What Are Shingles? The Symptoms, Causes, Prevention, And Treatment

Anyone that has experienced shingles will tell you how painful and uncomfortable this viral infection can be. This condition, otherwise known as herpes zoster, is caused by the reactivation of varicella-zoster, the chickenpox virus.

After a person, commonly a child recovers from chickenpox, this virus tends to remain in specific nerve cells. This viral presence will usually remain until adulthood.

For many adults, these nerve cells will host varicella without the virus ever making an appearance or causing further complications. However, the shingles virus isn’t always inactive. There are cases where the virus re-activates.

In such a scenario, the telltale symptoms of this skin infection may be observed. Shingles usually appear as a strip on one section of the body in adults and older people.

Shingles vs hives

Shingles are hard to miss. These tend to appear as a painful rash on one side of the face or body. Within this rash are fluid-filled blisters that will usually last for around seven to 10 days, within which time they should scab over.

The pain, blister formation, and peculiar appearance of rashes on one section of the body set shingles apart from more common skin conditions.

For example, hives (urticaria) appear not as blisters but in the form of red, raised welts. These welts often take on different sizes and can affect any part of the body.

You may experience hives as an allergic reaction to insect bites, food, medicine, or even for an unknown cause. In comparison, shingles are caused by a viral infection. 

Hives only make a short-term appearance. Within a few hours or days, your skin should be all cleared up. They may stay on longer in chronic cases, however.

Are shingles contagious?

If you have shingles and are worried about infecting other people, there are a few things to know. First, this condition isn’t immediately contagious. However, coming into contact with the fluid in the shingles’ blisters can cause the rash to erupt.

That said, people who have gone their whole lives free of chickenpox may be at risk of contracting the illness following exposure to the varicella virus. Anyone who has had chickenpox is at risk of getting shingles.

Shingles are transmissible through direct skin contact or when infected droplets are taken in.

Keeping the rash covered can reduce the chances of spreading the virus to other people. When your blisters are dried up and scabbed, you have very slim odds of exposing vulnerable people to chickenpox.

Statistics

How common are shingles?

Shingles are a common skin condition affecting everyone, from children and middle-aged adults to much older people. In the U.S., one in three people¹ will experience this rash outbreak in their lifetime. Every year, 1 million people in the U.S. have a few days or weeks spent managing shingles symptoms. 

The risk of this disease increases with age. About half of the population of people² who will live up to the age of 85 are at risk of a shingles outbreak. 

Who gets shingles?

Most people who display shingles symptoms are usually in their 50s³. It’s fairly uncommon for this condition to affect anyone below the age of 40. The reason behind this isn’t exactly certain. While unconfirmed, it is suggested that the body’s defense system keeps the virus dormant until around that age. 

Shingles can sometimes reveal the state of your immune system. This condition tends to flare up when there is weakened immunity.

People living with compromised body defense systems are at risk of shingles. This includes cases where the following conditions are being managed:

  • Cancers such as leukemia

  • Human Immunodeficiency Virus (HIV)

  • Immunosuppressive medications, e.g., drugs used to manage severe psoriasis or advanced psoriatic arthritis

  • Chemotherapy

While shingles aren’t exactly influenced by gender, one study⁴ has shown that women might be at a higher risk of developing this condition than men.

  1. Shingles (herpes zoster) | Centers for Disease Control and Prevention

  2. Varicella zoster virus infection (2017)

  3. Shingles: Who gets and causes | American Academy of Dermatology Association

  4. Gender difference in the incidence of shingles (2004)

Symptoms

When your body is expecting an outbreak of shingles, it usually displays a few warning signs. For starters, you may observe unexplained tiredness and fever around two to three days before the rash appears.

When the blisters are set to appear, a person with this infection might complain of tingling sensations under the skin. Herpes zoster usually appears across a single strip of skin on either the right- or left-hand side of the body. Most people will get these blisters over their torso or chest, but they aren’t limited to those areas. The rash may develop on the face, arms, eyes, or ears.

Common signs of shingles include¹:

  • Moderate to severe stinging or burning in the affected areas

  • Reddish patches on the skin with bumps

  • Small itchy blisters

Facial symptoms

Although these are rare, shingles may sometimes appear across one side of the face. This painful rash of blisters can also affect facial nerves, leading to brief facial paralysis. This paralysis usually clears up after the infection is managed properly.¹

Eye symptoms

Shingles on the face can sometimes spread to the eye. When the eye is affected, this condition is known as ophthalmic shingles².

