What is herpes zoster?

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Matthew F. McCarty, MD
Anesthesiology

Shingles is an infection caused by the varicella-zoster virus or the same one that causes chicken pox. It is thought the virus resides in nerve fibers after our childhood infection with chicken pox and then as an adult when the immune system is weakened by medications, disease or stress it becomes active once again. Shingles can develop at any age but higher risk groups are those over 60 or if you had chickenpox before age one. Now there is an immunization for shingles which markedly helps to reduce but not prevent ones chance for developing the condition. Tingling and burning are usually the first symptoms often on one side of the face trunk or extremity. This is followed by red blister formation that ends in scab development where the crusts fall off in 2-3 weeks. Other symptoms can include chills, headache, hearing loss, vision problems, abdominal pain, joint pain and swollen glands.

Treatment is best begun within 24 hours of feeling the burning pain. Regardless a rash of blisters often develops and cool compresses, non-opioid analgesics and neuropathic medication such as lyrica or gabapentin can reduce the burning shooting, itchy type pain caused by the nerve inflammation. Antivirals such as Acyclovir, famcyclovir and valacyclovir are drugs which when administered early reduce the chance of developing a complication after shingles called post herpetic neuralgia. These drugs reduce that chance by about 50%. PHN or post herpetic neuralgia usually is diagnosed 3 months after infection and is characterized by shooting pain and marked sensitivity over the healed rash site. Since the infection initially begins in a nerve root followed by destruction and swelling within the fiber, epidural or oral steroids can also be an effective way to reduce the chance of PHN developing presumably by reducing the swelling of the active infection and consequent nerve damage. Epidural steroids do little to help the condition of PHN once diagnosed.

Most recently a new therapy aimed at stopping the constant pain of PHN has been developed. Qutenza is a patch covered in hot chili pepper oil that when applied by a doctor to the painful PHN site will deactivate the small nerve fibers responsible for the burning pain. This might need to be repeated in 3-5 months but it is a welcome option to many of these sufferers.

Angela Lowery
Family Medicine
Herpes zoster (shingles) is a painful infection of a nerve and the area of the skin surrounding that nerve. It is caused by the same virus that causes chicken pox, varicella-zoster virus. Shingles main symptoms are pain and a rash that develops into itch blisters. These blisters cannot cause others to get shingles but it is a possibility a person that has not had chicken pox or has not been vaccinated against the virus, that causes chicken pox, can actually contract chicken pox from a shingles infected person.

This infection is produced by varicella zoster, the virus that causes chickenpox. After an initial outbreak of chickenpox (often during childhood), the virus remains inactive within the nerve cells of the central nervous system (CNS). But in some people, varicella zoster reactivates later in their lives. When this occurs, the virus travels down long nerve fibers and infects some part of the body, producing a blistering rash (shingles), fever, painful inflammations of the affected nerve fibers, and a general feeling of sluggishness.

Varicella zoster may travel to the head and neck, perhaps involving an eye, part of the nose, cheek, and forehead. In about 40 percent of those with shingles in these areas, the virus infects the cornea. Doctors often prescribe oral antiviral treatment to reduce the risk of the virus infecting cells deep within the tissue, which could inflame and scar the cornea. The disease may also cause decreased corneal sensitivity, meaning that foreign matter, such as eyelashes, in the eye are not felt as keenly. For many, this decreased sensitivity is permanent.

Although shingles can occur in anyone exposed to varicella zoster, research has established two general risk factors for the disease-advanced age and a weakened immune system. Studies show that people over age 80 have a five times greater chance of having shingles than adults between the ages of 20 and 40. Unlike herpes simplex virus I (HSV-1), varicella zoster does not usually flare up more than once in adults with normally functioning immune systems.

Be aware that corneal problems may arise months after the shingles are gone. For this reason, it is important that people who have had facial shingles schedule follow-up eye examinations.

This answer is based on source information from the National Institute of Diabetes and Digestive and Kidney Diseases.

Continue Learning about Viral Infections

Viral Infections

Viral Infections

Viral infections like herpes simplex, respiratory syncytial virus (RSV), chicken pox and rotavirus are infections caused by a virus instead of a bacterium. Viral infections do not respond to antibiotics, but some specific viruses ...

like influenza A and B can be treated with certain antiviral medications. Most commonly, treatment for viral infections includes drinking lots of fluids, getting rest, eating well and letting the illness run its course.
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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.