Shingles

Shingles, also known as herpes zoster, is a viral infection caused by the varicella-zoster virus (VZV), the same virus responsible for chickenpox. Shingles affect the nerves and manifests through various symptoms.

Common symptoms of shingles typically develop in three stages and may include:

1. Prodrome (Early symptoms stage)
   • Symptoms may appear 1-4 days before the rash onset.
   • Early signs include localized tingling, itching, or burning sensations, often accompanied by intermittent stabbing pain.
   • Some individuals may experience systemic symptoms like tiredness, fever, headache, and enlarged lymph nodes in the affected area.
2. Infectious rash (Acute stage)
   • Lasting 7-10 days, the rash typically appears in a band or line on one side of the body, following the path of nerve fibers.
   • It may occur on the trunk, neck, forehead, or genitals, accompanied by pain.
   • The rash evolves from red lesions to blisters, and crusting over 1-2 weeks.
   • Rubbing or scratching the rash can lead to infectious lesions, potentially transmitting the virus.
3. Resolution (Healing stage)
   • Usually, within ten days of rash onset, lesions begin to crumble. This can last 2-4 weeks and may indicate the end of infection.
   • Healing may take longer in older or immunocompromised patients, with possible scarring or changes in skin color post-resolution.

Are shingles contagious?

Shingles patients are contagious once the blisters appear. Those who never had chickenpox or didn’t get the vaccine can get infected with VZV from someone who has shingles.

VZV can spread by direct contact with the fluid from shingles blisters or by breathing in virus particles from the blisters. If infected, people will get chickenpox, not shingles. However, they could develop shingles later in life.

Individuals suffering from chickenpox are more likely to spread VZV than individuals with shingles.

Covering rashes can lower the risk of spreading the virus.

Learn more about virus transmission and ways to prevent it.

Shingles, also known as herpes zoster, occurs when the varicella-zoster virus (VZV), which is responsible for chickenpox, is reactivated. Once an individual has recovered from chickenpox, the virus lies dormant in nerve tissues. This dormant state persists indefinitely, but if the virus reactivates, it manifests as shingles. However, not everyone who has had chickenpox will experience shingles. While the exact cause of shingles remains uncertain, it is often linked to age-related decline in immunity.

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Shingles, caused by the varicella-zoster virus, can affect anyone who has previously had chickenpox. Several factors increase the likelihood of developing shingles:

• Age: Shingles primarily affects older adults, with those over 50 at higher risk due to age-related weakening of immunity.
• Stress: Elevated stress levels can weaken immunity, making the body more susceptible to viral infections like shingles.
• Weakened immunity: Certain conditions, such as cancer and HIV/AIDS, can compromise the immune system, elevating the risk of shingles.
• Immunosuppression: Long-term use of immunosuppressive medications can predispose individuals to shingles in cases such as:
  • Radiation or chemotherapy for cancer treatment
  • Organ transplant
  • Severe psoriasis or advanced psoriatic arthritis
• Recent trauma or injury: Physical trauma or injury to the skin can sometimes trigger the reactivation of the varicella-zoster virus, leading to shingles in the affected area.

Shingles are usually easy to recognize and diagnose due to their classic skin rashes. Diagnosis typically involves a combination of medical history and physical examination. Testing for the varicella-zoster virus (VZV) involves analyzing blood, fluid, or tissue samples using various methods:

• Medical history: The healthcare provider will inquire about symptoms, including any pain, tingling, or rash, as well as any recent illnesses or exposures.
• Physical examination: The doctor will examine the rash and affected skin area. Shingles typically present as a unilateral (on one side of the body), painful, and blistering rash that follows a dermatomal distribution (in a band or strip along a specific nerve pathway).
• Polymerase Chain Reaction (PCR) test: This test detects genetic material from VZV in a sample, often obtained by swabbing open blisters. PCR is highly accurate and provides rapid results, making it the preferred method for confirming VZV infection.
• Viral culture test: Cells from a swab sample are cultured in a laboratory to detect VZV presence. While this test is useful, it is less accurate compared to PCR.
• Direct fluorescent antibody (DFA) test: This test, conducted on swab samples, employs a fluorescent dye and specialized microscope to identify VZV. Although it yields rapid results, it is not as precise as PCR.
• Antibody test: This blood test detects antibodies produced against VZV. IgM antibody testing indicates current or recent VZV infection, while IgG antibody testing reveals past exposure to VZV.