Eruptions in this form, observed with other symptoms of shingles, can be dangerous. This is because eye damage (acute retinal necrosis³) is a known complication of shingles. A person may even experience permanent damage to the eyes when shingles appear around the face. 

To prevent vision loss, it’s important to see a healthcare professional at the first sign of this condition. 

Ear symptoms

In some cases, your hearing can suffer as a result of shingles. The virus can spread from facial nerves to auditory nerves, causing hearing loss. This infection may also lead to vertigo, a condition where a person experiences dizziness.⁴

When facial nerves near the ear are affected by shingles, this can lead to facial paralysis and hearing loss. This condition is known as Ramsay Hunt syndrome⁵. In some cases, shingles may cause brain inflammation.⁶

After their appearance, the itchy blisters can last up to five days. Following that time, they will typically dry up, leaving yellowish scabs behind. People with shingles mostly experience itching. They may also complain of pain at even the gentlest touch.

Causes

After causing chickenpox, the varicella-zoster virus works its way to nerve fibers along the spinal cord or the base of the skull. This virus will typically remain dormant in the dorsal root ganglion along the spinal nerve.

For most people, life can continue without ever experiencing shingles. This is despite the virus occupying the sensory nerve ganglion. However, this can change when the immune system is weakened.

If immunity is compromised as a result of illness, old age, and stress, among others, the virus may move along the spinal nerve root to get to the skin. Once there, varicella-zoster will multiply in the skin cells, causing inflammation and a distinct rash¹. It is the inflammation along the nerve endings that is usually responsible for shingles-related pain¹.

Risk factors

If you’ve never had chickenpox, you’re probably curious about your odds of developing shingles.

Having a previous infection with chickenpox puts you at a higher risk of shingles later in life. Likewise, people who have received the shingles vaccine (Zostavax) may find that they can develop herpes zoster as they get older². 

After the age of 40, but mostly around 50, the chances of getting shingles become higher. This risk is also present in people who live with conditions that affect immunity. Similarly, immunosuppressive drugs may indirectly contribute to one’s chances of developing shingles. 

While women may be at higher risk of this infection than men, African Americans are more at risk as well. On average, shingles are 50% more common in African Americans than in white communities².

Complications

A person with shingles can have a number of outcomes. In some cases, the eruptions may leave as quickly as they appear. The infection usually causes only mild symptoms. 

Sometimes, however, blisters may last a little longer before disappearing. In these cases, people with herpes zoster may experience complications from the skin infection.

Postherpetic neuralgia (PHN)

PHN is one of the most common potential complications of shingles. You may be dealing with this condition if you continue to experience pain in the rash area after around 90 days have passed.²

You should know that if you’re under 40, your chances of getting PHN are very slim. However, around 10%–13% of people over 60 who have had shingles may complain about PHN². The risk of this condition increases with age.

This long-term nerve pain can be so destabilizing that older patients have complained of depression, anxiety, weight loss, and difficulty carrying out daily tasks as a result of shingles³. 

Shingles during pregnancy

Women need to take extra care if they have shingles while pregnant. Ordinarily, shingles aren’t dangerous for the fetus like chickenpox is¹. However, the varicella virus can infect the fetus, which may cause health complications for the newborn⁴. 

Bacterial skin infections

In some cases, shingles can cause even further infections to the skin. In addition to the viral infection, bacterial superinfection from agents like Staphylococcus aureus can affect skin lesions. 

Cranial nerve damage

Shingles can also cause nerve damage in the form of Ramsay Hunt syndrome. Other cranial nerve palsies such as ophthalmoplegia (eye muscle paralysis) and polyneuritis cranialis (cranial nerve inflammation) are known shingles complications².

The lungs and liver may also suffer from the effects of this viral infection. Shingles may cause complications such as pneumonitis (inflammation of lung tissue) and hepatitis (inflammation in the liver)². Membranes in the brain and surrounding tissue can also suffer from shingles complications².

When people live with compromised immune systems, their risk of developing shingles becomes higher. Also impacted are possible complications from these skin lesions. 

A weakened body defense system may experience more severe skin rashes². Likewise, this system is at higher risk of disseminated zoster — a condition where more than 20 skin lesions appear outside of the initial patch of the skin marked with shingles⁴. 

