Shingles

1 What is shingles?

Shingles is a skin disease that causes the formation of a painful rash. It is caused by a virus, the same one that causes chickenpox. Shingles rash is different from most other rashes in that it is very painful. In itself, shingles is not a life-threatening disease.

You can only have shingles if you had chicken pox before. Usually, a rash caused by shingles appears on one side of the body and only affects a small section of the skin.

It is also accompanied by other symptoms such as fever and fatigue.

Shingles can be contagious; not in a way that a person with shingles can give it to others, but in a way that the virus can be passed to others and cause chicken pox.

The risk of shingles is higher if your immune system is weak, and as you become older; people at age 50 or older face the most risk.

Shingles is not a life-threatening condition, and it goes away on its own. However, shingles can cause serious complications such as encephalitis and loss of vision if the rash occurred around or in the eye.

Treatment shortens the course of shingles and reduces the risk of complications. You can reduce the likelihood of shingles by keeping your immune system in good shape. Discuss the shingles vaccine with your doctor.

 

Shingles is not a very common condition in younger people, and it tends to affect older individuals. Not all people who had chicken pox will eventually have shingles later in life. Although most people only experience a single bout, it is possible to have shingles two or several times.

Complications of shingles, such as encephalitis, postherpetic neuralgia, and vision loss, are serious. Treatment for shingles is focused on reducing pain.

There is no cure for shingles, but medicines help shorten the course of the disease and reducing the risk of complications.

2 Is shingles contagious?

ShinglesContagious

Yes.

Touching the shingles rash can pass the virus. A person with shingles passes the virus to others and causes chicken pox, not shingles, to individuals who have never experienced the condition.

Speak with your doctor to examine shingles pictures so you are able to recognize the differences between chicken pox and shingles. While they come from the same virus, they appear very differently on the skin.

Shingles is contagious until the rash crusts over. If you have shingles, isolate yourself from people as often as you can.

If you have shingles, especially avoid the following:

  • Pregnant women
  • Infants
  • Anyone vulnerable to disease
  • Those with weak immune systems
  • The elderly

You can get shingles only after you have had a bout of chicken pox, and this can happen years after having chicken pox.

3 Can you get shingles more than once?

Yes!

Typically, once someone has shingles, he or she won't get it again. However, some people can have shingles two or more times. 

Severity does not necessarily worsen the second time, though it is possible. 

4 How long does shingles last?

Usually, symptoms of shingles last anywhere between two to six weeks.

Treatment with antivirals helps reduce the duration of shingles.

Shingles will last longer and may induce more scarring if left to heal on its own.

5 Symptoms: What does shingles look like?

Shingles usually start as pain specific to a body part. This pain is often intense and can be mistaken as a symptom of a problem in the heart, lungs, or kidneys. Then, after few days or sometimes weeks, the characteristic shingles rash appears.

The shingles rash first appears as patches of red, and then later turns into blisters. Within days, the blisters turn dark in color and eventually form crusts. Shingles often occurs as a ribbon or stripe, and it typically appears on one side of the body or torso.

Pain in shingles is very intense. It is described as throbbing, stinging, or aching, with shooting stabs of pain. In most patients, the pain intensifies whenever the skin or rashes are touched.

Shingles originates from the nerves, so it often follows the route of a nerve, which is why the rash follows a stripe pattern. This also explains why shingles are painful not just on the surface of the skin.

The shingles rash may also occur on the neck or face, and some may have the rash around the eye, which can be dangerous. However, some individuals only have pain but do not have a rash.

Aside from the painful rash, you may also experience the following:

Shingles rash often occurs singly. However, some people with depressed immune systems may have more than twenty separate lesions, which can be serious. Having widespread rashes and extreme pain should be considered a medical emergency.

In the case of encephalitis, symptoms appear as long as a month after a bout of shingles. Symptoms of encephalitis include fatigue, headache, fever, paralysis of the face, confusion, seizures, double vision, and trouble with speech or hearing. Its symptoms can be mistaken for a stroke.

6 Causes: How do you get shingles?

The virus, Varicella zoster, causes shingles and chicken pox.

Initial exposure causes chicken pox, and then the virus resides dormant in the nerves where the activity of the immune system keeps it from causing infection.

