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Shingles: Symptoms, Causes, Treatments by Dr. Zach Levine

BT Montreal | posted Tuesday, Dec 5th, 2017

  1. What is shingles?


Shingles is a painful rash that is shaped like a band or a belt. Shingles can affect people of all ages, but it is most common in those older than 50. Another name for shingles is “herpes zoster.”


  1. What causes shingles?


Shingles is caused by the same virus that causes chickenpox. After someone has chickenpox, the virus sometimes hides out, “asleep” in the body. Years later, it can “wake up” and cause shingles. The first time a person is infected with that virus, he or she gets chickenpox, not shingles.


  1. Who gets shingles?


RISK OF SHINGLES — Up to 20 percent of people will develop shingles during their lifetime. The condition only occurs in people who have had chickenpox, although occasionally, chickenpox is mild enough that you may not be aware that you were infected in the past.

Age — Shingles can occur in individuals of all ages, but it is much more common in adults aged 50 years and older.

Immune status — Shingles can occur in healthy adults. However, some people are at a higher risk of developing shingles because of a weakened immune system. The immune system may be weakened by:

  • Certain cancers or other diseases that interfere with a normal immune response
  • Immune-suppressing medications used to treat certain conditions (eg, rheumatoid arthritis) or to prevent rejection after organ transplantation
  • Chemotherapy for cancer
  • Infection with the human immunodeficiency virus (HIV), the virus that causes AIDS


  1. Is shingles contagious?


Yes and no. It is not possible to “catch” shingles from someone who has the rash. But it is possible to “catch” the virus and then get sick with chickenpox. Shingles and chickenpox are caused by the same virus.


You probably will not catch the virus (or get chickenpox) if you:

  • Had chickenpox or shingles in the past
  • Had the chickenpox vaccine
  • Were born in north america before 1980 (most people born before 1980 have had chickenpox even if they don’t remember it)


  1. What are the symptoms of shingles?


At first, shingles causes weird sensations on your skin. You might feel itching, burning, pain, or tingling. Some people get a fever, feel sick, or get a headache. Within 1 to 2 days, a rash with blisters appears. Blisters most often appear in a band across the chest and back. They can show up on other parts of the body, too. The blisters cause pain that can be mild or severe.

Within 3 to 4 days, shingles blisters can become open sores or “ulcers”. These ulcers can get infected. Within 7 to 10 days, the rash should scab over. By then, most people are no longer contagious.


  1. Can shingles be serious?

Pain and seriousness get worse with increasing age.

Yes. Shingles can be serious, but that is rare. About 1 out of 10 people with shingles will get something called “postherpetic neuralgia,” or “PHN.” People with PHN keep feeling pain or discomfort even after their rash goes away. This pain can last for months or even years. It can be so bad that it makes it hard to sleep, causes weight loss, and leads to depression.

Shingles can also cause:

  • Skin infections
  • Eye problems (if the rash is near the eye)
  • Ear problems (if the rash is near the ear)
  • Dangerous infections in people who have other health problems


  1. Should I be treated?


Yes — for the virus and if needed for the pain


Treatment of shingles usually includes a combination of antiviral and pain-relieving medications. The affected areas should be kept clean and dry.

Antiviral medications — Antiviral medications stop the varicella zoster virus from multiplying, speed healing of skin lesions, and reduce the severity and duration of pain.

Antiviral treatment is recommended for EVERYONE with shingles, and is most effective when started within 72 hours after the shingles rash appears. After this time, antiviral medications may still be helpful if new blisters are appearing.

Three antiviral drugs are used to treat shingles: acyclovir (Zovirax®), famciclovir (Famvir®), and valacyclovir (Valtrex®). Acyclovir is the least expensive treatment but it must be taken more frequently than the other drugs.


Pain medications — The pain of shingles and postherpetic neuralgia can be severe, and prescription medications are frequently needed.


Treatment of postherpetic neuralgia — Treatment is available to reduce pain and maintain quality of life in people with postherpetic neuralgia. Treatment generally begins with a low-dose tricyclic antidepressant, and may also include narcotic medications and an anti-seizure medication.

Tricyclic antidepressants — Tricyclic antidepressants (TCAs) are commonly used to treat the pain of postherpetic neuralgia. The dose of TCAs is typically much lower than that used for treating depression. It is believed that these drugs reduce pain when used in low doses, but it is not clear how the drug works.

Anti-seizure medications — Medications that are traditionally used to prevent seizures, called anticonvulsants, can sometimes reduce the pain of postherpetic neuralgia. They may be used instead of or in addition to TCAs. Anticonvulsants commonly used for postherpetic neuralgia include gabapentin (Neurontin®) and pregabalin (Lyrica®).

Capsaicin — Capsaicin is a substance derived from chili peppers that can help to treat pain. Capsaicin cream (Zostrix®) may be recommended to treat postherpetic neuralgia. However, the side effects of the cream (including burning, stinging, and skin redness) are intolerable for up to one-third of patients.

Topical anesthetics — Lidocaine (Xylocaine) gel is a medicine that you can rub into your skin. A lidocaine patch (Lidoderm®) is also available, which you wear on your skin for 12 hours per day. It delivers a small amount of lidocaine to the most painful or itchy areas. However, the benefit of lidocaine is likely to be moderate at best.

Steroid injections — For people with postherpetic neuralgia who have severe pain despite using the above measures, an injection of steroids directly into the space around the spinal cord may be considered. Steroid injections are not used to treat facial pain.

In one study of patients with postherpetic neuralgia for at least one year, steroid injections led to good or excellent pain relief in about 90 percent of individuals [1].


  1. When can I return to work?  How long is it contagious? — contagious until all blisters are dry and crusted over

If you have shingles, you may wonder when it is safe to return to work. The answer depends upon where you work and where your blisters are located.

  • If the blisters are on your face, do not return to work until the area has crusted over, which generally takes seven to 10 days.
  • If the blisters are in an area that you can cover (eg, with a gauze bandage or clothing), you may return to work when you feel well.


  1. How can we prevent shingles?

Who can get the vaccine?


Vaccination — a vaccine is now available to reduce the chance of developing shingles. If you do develop shingles after receiving the vaccine, your infection may be less severe and you are less likely to develop postherpetic neuralgia

There are two vaccines that have been approved for adults over 50 years.


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