Shingles: A throwback you’d like to throw back!

One in three of all adults reading this article will develop shingles in their lifetime, usually after age 50. Not because you’re reading this article – but because when you were a child, you probably had chickenpox.

Shingles is the reactivation of a viral infection in the nerves to the skin that causes pain, burning, or a tingling sensation, along with an itch and blisters in the skin supplied by the affected nerve.  It is caused by the varicella zoster virus, or VZV — the same virus that causes chickenpox.  When the itchy red spots of childhood chickenpox disappear, the virus remains in a dormant state in our nerve cells, able to strike again. This second eruption of the chickenpox virus is called shingles or herpes-zoster.  Shingles is not caused by the same virus that causes genital herpes, a sexually transmitted disease.

Shingles occurs when an unknown trigger causes the virus to become activated.  It afflicts approximately one million Americans annually, and children are vulnerable, too. However, about half of all cases occur in men and women 60 years old or older.

People who develop shingles typically have only one episode in their lifetime, though it can strike a person a second or even third time. Since most of us had chickenpox as children, we’re at risk, even if the case was so mild that it may have passed unnoticed.  In the original exposure to VZV (chickenpox), some of the virus particles settle into nerve cells where they remain for many years in an inactive, hidden (latent) form.

When the VZV reactivates, it spreads down the long nerve fibers that extend from the sensory cell bodies to the skin. As the virus multiplies, a telltale rash erupts. With shingles, the nervous system is more deeply involved than it was during the bout with chickenpox, and the symptoms are often more complex and severe.

Incidence increases with age – shingles is 10 times more likely to occur in adults over 60 than in children under 10.  People with compromised immune systems, a natural consequence of aging, or from use of immunosuppressive medications such as prednisone are at increased risk of developing shingles.

What does shingles look like?

Shingles is a painful rash that develops on one side of the face or body. The rash forms blisters that typically scab over in seven to 10 days and clear up within two to four weeks.

Before the rash develops, people often have pain, itching or tingling in the area where the rash will develop. This may happen anywhere from one to five days before the rash appears. Most commonly, the rash occurs in a single stripe around either the left or the right side of the body. In other cases, the rash occurs on one side of the face. In rare cases (usually among people with weakened immune systems), the rash may be more widespread and look similar to a chickenpox rash. Shingles can affect the eyes and cause loss of vision.

Other symptoms of shingles can include fever, headache, chills and an upset stomach.

Shingles cannot be passed from one person to another. However, the virus that causes shingles, the varicella zoster virus, can be spread from a person with active shingles to another person who has never had chickenpox. In such cases, the person exposed to the virus might develop chickenpox, but they would not develop shingles.

The virus is spread through direct contact with fluid from the rash blisters caused by shingles.  A person with active shingles can spread the virus when the rash is in the blister-phase. A person is not infectious before the blisters appear. Once the rash has developed crusts, the person is no longer contagious.

Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered.

If you have shingles, here are some important steps to remember:

  • Keep the rash covered.
  • Avoid touching or scratching the rash.
  • Wash your hands oftento prevent the spread of varicella zoster virus.

Until your rash has developed crusts, avoid contact with:

  • Pregnant women who have never had chickenpox or the chickenpox vaccine;
  • Premature or low-birth-weight infants; and
  • People with weakened immune systems, such as people receiving immunosuppressive medications or undergoing chemotherapy, organ transplant recipients, and people with human immunodeficiency virus (HIV) infection.

Reducing the chance of contracting shingles

Several antiviral medicines – acyclovir, valacyclovir, and famciclovir – are available to treat shingles. These medicines will help shorten the length and severity of the illness. But to be effective, they must be started as soon as possible after the rash appears.  Analgesics (pain medicine) may help relieve the pain caused by shingles. Wet compresses, calamine lotion, and colloidal oatmeal baths may help relieve some of the itching.

The only way to reduce the risk of developing shingles and the long-term pain from post-herpetic neuralgia (PHN) – a condition that can afflict people after they’ve recovered from shingles – is to get vaccinated. Shingles vaccine (Zostavax®) reduces the risk of developing shingles and the long-term pain that can sometimes afflict those who have had shingles. The Center for Disease Control (CDC) recommends that people aged 60 years and older get one dose of shingles vaccine. Shingles vaccine is available in pharmacies and doctor’s offices.

Additionally, the chickenpox vaccine became available in the United States in 1995.  Immunization with the varicella vaccine (or chickenpox vaccine) – now recommended in the United States for all children between 18 months and adolescence – can protect people from getting chickenpox.  People who have been vaccinated against chickenpox are probably less likely to get shingles because the weak, “attenuated” strain of virus used in the chickenpox vaccine is less likely to survive in the body over decades.

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