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Shingles (herpes zoster) is a viral infection that may cause pain, burning, or a tingling sensation on either the left or right side of the body.
JULIA FASHNER, MD, Saint Joseph Family Medicine Residency Program, South Bend, IndianaAMANDA L. Patient information: See related handout on shingles, written by the authors of this article. Herpes zoster (shingles) presents as a painful vesicular rash and is caused by reactivation of the varicella-zoster virus within the dorsal root or cranial nerve ganglia.
Antiviral therapy for herpes zoster: randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older. Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia.
Oral acyclovir therapy accelerates pain resolution in patients with herpes zoster: a meta-analysis of placebo-controlled trials. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP).
The varicella zoster virus is a type of herpes simplex virus (HSV) but is not the same as the herpes simplex virus that causes genital herpes.
Herpes zoster is not a virus but a syndrome that arises with reactivation of the varicella zoster virus (VZV) years or even decades after chickenpox. Herpes zoster is the same as shingles, an alternative and commonly used name for this condition. Herpes zoster is more likely to occur in a person with a depressed immune system and the elderly. Herpes zoster, commonly known as just zoster or shingles, is a condition caused by the reactivation of the varicella zoster virus (VZV).
Shingles is the syndrome where a painful skin rash marked by the presence of tiny blisters usually forms on a dermarcated area on the skin surface of the head or trunk. Once the virus reactivates, it causes inflammation of the nerves and is therefore also known as acute posterior ganglionitis. However, shingles often arises for no known reason even in a person without any of these contributing factors. Images from CDC (1)The main symptoms of herpes zoster (shingles) is an itchy skin rash and pain which has been discussed in detail below.
Herpes zoster mainly affects sensory nerves but motor nerves that control muscles may also be affected. Pain that lasts for longer than a month, even after the rash clears, is most likely a complication of shingles known as post-herpetic neuralgia.
All images have been sourced from the Dermatology Atlas (2) courtesy of Samuel Freire da Silva, M.D. Tricyclic antidepressants, anticonvulsants and corticosteroids along with anesthetics may be needed for post-herpetic neuralgia.
Treatment should be commenced immediately once a diagnosis of shingles is made, preferably within the first few days of the onset of the rash.
Zoster vaccine to prevent shingles and should be considered only for a person older than 60 years of age. Ask a Doctor Online Now!Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Shingles, also known as zoster or herpes zoster, is a painful skin rash caused by the varicella zoster virus, the same virus that causes chickenpox. Before the rash develops, there is often pain, itching, or tingling in the area where the rash will develop. Most commonly, the rash occurs in a single stripe around either the left or the right side of the body. To provide even greater transparency and choice, we are working on a number of other cookie-related enhancements.
Several days or weeks later, a band, strip, or small area of rash usually appears in the same area and progresses into blisters, which scab over before clearing up over the next few weeks.
Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. An estimated 1 million cases occur in the United States each year, and increasing age is the primary risk factor. These symptoms may occur one to five days before the appearance of the rash.4 Abnormal skin sensations range from itching and burning to hyperesthesia and severe pain. After the active phase of the infection resolves, the virus stays dormant at the spinal nerve root, specifically the dorsal root ganglion.


It mainly affects the sensory nerves but can sometimes involve the motor nerves – those nerves that control muscles in the body. These symptoms usually settle after 10 to 15 days but can take up to one month to resolve completely.
This gives rise to symptoms such as paralysis of the diaphragm, bladder and bowel problems, cranial nerve palsies and muscle weakness. A dermatome is an area of the skin which is innervated by nerves from a single spinal root. However, if the infection occurs in a vaccinated person it is usually less severe and shorter in duration. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. An important characteristic of the shingles rash helpful in diagnosis, is that it does not cross over from one side of the body to the other. The virus moves along the nerve fibres and affects cells of the skin, resulting in a skin rash. It is intended for general information purposes only and does not address individual circumstances.
The intensity of the pain may lead to a misdiagnosis, such as renal colic or myocardial infarction, depending on location.The rash (Figure 1) begins as maculopapular lesions in a unilateral, dermatomal distribution that rarely crosses the midline. Postherpetic pain may take several forms, including allodynia (nonpainful stimulus perceived as painful), hyperpathia (slightly painful stimulus perceived as very painful), and dysesthesia (abnormal sensation with no stimuli).8Women are at greater risk of postherpetic neuralgia.
Shingles can affect any age group but is more commonly seen in the elderly and those with depressed immune defenses.
Although the peripheral nerves to the trunk is commonly affected, the virus may cause inflammation of any part of the nervous system, even the brain (encephalitis), meninges (meningitis) or both (meningoencephalitis). Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Anyone who has recovered from chickenpox may develop shingles; even children can get shingles.
It is caused by the herpes varicella-zoster virus, the same virus that's behind chickenpox.
It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Lesions progress to clear vesicles that become cloudy within three to five days, then crust and heal within two to four weeks. All three drugs are available in a generic form, although acyclovir is significantly less expensive than famciclovir or valacyclovir 13A  (Table 2). The varicella zoster virus causes the common childhood infection known as chickenpox which resolves after a few weeks. The virus targets certain nerves with symptoms such as the rash and pain being isolated to those areas of the skin supplied by a single spinal nerve.
In rare cases (usually among people with weakened immune systems), the rash may be more widespread and look similar to a chickenpox rash. The virus is never fully cleared from the body and shingles occurs when the virus reactivates. Never ignore professional medical advice in seeking treatment because of something you have read on the BootsWebMD Site. Adjunct medications, including opioid analgesics, tricyclic antidepressants, or corticosteroids, may relieve the pain associated with acute herpes zoster. Superimposed bacterial skin infections with streptococci and staphylococci should be treated with appropriate oral antibiotics.
The average wholesale cost of Zostavax is $194 per dose,13 and many insurance plans do not cover it. However, the virus remains dormant for long periods of time in the body and may sometimes reactivate to cause inflammation of the nerve roots. Although shingles resolves within a month, it can sometimes lead to complications or the pain can persist for months thereafter (post-herpetic neuralgia).
What does the shingles rash look like?Pain, itching, tingling, burning are all symptoms of shingles that may occur several days before the outbreak of the rash.
There is conflicting evidence that antiviral therapy during the acute phase prevents postherpetic neuralgia. This does not happen in every person who had chickenpox and is more frequently seen in diminished immune states. Vaccines provide an effective albeit not guaranteed protection against developing shingles. Starting as small blisters on a red base, with new blisters continuing to form for three to five days, shingles is painful.


