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Shingles
 About Shingles
Shingles is very common. Fifty percent of all Americans will have had shingles by the time they are 80. While shingles occurs in people of all ages, it is most common in 60- to 80-year-olds.
Shingles is a painful skin disease caused by a reactivation of the chickenpox virus. It is distinctive because it affects only one side of the body. The early signs of shingles usually develop in three stages: severe pain or tingling, possibly itchy rash, and blisters that look like chickenpox.
The name shingles comes from the Latin word cingulum, which means "belt" or "girdle." The scientific name for the virus that causes shingles is varicella-zoster, combining the Latin word for "little pox" with the Greek word for "girdle." Another name for shingles is herpes zoster.
The virus that causes shingles is a herpes virus. Once you are infected with this kind of virus, it remains in your body for life. It stays inactive until a period when your immunity is down.
If you have had chickenpox, shingles is not contagious. Nothing will happen to you if you are exposed to someone who has shingles. If you have never had chickenpox, however, avoid contact with anyone who has shingles; the fluid from their open blisters is infectious. You will not get shingles, but you could get chickenpox if exposed.
If you have not had chickenpox and you come into contact with someone who has shingles, ask your doctor whether you should get a chickenpox vaccination.
Unlike chickenpox, with shingles, the virus is NOT transmitted by someone breathing or coughing on you. You have to come in contact with the blister fluid itself. Once the blisters scab over, the contagious period is ended.
The pain of shingles can be debilitating. If it is severe and persists for months or years, it is called postherpetic neuralgia. And unfortunately, persistent pain is a common symptom in people over 60.
Outbreaks that start on the face or eyes can cause vision or hearing problems. Even permanent blindness can result if the cornea of the eye is affected.
Bacterial infection of the open sores can lead to scarring. In a very small number of cases, bacteria can cause more serious conditions, including toxic shock syndrome and necrotizing fasciitis, a severe infection that destroys the soft tissue under the skin.
The burning waves of pain, loss of sleep, and interference with even basic life activities can cause serious depression.
In patients with immune deficiency, the rash can be much more extensive than usual and the illness can be complicated by pneumonia. These cases are more serious, but they are rarely fatal.
If you are basically healthy, shingles usually resolves without complications. You are not likely to ever get it again!
More importantly, the new shingles vaccine may one day make shingles a rare disease.
Quiz 1. Shingles is a rare disease.
FALSE is the correct answer. At present, a person has a 50 percent chance of coming down with shingles by the time he or she is 80 years old. For a long time, shingles was a very frustrating disease because there was no effective treatment for it.
2. Shingles is sometimes called herpes zoster.
TRUE is the correct answer. Shingles is caused by a herpes virus, which is a kind of virus that stays in your body forever. "Zoster" is a Greek word that means "girdle," which is what shingles often looks like around one side of your waist.
3. You can get shingles from somebody who has shingles.
FALSE is the correct answer. A person who has shingles cannot transmit shingles to someone else. But if you have never had chickenpox, you can get chickenpox from contact with someone who has shingles. The virus is transmitted through contact with the actual blister fluid.
4. Vision problems can be a complication of shingles.
TRUE is the correct answer. When the rash is on the face, the cornea of the eye can be affected. It can cause permanent vision impairment or even blindness.
Causes and Risk Factors
Shingles is caused by a germ called varicella-zoster virus -- the one that gave you chickenpox when you were a child. As you recovered from chickenpox, the sores healed and the other symptoms went away, but the virus remained. It is with you for life.
The virus hides out in nerve cells, usually in the spine. But it can reactivate. Somehow, the virus gets a signal that your immunity has become weakened. This triggers the reactivation.
In the reactivation, the virus follows a nerve path called a dermatome. The nerve path begins at specific points in the spine, continues around one side of the body, and surfaces at the nerve endings in the skin. The pattern of the rash reflects the location of that nerve path.
The leading risk factor for shingles is a history of having had chickenpox. One out of every five people who have had chickenpox is likely to get shingles.
Another risk factor is aging. As we age, our natural immunity gradually loses its ability to protect against infection. The shingles virus can take advantage of this and reactivate.
Conditions that weaken immunity can also put people at risk for shingles. Shingles is especially dangerous for anyone who has had cancer, radiation treatments for cancer, HIV infection, or a transplant operation.
Most cases of shingles occur in adults. Only about 5 percent of cases occur in children. With children, immune deficiency is the primary risk factor, but children who had chickenpox before they were one year old may also get shingles before they become adults.
There have been studies of adults who had chickenpox as children and were later exposed to children who had chickenpox. Interestingly, that exposure apparently boosted the adult's immunity, which actually helped them avoid getting shingles later in life.
Stress is another factor that may contribute to outbreaks. While stress alone does not cause the outbreaks, shingles often occurs in people who have recently had a stressful event in their lives.
Quiz 1. What kind of germ, or microbe, causes shingles?
A. bacteria
B. virus
C. fungus
B is the correct answer. Shingles is caused by a virus. People often use the word germ to describe the many bacteria, viruses, and fungal organisms that surround us. They are a normal part of our environment, but some can make you sick. Viruses, for instance, can cause diseases such as colds, flu, hepatitis, and shingles.
2. Where does the virus hide out while it is inactive?
A. in the lungs
B. circulating in the blood
C. in the nerve cells
C is the correct answer. As you recover from the chickenpox, your immune system drives the virus to retreat to the nerve cells along the spine. The virus remains there for the rest of your life.
3. Who is most at risk for getting shingles?
A. children
B. elderly people who have had chickenpox
C. young adults who have had measles
B is the correct answer. Anyone who has had chickenpox can get shingles, but it is most common in people over 60.