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Preventing shingles primarily involves vaccination and healthy lifestyle habits to bolster immune function.

1. Get vaccinated against Shingles
   The most effective method for preventing shingles is through vaccination. SHINGRIX is a recombinant subunit vaccine designed to stimulate the immune system's production of antibodies against the varicella-zoster virus. Studies show that two doses of Shingrix offer over 90% protection against shingles and its complications.

   Who should get SHINGRIX?
   CDC recommends two doses of recombinant zoster vaccine (RZV, Shingrix), separated by 2 to 6 months, to those who:

   • Are 50 years and older.
   • Are 19 years and older with weakened immune systems due to immunodeficiency or immunosuppressive therapy.

   Important Note: SHINGRIX is not indicated for the prevention of primary varicella infection (Chickenpox).

   Who should not get SHINGRIX?
   Individuals with a history of a severe allergic reaction to any component of the vaccine or after a previous dose of Shingrix. Vaccination may be postponed for pregnant or breastfeeding individuals or those experiencing an acute episode of shingles.

2. Get timely treatment for Chickenpox
   Timely treatment of Chickenpox is crucial for averting future complications like Shingles. Antiviral medications can mitigate the severity and duration of the infection, lowering the risk of viral latency and subsequent reactivation. Ensure your child receives the Chickenpox vaccine at the recommended ages:

   • First dose: 12-15 months old
   • Second dose: 4-6 years old

   For individuals 13 years and older without prior Chickenpox or vaccination, two doses, spaced at least 28 days apart, are advised.

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3. Avoid contact with individuals with chickenpox or shingles
   Avoiding close contact with individuals having chickenpox or shingles can reduce the risk of exposure to the virus.

4. Maintain a Healthy Lifestyle
   Adopting a healthy lifestyle can support immune function and reduce the risk of shingles. Make sure to:

   • Consume a balanced diet rich in fruits, vegetables, lean proteins, and whole grains.
   • Engage in regular exercise to promote overall health and immune function.
   • Manage stress through relaxation techniques such as meditation, yoga, or deep breathing exercises.
   • Get adequate sleep each night to support a healthy immune system.

Shingles typically resolve on their own within a few weeks. However, prompt treatment can help alleviate symptoms and reduce the risk of complications. Treatment approaches for shingles include:

1. Antiviral medications
   • Acyclovir
   • Famciclovir
   • Valacyclovir
2. Topical antibiotics

   Topical antibiotic creams such as Mupirocin or Framycetin may be recommended alongside antiviral therapy to prevent secondary bacterial infections.

3. Pain management
   • Application of cool compresses to the affected area
   • Use of medicated lotion or creams to soothe irritated skin
   • Numbing medications such as lidocaine
   • Rest and over-the-counter pain relievers like acetaminophen or ibuprofen
   • Prescription painkillers like codeine for severe pain
4. Anticonvulsants and tricyclic antidepressants

   Certain medications were initially developed for other purposes but may be prescribed off-label to help alleviate nerve pain associated with post-herpetic neuralgia, such as:

   • Gabapentin or Pregabalin (Anticonvulsants)
   • Amitriptyline or Nortriptyline (Tricyclic antidepressants)
5. Post-Herpetic Neuralgia Management

   Post-herpetic neuralgia, a common complication in elderly patients, can be managed with various treatments once the lesions have crusted. These include:

   • Local anesthetic applications
   • Topical capsaicin
   • Transcutaneous electrical nerve stimulation or acupuncture
   • Botulinum toxin into the affected area

   For elderly PHN patients intolerant to oral medications, topical therapies like Lidocaine 5% patch can provide relief.

