usually appears when the infection is spreading from the trigeminal nerve to the vestibulocochlear nerve. Common symptoms of shingles oticus are hearing loss and rotational dizziness, commonly known as vertigo.  Because the trigeminal nerve has multiple branches (three, to be more exact) and their terminations spread throughout the face, shingles can appear in the mouth as well. In this case, inflammation, pain and discomfort appear in the mucous membrane of the mouth – usually on the palate, gums and jaw. This type of shingles may appear on its own, or in a combination of other localizations. Although oral shingles may look similar to other oral viral infections, it can be easily distinguished because of the localization on a single half of the mouth.

Oral shingles looks initially like a series of opaque blisters (for approximately 4 days). In the following two weeks, the blisters will erupt and cause ulcerations, which are, oftentimes, incredibly painful. Many are unable to identify the pre-eruption symptoms of oral shingles, due to the fact that these are similar with a toothache.

Signs and Symptoms of Disseminated Shingles

In individuals with a weak immune system, shingles occurs as a wide rash, commonly known as disseminated shingles. In this case, other organs, such as brain or liver may be affected – this leads to hepatitis or encephalitis.

 

Shingles Causes

The infection is caused by the varicella-zoster virus (VZV), which is a double-stranded virus. Initially manifesting as chickenpox during ones’ childhood, the virus can cause later in life shingles. The VZV is not eliminated after the eruption episode that appears in chickenpox passes, but it remains dormant in the ganglions adjacent to the spinal cord, or the trigeminal ganglion that is at the base of the skull. Shingles appears exclusively in those who have had chickenpox in their lifetime. Although it can sometimes appear in children, this is an infection more specific to adults, especially those who passed the age of 50. Usually, in people with a healthy immune system, the virus is unlikely to reactivate. Some risk factors associated with the reactivation of the VZV are:

• Poor immune system due to aging, immunosuppressive therapies;
• Psychological stress, that decreases the resilience of the immune system.

When the virus reactivates, it becomes active in neuronal cells and multiplies until becomes carried away on the axons of the nerves and reaches the surface of the skin, where it causes blistering and inflammation.

The infection can be transmitted to individuals that are not immune, especially those who never had chickenpox. However, the transmitted infection is not shingles, but chickenpox. Touching the affected area is one transmission way.

Shingles Diagnosis

In order to receive the shingles diagnosis, a person must first of all show the specific blistering present in this affection. A visual diagnosis is oftentimes enough for medical staff, and even general practitioners can make it. However, in many cases, further tests are recommended because although the infection is causing infection in a specific pattern, the zosteriform herpes simplex virus can cause a similar one. In some cases, shingles does not cause a rash, or it appears later in the affection (zoster sine herpete), case in which it is difficult to diagnose.

Another diagnosis method for shingles is laboratory tests. One of the most recommended tests is the VZV-specific IgM antibody in blood tests. However, this antibody appears in blood tests only when the chickenpox or shingles is active, and not while the virus is dormant. A differential diagnosis for shingles is also necessary in some cases, because the eruption can be easily mistaken for herpes simplex, impetigo or dermatitis herpetiformis.

 

Shingles Treatment & Care

Treatment and care therapies for shingles have been developed in time, however, these only aim to reduce the severity of which the patient is experiencing the symptoms. Oftentimes, postherpetic neuralgia calls for a different approach, symptomatic treatment being necessary in order to reduce the complications. However, regardless of the complications, in most of the people, the complications disappear completely within a year.

• Analgesics are usually recommended in treating the discomfort caused by shingles. Over-the-counter analgesics usually succeed in treating the pain caused by shingles. Calamine, a compound of various lotions and creams recommended for the topical treatment of shingles, has calming effects on the irritated skin of the patients. Morphine is oftentimes used to sooth the more severe pain some patients experience. For the crusted areas, capsaicin cream is usually recommended. Gabapentin and antivirals will diminish postherpetic neuralgia.
• Antivirals are used to reduce the duration and severity of shingles. The standard treatment includes acyclovir, but recent development in the pharmaceutical industry include valaciclovir and famciclovir, treatments with similar effects, in some cases, even better effects. In those immunocompromised, injectable acyclovir is used.
• Steroids such as corticosteroids don’t seem to decrease the chances to get long-term pain from shingles. Also, their effectiveness in shingles has not been properly studied.

These therapies seem to all be effective in the case of Zoster ophthalmicus as well.

 

Shingles Prevention

The only prevention therapy for shingles is getting vaccinated. People aged 50, usually are recommended a single dose of shingles vaccine, as a preventive approach to the disease. The vaccine for shingles is available at medical offices and pharmacies. People interested in this vaccine can ask their GP for a recommendation.

 

Shingles Prognosis

This condition usually disappears within 5 weeks from the debut. In some cases (about 1 in 5 people), the patient will develop a painful condition, called postherpetic neuralgia. Zoster sine herpete is the condition in which a painful stripe remains where the inflammation used to be, without the usual inflammation. Complications may appear under the form of aseptic meningitis, myelitis, cranial neuropathies and polyneuritis. Partial face paralysis is very likely to occur, so is encephalitis and ear damage. If the infection occurs during pregnancy, the fetus may be born with complications and due to a series of infections that may appear during the pregnancy.

The risk of developing cancer after shingles seem to be slightly increased, but the mortality doesn’t seem to be affected in the presence of it. However, there may appear some complications:

• Bacterial infections;
• Motor weakness in the affected area;
• Eye involvement. Since the trigeminal nerve is involved in this affection, it should be treated aggressively, otherwise the risk of blindness emerges.
• Postherpetic neuralgia has already been mentioned and it involves severe pain in the affected area.

 

Shingles Conclusions

Although shingles is not a life-threatening condition, in some cases it leads to several complications, including a higher risk of developing cancer. The treatment consists of antivirals and analgesics, and has as a main goal reducing the intensity at which the patient is experiencing this condition. More frequent in individuals over 50 years old, it can occur in children as well, but at a smaller intensity. children usually don’t experience any pain and discomfort during this eruption, while in the case of adults, it can sometimes be debilitating.  It cannot appear without a previous infection with chickenpox, the two being caused by the same virus.