4. What is one of the questions doctors might ask if they suspect a patient has shingles?
A. Have you had chickenpox?
B. How old were you when you had the measles?
C. Has anyone near you had the flu recently?
A is the correct answer. Shingles is caused by a reactivation of the chickenpox virus, so if a patient does not recall having had chickenpox, a shingles diagnosis is less likely.
Symptoms and Diagnosis
An outbreak of shingles usually begins with a burning, itching, or tingling sensation on the back, chest, or around the rib cage or waist. It is also common for the face or eye area to be affected.
Some people report feeling feverish and weak during the early stages. Usually within 48 to 72 hours, a red, blotchy rash develops on the affected area. The rash erupts into small blisters that look like chickenpox. The blisters seem to arrive in waves over a period of three to five days.
The blisters tend to be clustered in one specific area, rather than being scattered all over the body like chickenpox. The torso or face are the parts most likely to be affected, but on occasion, shingles breaks out in the lower body. The burning sensation in the rash area is often accompanied by shooting pains.
After the blisters erupt, the open sores take a week or two to crust over. The sores are usually gone within another two weeks. The pain may diminish somewhat, but it often continues for months -- and can go on for years.
Shingles can be quite painful. Many shingles patients say that it was the intense pain that ultimately sent them to the doctor. They often report that the sensation of anything brushing across the inflamed nerve endings on the skin is almost unbearable.
A typical shingles case is easy to diagnose. The doctor might suspect shingles if
- the rash is only on one side of the body
- the rash erupts along one of the many nerve paths, called dermatomes, that stem from the spine
The doctor usually confirms a diagnosis of shingles if the person also
- reports a sharp, burning pain
- has had chickenpox
- has blisters that look like chickenpox
- is elderly.
Some people go to the doctor because of burning, painful, itchy sensations on one area of skin, but they don't get a rash. If there is no rash, the symptoms can be difficult to diagnose because they can be mistaken for numerous other diseases.
In cases where there is no rash or the diagnosis is questionable, doctors can do a blood test. If there is a rash, but it does not resemble the usual shingles outbreak, skin scrapings from the sores can also be used.
Quiz 1. The most common symptom of shingles is a sore throat.
FALSE is the correct answer. Pain tends to be the worst of the shingles symptoms -- and the most common. In an otherwise healthy person, coughing and sore throat would not be associated with shingles.
2. Most people get the rash on the rib cage, chest, back, or face.
TRUE is the correct answer. The shingles rash tends to occur from the waist upward, in the areas nearest to the spinal nerve path. In a few cases, the rash breaks out in the lower body.
3. The pain usually disappears within 48 to 72 hours.
FALSE is the correct answer. More than 50 percent of shingles patients over 60 will have pain that continues for several months.
4. A rash that appears on only one side of the body is the most distinctive symptom of shingles.
TRUE is the correct answer. When the virus reactivates, it tends to follow a single nerve path, so it will break out on either one side of the body or the other. The combination of pain, rash, and blisters -- all on one side of the body -- is the hallmark of a shingles diagnosis.
Treatment and Prevention
Treatment with an antiviral can reduce the severity of the nerve damage and speed healing. If you suspect you have shingles, see your doctor within 72 hours of the first sign of the rash.
The doctor can confirm the diagnosis, prescribe the antiviral pills, and may also prescribe other drugs such as pain relievers. Patients with long-term pain may also be treated with numbing patches, tricyclic antidepressants, and gabapentin, an anti-seizure medication.
While these treatments can reduce the symptoms of shingles, they are not a cure. The antivirals do weaken the virus and its effects, but the outbreak still tends to run its course.
Good hygiene, including daily bathing, can help prevent secondary bacterial infections. It is a good idea to keep fingernails clean and well trimmed to reduce scratching.
In May 2006, the U.S. Food and Drug Administration approved a vaccine to prevent shingles in people age 60 and over who have already had chickenpox but who have not had shingles. The vaccine is designed to boost the immune system and protect older adults from shingles later on.
The vaccine is basically a stronger version of the chickenpox shot, which became available in 1995. The chickenpox shot prevents chickenpox in 70 to 90 percent of those vaccinated, and 95 percent of the rest have only mild symptoms. Millions of children and adults have already received the chickenpox shot.
Interestingly, the chickenpox vaccine may reduce the shingles problem. Widespread use of the chickenpox vaccine means that fewer people will get chickenpox in the future. And if people do not get chickenpox, they cannot get shingles. Use of the shingles and chickenpox vaccines may one day make shingles a rare disease.
Quiz 1. If you get to the doctor within 72 hours of a shingles outbreak, the doctor may give you
A. antibiotics
B. antivirals
C. vitamins.
B is the correct answer. Since shingles is caused by a virus, doctors prescribe antivirals, which weaken the virus. Antibiotics would not be effective unless there was a secondary bacterial infection. Vitamins would be useful only if you had a vitamin deficiency; they would have no effect on the virus.
2. What kinds of treatments are used for the pain?
A. painkillers, antidepressants, and anti-seizure medication
B. chicken soup and garlic
C. vitamins and minerals
A is the correct answer. Each patient responds differently to pain medicine, so there are several options. Common pain relievers can be effective, but persistent pain may require treatment with pain patches, tricyclic antidepressants, and gabapentin, an anti-seizure medication.
3. Why do researchers expect that shingles may become a rare disease in the future?
A. New antibiotics may be discovered.
B. Vaccines against chickenpox and shingles are now being used.
C. New sterilization techniques in the home keep it from spreading.
B is the correct answer. As more and more children are immunized against chickenpox and older adults are immunized against shingles, a bout with shingles may actually become a rare occurrence. Antibiotics are not used to treat or prevent chickenpox and shingles. Keeping surfaces sterilized in the home is not a practical way to prevent the spread of shingles.
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