Factors like malnutrition, illnesses, medications, or natural aging cause the immune system to decline. These may trigger the virus to become active again, replicate, and infect the nerves that cause shingles and pain.

Varicella zoster is a member of the herpes virus family, which also includes:

  • Epstein-Barr virus
  • Cytomegalovirus
  • Herpes simplex virus infection-1 (HSV-1)
  • Herpes simplex virus infection-2 (HSV-2).

These viruses are the cause of infectious mononucleosis, cytomegalovirus infection, cold sores, and genital warts, respectively.

7 Making a diagnosis

Many people see their doctor after mistaking shingles pain symptoms for something else.

If there are rashes, doctors can easily diagnose shingles by examining the rash and other symptoms. In most cases of shingles with visible rash and no complications, no lab tests are needed.

To identify a rash caused by shingles or other conditions, in some cases, the doctor may take samples from the rash to be examined in the lab for the presence of viruses or other infections. A physical exam is also done to determine the extent of the infection. Other tests, such as an HIV test, may be done if the patient has symptoms of a compromised immune system.

If the doctor suspects complications, he or she may order an MRI (magnetic resonance imaging) to check your brain or organs for encephalitis or other problems.

Another procedure called lumbar puncture (extraction of fluid near the spinal cord using long needle syringe) can be done to check for the presence of viruses in the spinal fluid, though this is very rare.

8 Treatment for shingles

Shingles has no cure, but treatment can help to alleviate symptoms until the condition goes away.

In the case of shingles without the involvement of the eye, encephalitis, or a compromised immune system, the patient can stay at home. If home care is advised, physical isolation is required so the virus cannot be passed to others.

The doctor may prescribe antiviral drugs that work against the Varicella zoster virus. These drugs speed up healing and reduce the risk of complications.

Some antiviral drugs prescribed for shingles include:

  • Acyclovir
  • Valacyclovir
  • Famciclovir

These antivirals are typically given for 7 to 21 days. Longer treatment may be needed for patients with immune system problems.

Earlier treatment with antivirals often helps shorten the duration of shingles and improves the effect of painkillers. Always take antivirals as instructed by your doctor. Premature discontinuation of antiviral drugs can make the shingles virus resistant to the drug, and much harder to treat in the future. If you stop taking antibiotics early, the shingles virus may come back very soon after, and with much worse symptoms.

Pain relief is important because shingles often causes inability to sleep. Your doctor will prescribe skin creams that contain capsaicin and lidocaine to alleviate pain caused by shingles. Anticonvulsant drugs (gabapentin) and antidepressants (amitriptyline) are also prescribed for pain, although it is suitable only for select cases.

Injections of corticosteroids may be given to alleviate redness. For extreme pain, the doctor may prescribe a combination of painkillers with narcotics. Not all people with shingles need pain relief from narcotics.

Shingles occurring in and around the eye requires urgent emergency treatment to avoid scarring and blindness. You may have to stay in the hospital for an extended period of time. Cold compresses and painkillers are often recommended to alleviate irritation and pain in the eye.

To prevent dryness that causes scarring, lubricating drops might be applied to the affected eye from time to time. Antivirals are still needed to prevent the infection from worsening. In the case of bacterial infection, the doctor may also prescribe antibiotic eye drops.

You may be referred to an eye doctor (ophthalmologist) to address vision issues if deemed necessary.

In the case of encephalitis caused by shingles, the focus of treatment is to prevent the brain from swelling and causing further damage. The patient needs to be hospitalized and monitored. The doctor may prescribe corticosteroids to control swelling, as well as antivirals for infection.

Typically, surgery is not needed for shingles

9 Prevention of shingles

There is a vaccine for shingles called Zostavax. This can be given to people 60 years old and older to reduce the risk of infection. This vaccine is also recommended after having shingles to avoid the possibility of having the infection again.

Getting the Zostavax vaccine also reduces the risk of postherpetic neuralgia.

You can only get the shingles vaccine after the rash and pain is completely gone. The vaccine is not suitable for pregnant women, and for people with a weak immune system due to HIV, medicines, or cancer.

You can also prevent shingles by keeping a distance from people with shingles.