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Do’s and Don'ts for Shingles

• Isolate during the contagious phase.
• Avoid Aspirin in children due to the risk of Reye's Syndrome (a rare but serious illness in children, linked to viral infections, causing liver and brain swelling).
• Please consult a doctor before using anti-inflammatory painkillers, as they can increase the risk of severe skin infections.
• Practice daily cleansing with warm water to help prevent secondary bacterial infections.
• Keep nails short, and consider wearing gloves to avoid scratching your skin.

1. Baths

A 15-minute bath with cool water can ease shingles pain and itching.

Daily bathing keeps skin clean to prevent infections.

Use gentle, fragrance-free cleansers and avoid harsh scrubbing.

Pat dry with a clean towel and launder it promptly to prevent virus spread.

Oatmeal baths can also provide relief from the burning and itching sensations of shingles.

2. Rash care

Wash the rash with a fragrance-free cleanser daily.

Apply a thin layer of clean petroleum jelly and cover it with a sterile, non-stick bandage.

Wash hands after touching the rash.

Do not let dressings or plasters stick to the rash.

Avoid clothing or fabrics that may irritate the rash; opt for loose, breathable clothing.

Avoid using antibiotic cream as it may slow the healing process.

Keep nails short to prevent scratching and minimize the risk of infection.

After scabbing, relieve itching with calamine lotion.

3. Herbal remedies

The following herbal remedies may offer relief from shingles symptoms, but it's important to consult with a doctor before using them, especially if you're already receiving medical treatment.

• Turmeric (Haldi): Known for its anti-inflammatory and immune-boosting properties, turmeric may help reduce inflammation and promote healing of the shingles rash. How to use: Add turmeric powder to your food or drink turmeric tea by steeping fresh or dried turmeric rhizomes in hot water.
• Chamomile flower: Chamomile has anti-inflammatory and soothing properties that can help relieve pain and inflammation associated with shingles. How to use: Make chamomile tea by steeping chamomile flowers in hot water and drinking it at least twice daily.
• Licorice (Mulethi): Licorice root contains compounds with antiviral and anti-inflammatory properties, which may help reduce the severity and duration of shingles outbreaks. How to use: Prepare licorice root tea by simmering dried licorice root in water for 10-15 minutes and drink it up to three times a day.
• Passionflower leaf: Known for its calming and soothing properties, passionflower may help reduce stress and promote relaxation, as well as relieve pain associated with shingles. How to use: Prepare passionflower tea by steeping dried passion flower leaves in hot water and drink it several times a day.
• Calendula flower: Calendula has anti-inflammatory and wound-healing properties, which can help soothe and promote healing of the shingles rash. How to use: Apply calendula cream or ointment topically to the affected area several times daily. Choose products made from high-quality calendula extract and consult a doctor before use, especially if you have allergies or skin sensitivities.

4. General health measures

• Get adequate rest.
• Consume a healthy, well-balanced diet rich in vitamins and minerals.
• Drink plenty of fluids to stay hydrated.
• Engage in enjoyable activities to distract from discomfort.
• Practice stress-reduction techniques such as meditation or deep breathing to minimize discomfort and promote healing.

5. Monitor your health

• Report any signs of infection, persistent pain after rash clearance, or feeling unwell to your doctor.
• Discuss the possibility of getting the shingles vaccine with your doctor after the rash has cleared.

6. Prevent transmission

• Cover the rash and avoid touching or scratching it.
• Limit close contact with individuals who have not had chickenpox or the varicella-zoster vaccine to prevent spreading the virus.
• Do not share towels, swim, play contact sports, or go to work or school if your rash is weeping (oozing fluid) and can’t be covered.
• Isolate from pregnant women, infants, sick individuals, and those without immunity to chickenpox until the rash has cleared to prevent transmission.

Interesting Fact! Shingles during pregnancy do not harm the unborn baby as the mother already carries the virus. However, chickenpox in pregnancy can be severe and requires immediate medical care to avoid complications for both mother and baby.