Diagnosis

By examining the pattern of the blistering rash, it may not be too hard to identify shingles on your skin. However, to make an accurate diagnosis, it’s important to present your skin lesions to a healthcare provider. This is especially because shingles can sometimes be confused with the effects of the herpes simplex virus, contact dermatitis, and scabies, among others².

A healthcare professional will typically recommend laboratory testing to determine whether you have shingles or another condition altogether⁴.

PCR testing

PCR testing examines the fluid in the blisters for the DNA of the varicella virus. It also tests lesions in the eye, or even blood, to identify what may be causing the rash. 

Testing is useful in cases where unusual shingles symptoms such as lesions outside normal zones are presented. 

Direct fluorescent antibody testing

If you experience skin lesions around your eye, direct fluorescent antibody testing will examine corneal or blister fluid to determine what is happening.

Also used is a Tzanck smear, which identifies if a lesion is caused by the herpes virus. Likewise, a health professional may recommend a test to determine if your body has released IgM antibodies to fight against shingles. This will signal the presence of the viral infection.

  1. Shingles: Overview (2006)

  2. Shingles (herpes zoster): Clinical overview | Centers for Disease Control and Prevention

  3. Shingles | National Institute on Aging

  4. Herpes zoster (2022)

Treatments

To manage shingles, look for options that can manage ongoing pain, skin sensitivity, itching, and other possible symptoms of this condition.

Medication

Pain medicine

Over-the-counter pain relievers or prescription pain medications can provide relief from the pain caused by shingles. In cases of intense pain caused by herpes zoster, opioid medication may be prescribed by a health professional.

Antiviral treatment

Also available are antiviral medications that help manage the severity and length of the shingles illness. Antiviral drugs such as acyclovir, valacyclovir, and famciclovir are useful for treating this infection.

To make sure these drugs are effective, begin treatment early. This should be after a proper diagnosis is made. 

Antidepressants

While this medication is popularly used for depression, antidepressants¹ are also useful for managing shingles. This treatment helps manage the neuropathic pain that occurs when the nervous system suffers damage. In particular, tricyclic antidepressants have shown promise for managing shingles¹. 

To prevent your skin from experiencing further infection, topical antibiotic creams can prevent secondary bacterial infections. 

Anti-inflammatory drugs

To relieve the extreme pain that may be caused by shingles, anti-inflammatory medications may be prescribed. Anti-inflammatory corticosteroids or non-steroidal anti-inflammatory drugs can help manage mild to moderate pain brought on by this infection. 

Home remedies

If you’re considering other treatment options to manage your shingles, home remedies are available to provide relief. They include options like an oatmeal bath, a cool compress, and calamine lotion to soothe skin itching².

  1. Pain, pain, go away (2008)

  2. Shingles | National Institute on Aging

Prevention

If you have yet to experience shingles, the National Institute on Aging¹ recommends vaccination to prevent this skin infection.

The shingles vaccine, Shingrix, has proven to be effective in preventing shingles and possible complications such as postherpetic neuralgia. Other options include the Zostavax vaccine.

Anyone over the age of 50 is advised to get this vaccine even if they’ve already experienced shingles. Over 50-year-olds yet to be infected and those who have already had the chickenpox vaccine may receive the vaccine as a preventative measure.

Likewise, if you’re unsure about having chickenpox when you were younger, this vaccine can help reduce your risk of getting shingles.

However, while this vaccine is encouraged, it may not be your best preventative option if you²:

  • Are currently managing shingles

  • Are down with an illness or fever

  • Have previously experienced a negative reaction to a dose of the shingles vaccine

  1. Shingles | Washington State Department of Health

  2. Shingles | National Institute on Aging

Doctors & specialists

When should you see a doctor?

Shingles can lead to dangerous health outcomes. At the first sign of a rash that might signal this infection, it’s important to see a medical professional. This visit should ideally take place within the first three days of noticing the rash.

This time frame allows for treatment options to begin early. Early intervention can provide relief and manage the odds of shingles complications. 

Which doctors treat shingles?

When those first few symptoms of shingles appear, a dermatologist¹ is one of the recommended specialists to be consulted to review the signs. These skin doctors can diagnose this skin eruption by simply looking at it. They may also make use of laboratory tests to confirm their suspicions of the illness.

Dermatologists can prescribe medication to manage the pain, itchiness, and inflammation that follow shingles.

  1. Shingles: Diagnosis and treatment | American Academy of Dermatology Association


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