Shingles is caused by the varicella-zoster virus. A person will usually develop chickenpox the first time they are infected with varicella-zoster. After recovery, the virus lays dormant in the nervous system for decades and then reappears at a later time as shingles. Everyone who has had chickenpox (9 out of 10 adults) is at risk of developing an attack of shingles, and the risk of contracting them increases with age.

Symptoms

The first sign of shingles is often a tingling feeling on the skin, itchiness or stabbing pain. A rash appears after several days, beginning as a band or patch of raised dots on the side of the trunk or face. Shingles can affect nerves in the chest, back, arms, legs or face. It develops into small, fluid-filled blisters that begin to dry out and crust over within a few days. When the rash is at its peak, symptoms can range from mild itching, to extreme and intense pain. In the most severe cases, the lesions blend together and form a carpet of scabs - in some cases the rash leaves permanent scars. The rash and pain usually disappear within three to five weeks.

Outbreaks of shingles may occur for no apparent reason, but there may be some predisposing factors that can be identified. These include:

• Advancing age
• General illness
• Immune system disorders (e.g., HIV)
• Certain cancers (e.g., Lymphoma)
• Medications which affect the immune system (e.g., Prednisone)

Possible Complications

Shingles is not usually dangerous to healthy individuals, although it can cause great misery during an attack. Anyone with shingles on the upper half of their face, no matter how mild, should seek medical attention at once. There is some danger the virus could cause damage to the eye, resulting in blindness. Other complications are rare, but may include partial facial paralysis (usually temporary), ear damage or encephalitis (inflammation of the brain).

Is It Contagious?

Coming into contact with someone who has shingles will not cause you to "catch" a case of shingles, although there may be a small risk of contracting chickenpox if you have never had it before. In chickenpox, the virus is spread by coughing and sneezing and is highly contagious, but in shingles the virus is not shed from the throat and is therefore is much harder to pass on to others. Because the shingles rash contains the varicella-zoster virus, the infection can theoretically be passed on during the time the rash (blisters or sores) is visible. Once the scabs have healed over, they are no longer infectious.

Can Shingles be Prevented?

Chickenpox must be prevented in order to prevent shingles. A vaccine for chickenpox is now available, and it is hoped that immunized individuals will be less likely to develop shingles in later life.

Does Past Infection Make a Person Immune?

Yes. Most people who have shingles have only one episode with the disease in their lifetime. Those with impaired immune systems (people with AIDS, cancer, or leukemia, for example) may suffer repeated attacks.

Treatment

It is very important to treat shingles with an antiviral drug within 72 hours of the appearance of the skin rash. Antiviral drugs help stop the activity of the virus, thereby, minimizing nerve damage. The drugs also help reduce the severity and length of the outbreak, and decrease the likelihood of persistent pain. If treatment is not commenced within 72 hours of the onset of rash, there is a higher likelihood of persistent pain. Severe pain during the early stages of shingles is also associated with the development of persistent pain. Even the mildest stimulation may permanently sensitize the nerves, so it is important to manage severe, acute pain with appropriate pain relievers in addition to an antiviral drug to reduce the risk of long term pain.

There are three agents (only available by prescription) that have been demonstrated to be effective in treating shingles:

• acyclovir (Zovirax),
• famciclovir (Famvir), and
• valacyclovir (Valtrex).

Of these, valacyclovir (Valtrex) has been demonstrated to resolve the symptoms most rapidly.

Other Helpful Treatments

• Cold packs may be useful for temporary relief of symptoms in patients with pain after the rash is healed. Apply the packs frequently and with a protective layer (like a cotton towel) between the pack and the skin.
• Creams may be helpful, either because of the physical benefit of gentle massage, or because of ingredients such as capsaicin (Zostrix). Capsaicin is the chemical that makes chili peppers "hot". It can be applied after open skin lesions have healed, and works best when applied regularly. Most people get a temporary burning sensation where the cream has been applied, which is part of the action of the drug and wears off with continued use. It make take anywhere from 14 to 28 days before the full benefit of the cream is achieved.
• Calamine lotion may be applied during early phases of shingles to provide some cooling effect and comfort, but the crust it forms may be messy and difficult to remove.
• Light cotton clothing may reduce skin sensitivity from the rubbing of clothes.

Quick antiviral treatment is the key to effective management of shingles. See your physician within 72 hours of the rash appearing for treatment with an antiviral medication.

Compiled by Tom Danforth
Enderby, B.C.
Edited by Megan Stiles
Last Reviewed: September 2001