Shingles typically resolve within 2–4 weeks, but some individuals may encounter complications, including:

• Postherpetic Neuralgia (PHN)
  Even after the rash disappears, some may endure persistent pain in the affected area for over three months, known as Postherpetic Neuralgia (PHN). PHN involves damaged nerve fibers sending exaggerated pain messages from the skin to the brain, resulting in prolonged nerve pain.
• Eye problems
  Shingles affecting the ophthalmic nerve (a nerve responsible for sensory innervation of the upper face and eye) can lead to various eye problems, collectively known as Herpes Zoster Ophthalmicus. If not treated in time, these problems may lead to:
  • Inflammation of the cornea (keratitis)
  • Uveitis
  • Glaucoma
  • Vision loss
  
  Quick Byte! A shingles rash on your face constitutes a medical emergency as it could impact eyesight. Prompt medical attention is essential to safeguard your vision.
• Ramsay Hunt syndrome
  This is a complication of shingles involving the facial nerve. It can cause:
  • Facial paralysis
  • Hearing loss
  • Vertigo
  • A rash in the ear or mouth
• Skin infection
  Scratching the shingles rash can lead to bacterial skin infection. This can cause additional discomfort and pain and may require antibiotic treatment.
• White Patches or Scarring
  After the shingles rash heals, some individuals may notice white patches in the affected area due to a loss of pigment (hypopigmentation) or scarring. These changes in skin appearance may be permanent.
• Inflammation of various organs
  While rare, shingles can lead to inflammation of the:
  • Lungs (Pneumonia)
  • Liver (Hepatitis)
  • Brain (Encephalitis)
  • Spinal cord (Transverse myelitis)
  • The protective membranes surrounding the brain and spinal cord (Meningitis)
  These complications can be serious and may require hospitalization and intensive medical treatment.
• Disseminated shingles
  In people with weakened immune systems, such as those with HIV/AIDS or undergoing immunosuppressive therapy, the shingles rash can spread to other parts of the body, potentially causing widespread infection and complications.

Several complementary and alternative therapies may be used to help alleviate the symptoms of shingles and promote overall well-being. However, it's essential to consult with a healthcare professional before trying any new treatment, especially if you're already receiving medical care for shingles.

Acupuncture

Acupuncturists will determine which pattern of shingles you are suffering from and choose the corresponding acupuncture points to treat the underlying energy imbalance. It involves the insertion of thin needles into specific points on the body to help alleviate pain and promote healing. Additionally, it strengthens your immune system to help fight off the virus and treat other symptoms you may be experiencing, such as nausea or headaches.

Living with shingles can significantly impact an individual's quality of life due to physical discomfort, emotional distress, and disruption of daily activities. Shingles can have both short-term and long-term effects on quality of life.

Short-Term Impact

• Shingles often presents with pain, tingling, or itching before the rash appears, making sleep difficult and affecting daily activities.
• Sensitivity of the affected area can lead to discomfort even with minimal contact, and the rash can become infected.
• Contagiousness during the rash phase requires avoiding contact with others, leading to feelings of isolation.

Coping Strategies:

• Seek medical attention for symptom management and potential antiviral treatment.
• Practice good hygiene to prevent infection of the rash.
• Communicate with loved ones about the need for isolation and seek support from them during this time.

Long-Term Impact (Postherpetic Neuralgia - PHN)

• Postherpetic neuralgia (PHN) can result from damaged nerve fibers during a shingles outbreak, causing ongoing pain lasting for months or even years.
• Debilitating pain can interfere with daily tasks, leading to isolation, loneliness, and an increased risk of depression or anxiety.
• If shingles affect certain areas of the body, such as the eye or ear, complications such as vision, hearing, and balance problems can occur.

Coping Strategies:

• Seek medical treatment for PHN management, including medications and pain management techniques.
• Stay socially connected despite the pain, engaging in activities that bring joy, and seeking support from friends and family.
• To reduce the risk of future outbreaks and complications, prioritize getting vaccinated against shingles.