Postherpetic neuralgia in the cutaneous nerve distribution may last from 30 days to more than six months after the lesions have healed. The vaccine must be frozen, and in-office administration requires a monitored, temperature-controlled freezer. Evidence supports treating postherpetic neuralgia with tricyclic antidepressants, gabapentin, pregabalin, long-acting opioids, or tramadol; moderate evidence supports the use of capsaicin cream or a lidocaine patch as a second-line agent. Shingles symptoms: Before the rashThe first symptoms of shingles appear one to four days before the rash. Immunization to prevent herpes zoster and postherpetic neuralgia is recommended for most adults 60 years and older. The first time someone is exposed to the virus, it causes the widespread, itchy sores known as chickenpox. Studies have shown that patients taking oxycodone, morphine, or methadone have better pain relief than those taking placebo.7 Opioids should be carefully adjusted in all patients for clinical response.
If you have shingles symptoms, seek medical advice even if you think you've never had chickenpox.
However, it should be used only if other agents have been ineffective.20Other treatments for postherpetic neuralgia have been investigated, but not all are effective.
Many childhood cases of chickenpox are mild enough to go unnoticed, but the virus can still linger and reactivate. Aspirin cream has been helpful in a few small studies, but the benefit is not considered significant.20 No recommendations can be made for the anticonvulsants valproate (Depakote)19 and carbamazepine (Tegretol)20 because of limited data.
To reduce the risk of complications, it's important to start treatment as soon as possible. Anesthetic agents such as N-methyl-d-aspartate receptor antagonists play a role in processing pain signals and could potentially benefit patients with postherpetic neuralgia. How long does shingles last?Shingles blisters usually scab over in seven to 10 days and disappear completely in two to four weeks.
In most healthy people, the blisters leave no scars, and the pain and itching go away after a few weeks or months.
But people with weakened immune systems may develop shingles blisters that do not heal in a timely manner.
Who's at risk of shingles?Anyone who has ever had chickenpox can get shingles, but the risk increases with age. However, it is possible for a person who has never had chickenpox to catch chickenpox from fluid from the blisters of someone with shingles.
Can shingles cause chronic pain?In some people, the pain of shingles may linger for months or even years after the rash has healed. This pain, due to damaged nerves in and beneath the skin, is known as postherpetic neuralgia.
In severe cases, the pain or itching may be bad enough to cause insomnia, weight loss, or depression.
Other complications of shinglesIf the shingles rash appears around the eye or forehead, it can cause eye infections and temporary or permanent loss of vision. These complications can usually be prevented by commencing treatment for shingles as soon as possible. Ramsay Hunt SyndromeAnother shingles complication is Ramsay Hunt syndrome, which affects some nerves in the head. Symptoms include earache, hearing loss, dizziness, vertigo, tinnitus, loss of taste and Bell's palsy paralysis of the face. Treatment: Antiviral medicationWhile there is no cure for shingles, antiviral medications such as aciclovir, valaciclovir and famciclovir may be recommended to reduce the severity and length of an attack. Treatment: Rash reliefOver-the-counter pain killing medication and anti-itch lotions, such as calamine, can relieve the pain and itching of the shingles rash. If the pain is severe or the rash is concentrated near an eye or ear, seek prompt medical advice.
Home care for shinglesColloidal or oatmeal baths are an old standby for relieving the itch of chickenpox and can help with shingles as well. To speed up the drying out of the blisters, try placing a cool, damp flannel on the rash (but not when calamine lotion or other creams have been applied).
The Department of Health says the Zostavax vaccination programme will prevent 38% of the 30,000 cases seen every year in people over 70.
Additionally, those who get the jab but still go on to develop shingles can expect to see a 55% reduction in symptoms.



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