Shingles

What is Shingles?

Shingles is a painful skin rash caused by the Varicella Zoster virus, the same virus that causes chickenpox. 1 in 5 people will develop shingles during their lifetime but it usually clears within 3 weeks. If you suspect shingles, see your GP or dermatologist quickly to prevent complications and maximise treatment efficacy, especially if it affects skin near your eye. You cannot catch shingles from someone suffering from shingles or chickenpox. However, you could catch chickenpox from the rash of an individual suffering from shingles if you have never had chickenpox before. Immunosuppressed individuals (whether due to medication or disease) are most at risk.

What are the causes for Shingles?

The cause of shingles is reactivation of Varicella Zoster virus, the same virus that causes Chickenpox. Chickenpox usually affects children. After the symptoms of Chickenpox resolve, the virus remains inactive within nerves next to the spinal cord (dorsal root ganglia). In some individuals, the virus may become reactivated at a later date, travelling along the nerve to the skin and manifesting with the symptoms of shingles.

There is often no apparent reason for the reactivation of the virus. However, the risk of developing shingles increases with age and being stressed. Additionally, the risk of developing shingles increases if you suffer from immunosuppression, either by drugs or disease such as HIV/AIDS.

Shingles can rarely lead to a condition called postherpetic neuralgia. This is severe pain lasting for months or more after the rash has gone. The risk of developing this complication is reduced by early treatment with antivirals.

What are the symptoms of Shingles?

The two most common symptoms of shingles are pain and a rash. The pain varies from mild to severe and may be accompanied by a tingling or burning sensation. The rash tends to develop 2-3 days after the pain begins and present with blistering and dry crusts. Scarring is rare. The rash typically affects a narrow area of skin stretching across the back or chest of the abdomen.

Other symptoms that are commonly experienced include joint pain, fever, headache and a general feeling of illness (malaise). In a minority of cases, the infection may affect a nerve in your face. In such cases, you may experience paralysis of face muscles, changes in vision, changes in hearing, paralysis of eye movement and drooping of the eyelids.

How is Shingles treated?

Shingles is diagnosed clinically by a dermatologist or GP. Treatment aims to reduce pain and target the virus. Painkillers such as paracetamol, codeine and ibuprofen may be used. Antivirals such as acyclovir are often prescribed to prevent the virus from multiplying, especially in older patients and those experiencing immunosuppression. In some cases, steroid medication may be commenced to minimise inflammation.

General advice aiming to minimise suffering during a bout of shingles is to wear loose fitting clothing and apply non-adherent dressings to prevent pain caused by contact with clothing. Keep the rash clean, dry and cool.

Zostazax is a vaccination that can prevent shingles. It is available on the NHS for older patients.