In addition, keeping your immune system in proper shape with healthy sleep habits, exercise, and a proper diet can prevent the varicella zoster virus from becoming active and causing shingles.

10 Alternative and homeopathic remedies for shingles

Several alternative and homeopathic remedies exist for shingles.

Taking good care of skin sores:

  • Avoid picking at and scratching blisters. If left alone, blisters will crust over and fall off naturally.
  • Use cool, moist compresses if they help ease discomfort. Lotions, such as calamine, may be applied after wet compresses.
  • Apply cornstarch or baking soda to help dry the sores so that they heal more quickly.
  • Soak crusted sores with tap water or Burow's solution to help clean away crusts, decrease oozing, and dry and soothe the skin.
  • Ask your doctor about using topical creams to help relieve theinflammation caused by shingles.
  • If your skin becomes infected, ask your doctor about prescription antibiotic creams or ointments.
  • Using medicines as prescribed to treat shingles or postherpetic neuralgia, which is pain that lasts for at least 30 days after the shingles rash heals.
  • Using nonprescription pain medicines, such as acetaminophen or ibuprofen, to help reduce pain during an attack of shingles or pain caused by postherpetic neuralgia. If you are already taking a prescription pain medicine, talk with your doctor before using any over-the-counter pain medicine. Some prescription pain medicines have acetaminophen (Tylenol), and getting too much acetaminophen can be harmful. Be safe with medicines. 
  • If home treatment doesn't help with pain, talk with your doctor. Getting your pain under control right away may prevent nerve damage that may cause pain that lasts for months or years.

  

Apart from them, some other measures that have been proven to be useful include:

  • Acupuncture
  • Biofeedback
  • Transcutaneous Electric Nerve Stimulation
  • Psychological therapies like cognitive behavioural therapy and relaxation and breathing exercises may be helpful

In desperate situations, pain management specialist may be consulted.

11 Lifestyle and coping

When treating shingles at home, physical isolation is very important. That means no sharing of personal items, clothing, towels, or eating utensils. Note that shingles is contagious as long as the rash is present and does not crust over.

Gloves must be worn when touching the rash, which is sometimes needed when applying medicated creams or eye drops. Always wash your hands before and after wearing gloves.

Some simple remedies can reduce pain caused by shingles. A cool bath or applying cold and wet compresses will alleviate some of the pain.

Make sure the rash and blisters are clean to prevent bacterial infections. Ask your doctor for a suitable antiseptic ointment to clean the rashes.

If you cover the opened blisters, use sterile gauze and change the dressing as often as your doctor recommends -- at least daily.

Wear new sterile gloves every time when touching the blisters, applying skin creams, or changing the dressing.

Taking antiviral medications helps promote quicker clearing of the rash. This reduces the opportunity for bacteria to cause infection.

It is important to continue prescribed medicines when treating shingles at home. If you suspect that you are having side effects from the medicines, consult your doctor right away.

12 Risks and complications of shingles

Shingles may cause serious complications. Among the most common is postherpetic neuralgia. In this condition, the shingles pain continues long after the rashes have cleared. This painful condition occurs when the damaged nerves continue to send exaggerated pain signals to the brain. It is significant, as lingering discomfort often affects the elderly and cause reduction of quality of life in old age.

Another serious complication of shingles is the formation of a rash near or around the eyes, which can lead to painful eye infections. Shingles in the eye often leads to swelling and pain, and will sometimes cause scratches or scarring in the cornea.

Another concern of shingles in the eye is the possibility of bacterial infection of the blisters. Shingles in the eye can lead to blindness if not treated urgently. 

Although rare, the shingles infection can be so severe that the patient faces the risk of inflammation of the brain or encephalitis. Shingles is among the most common cause of encephalitis. It occurs when the virus makes its way into the brain and causes infection. Encephalitis is often a consequence of shingles in the eye, face, or head. It can lead to paralysis of the face, or hearing or balance problems.

Individuals facing a higher risk of shingles are the elderly and those with compromised immune systems.

Having HIV/AIDS, tuberculosis, recent organ transplant surgery, use of corticosteroid medicines, or cancer often causes the immune system to decline, which increases the risk of shingles.

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