Shingles is a viral infection of the skin which occurs in patients who have previously had chicken pox. The virus that causes chicken pox is the same virus which lays dormant in nerve endings, becoming reactivated in the future and causing shingles. The virus responsible for both shingles and chicken pox is called the herpes varicella zoster virus (VZV).
Symptoms
Many patients will initially present with symptoms mimicking a mild case of flu, like tiredness and fever. This is followed by pain and also tingling and/ or itching in a discreet area of skin. These symptoms can last anywhere between two and ten days. The next stage is the appearance of a rash which occurs as a red painful patch of skin, followed by an eruption of small blisters, which may become filled with pus. In some people, the rash and pain can occur simultaneously.
Who gets Shingles?
Shingles only occurs in patients who have already had chicken pox, and it may occur more than once in a person's lifetime. After our first exposure to the VZV, we typically develop chicken pox. As our body recovers from the infection, the virus lays dormant in sensory nerve endings. As we age, a particular part of our immune system, which helps keeps VZV at bay, weakens. This is thought to explain why shingles is more common amongst the elderly. The following factors can all reduce our level of immunity and precipitate an attack of shingles:
Is it contagious?
Yes shingles is contagious, although it is less infectious than chicken pox. You will remain infectious until the last blister has crusted over, this is usually up to five days after the rash first appeared. It is important to realise that a person with shingles is only infectious to people who have never had chicken pox. If you have shingles, you cannot give someone else shingles, you can however give them chicken pox.
If you have shingles, it is important to avoid women who may be pregnant, especially if the woman has not had chicken pox. This is because the VZV can be harmful to both the mother and unborn child.
If you are an expectant mum, who has never had chicken pox, and have been exposed to someone with shingles or chicken pox, you should seek medical advice as soon as possible. Your doctor will arrange an urgent blood test to check your immune status. If you are not immune to VZV, then immunoglobluin (antibodies against the VZV virus) will be given.
Can it be prevented?
If you have never had chicken pox, then it is possible that having the VZV vaccine may reduce the chances of you developing chicken pox and shingles later on. The vaccine is given to all American children, and reports suggest some reduction in the incidence of chickenpox. It is too early to determine, however, whether this will also have an effect on reducing the incidence of shingles later in life.
If you have already had chicken pox, then it is likely that you may develop shingles at some point in the future. That said, there has been some research indicating that individuals over the age of 65 who are given the VZV vaccine may have a lower incidence of developing shingles. Additional research is still required though, to assess the benefits of vaccinating those over the age of 65.
Currently, the VZV vaccine is not available as part of the routine childhood immunisation program in the UK. It is, however, available from Care Quality Commission regulated private clinics. Discuss immunization with your own doctor before requesting it privately.
Complications
In some cases, patients suffering with shingles may go on to develop the following complications:
The blisters in the rash which accompanies shingles may become infected when burst, spreading bacterial flora to the surrounding skin. This can be treated with appropriate antibiotics.
Approximately 25% of patients over the age of 60 with shingles go on to suffer with chronic pain, called post herpetic neuralgia. This is a pain that persists even after the rash resolves. It usually lasts for a few months before easing and eventually resolving.
Shingles affecting the face, may involve one of the eyes, especially if the rash affects the tip of the nose. In such cases, the eyes must be reviewed by an ophthalmologist. Shingles affecting the area may lead to inflammation of various structures of the eye, and in rare cases, it could lead to a loss of vision.
Typically VZV affects sensory nerves, however in some cases, motor nerves may become involved. This can present with muscle weakness and cause one-sided facial weakness (known as Ramsay Hunt Syndrome) or limb weakness. The symptoms are usually temporary and tend to resolve spontaneously.
In patients with a severely compromised immune system, such as those suffering with AIDS or those on chemotherapy for cancer treatment, shingles can lead to rare but life threatening complications such as encephalitis and/ or meningitis. Encephalitis is infection of the brain itself, while meningitis involves infection of the coverings of the brain. Both conditions may present with severe headaches, altered personality and/ or confusion. Both require urgent hospital admission and treatment.
Treatment
The treatment of shingles can involve the following medications:
Calamine lotion is effective in soothing the itchy rash associated with shingles as well as any burning sensations or pain. Simple pain killers like paracetamol, ibuprofen and in some cases co-codamol, may be also be required to alleviate pain.
Where the rash has seen by a doctor, a prescription for antiviral medication such as Aciclovir is often prescribed. There is evidence that antiviral agents can help to reduce the duration of symptoms and also decrease the likelihood of complications such as post herpetic neuralgia. Patients who suffer with severe pain during or after the appearance of a rash, may also be started on steroids like Prednisolone. The use of steroids is usually reserved for severe cases.
Patients who continue to have pain, despite strong painkillers, antiviral treatment and steroids, may require neuropathic pain killers. These are drugs that come from two different groups of medications, antidepressants and anticonvulsants. These drugs often prove effective in controlling the pains arising from nerve damage. Another way of tackling severe pain from shingles can be the use of topical anaesthetics such as 5% lidocaine plasters, these have been shown to be very effective and often with minimal side effects when compared with other treatment options.
Conclusion
Shingles in many cases will clear up without complications, however if you have suffered with an attack of shingles and are left with chronic pain and would like more information and support please visit the Shingles Support Society. The society provides information on the treatment of both shingles and post herpetic neuralgia.
