Herpes zoster, more commonly known as shingles, is a painful viral infection caused by varicella zoster, the same virus that causes chicken pox. After a childhood attack of chicken pox, the virus lies dormant in the nerve cells that extend from the spinal cord or the brain. In adulthood, the virus can be reactivated, resulting in a second eruption of chicken pox. (Therefore, you cannot develop shingles unless you have had an earlier case of chicken pox.) The blistery rash characteristic of shingles follows a line on one side of the body or face in an area supplied by a particular spinal nerve.
Shingles strikes about one in five adults who have had chicken pox as children. While young people do develop shingles, the ailment most often occurs after age 50, with the incidence increasing with age. The chance of developing shingles is greatest for people whose immune system is weakenedâfor example, people infected with the HIV virus or cancer patients undergoing drug or radiation treatment.
You cannot catch shingles from someone who has it. The virus can be transmitted to others, but only to someone who has never had chicken pox and only if that person is exposed to the rash, in which case the person may develop chicken pox, not shingles. If you have shingles, you should avoid contact with small children, pregnant women, and any adults who have never had chicken pox. (In the United States, 95 percent of adults have had the disease; those who have not should be immunized, since many adults with chicken pox have more complications than children.)
The prognosis for shingles is generally good, unless the virus spreads to the brain or eyes. For most healthy individuals, the lesions heal and pain diminishes within three to five weeks.
However, some shingles sufferers, including as many as 50 percent of the sufferers over age 50, according to some estimates, will have debilitating pain that persists for more than one month (sometimes for many months) after lesions have healed. This pain, called post-herpetic neuralgia, or PHN, is not from shingles but from nerve cell damage caused by the viral infection.
Symptoms of Shingles
- Burning pain, tingling, and extreme sensitivity in one area of skin; the pain may last for one to three days before the skin reddens at the pain site.
- Mild chills, nausea and fever, malaise, headache
- A rash of small fluid-filled bubblelike blisters that breaks out on reddened skin. The rash forms along a band, most commonly on the torso and buttocks, but also on the arms, legs, and face. In nearly all cases the rash occurs only on one side of the body.
- Diarrhea and difficulty urinating
- Within about 10 days, the blisters form scabs.
What Causes Shingles?
No one is certain what triggers an attack of shingles. Researchers believe that the virus is reactivated when the immune system becomes too weak to keep the virus in a dormant state. This is probably why older people are more likely to get the infection. Stress and illness may also weaken the immune system, as does the use of immunosuppressant drugs. The immune system factor may also explain why people with HIV infection or AIDS, Hodgkin's disease, and other cancers, whose immune systems are suppressed due to illness or treatment for illness, are at increased risk of developing shingles.
What If You Do Nothing?
In most cases shingles is self-limiting, the body's immune system is ordinarily able to fight off the infection. However, the pain can be severe, and many people need medication for pain relief. Early treatment with antiviral drugs can also be important in bringing relief.
Medical intervention is critical, however, for people with damaged or suppressed immune systems. Not only are they vulnerable to shingles, but if they develop symptoms, there is a danger that the disease will spread and reach vital organs like the lungs, with results that are fatal.
Home Remedies for Shingles
Shingles can't be cured, so home remedies are aimed at relieving discomfort.
- Relieve the pain. For minor discomfort, take over-the-counter NSAIDs (aspirin, ibuprofen, or naproxen) or acetaminophen. For severe pain, your doctor can prescribe stronger medication.
- Cool it. Apply cool, wet compresses or ice packs to reduce pain. Calamine lotion may also feel soothing if applied after removing the compresses.
- Relieve the itch. Soak in a bath to which you've added colloidal oatmeal.
- Rest. If you are overly fatigued or develop a fever, rest in bed.
- Try deep heat. Capsaicin cream, an extract made of hot peppers, has been used in pain clinics to reduce the pain of PHN victims by interrupting the transmission of pain impulses to the brain. This over-the-counter remedy is sold for treating muscular aches and pains; consult your physician before using it. Be sure not to apply it until the lesions caused by your shingles have completely healed.
- Don't scratch. Although it is hard to resist scratching, you increase the risk that the blisters will become infected from dirt on fingernails.
- Clean regularly. Use soap and water to keep the rash area clean. This will prevent any bacterial infections from developing.
- Manage emotional stress. When suffering from herpes zoster, try to stay calm and well-balanced by practicing stress-relief techniuques regularly. Stress generally exacerbates the disease.
If you've never had chicken pox, it's best to avoid contact with the active rash of anyone with shingles or chicken pox. Your risk for developing shingles increases with age. The shingles vaccine (Zostavax®) is approved by the U.S. Food and Drug Administration (FDA) for use in people over the age of 50 and is recommended for people age 60 years and older. If you have already had shingles, the vaccine can help prevent future occurrences of the disease. Talk with your health care provider if you have questions about shingles vaccine.
Beyond Home Remedies: When To Call Your Doctor
Contact your physician as soon as you develop symptoms of shingles, and particularly if you have any illness that compromises your immune system. The earlier the symptoms are treated, the less severe the ailment may be. Be sure to contact your physician immediately if you develop shingles on your nose or forehead, this signals possible eye involvement, or if you experience any eye pain. Eye damage from shingles can lead to blindness.
What Your Doctor Will Do
After a close examination to confirm shingles, your physician may prescribe the antiviral medication acyclovir or newer agents such as famciclovir to minimize the pain of shingles, speed healing, and help prevent any complications. A combination of acyclovir and corticosteroids may be even more likely to reduce the severity of PHN. Other medications, including antidepressants, are sometimes effective for relieving PHN, and some alternative treatments (such as acupuncture) for chronic pain may also help people cope.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media