Shingles (herpes zoster)

Overview

Shingles, also known as herpes zoster, is a viral infection caused by the varicella-zoster virus, which is also responsible for chickenpox. Once a person has had chickenpox, the virus lies dormant within nerve cells in the body. Years or even decades later, it can then be reactivated and cause shingles.

The disease is characterised by a painful skin rash that typically manifests as a stripe of blisters on one side of the body or face. These blisters are filled with a clear fluid and can be highly itchy or painful. Other symptoms include fever, headache and a general feeling of being unwell.

It is important to understand that shingles itself is not infectious in the same way as chickenpox. However, a person with shingles can transmit the varicella-zoster virus to people who have not yet had chickenpox or have not been vaccinated against it. These individuals can then develop chickenpox as a result. Contact with open shingles blisters should therefore be avoided, particularly in order to protect people with a weak immune system, pregnant women and babies.

Occurrence & causes

The exact cause of the reactivation of the varicella-zoster virus is not fully understood, although it is assumed that a weakened immune system plays a key role. 

Factors that may encourage the reactivation of the varicella zoster virus include:

• Older age
• Stress
• Physical overexertion
• Certain medications and diseases that compromise the immune system, such as HIV/AIDS or cancer
• Immunodeficiency after an illness
• Congenital immune defects
• Toxins
• UV radiation

Risk groups

Shingles can essentially affect anyone who has previously had chickenpox. High-risk groups include, in particular, people with a weakened immune system and the elderly. The risk of developing herpes zoster increases with age, as the immune system weakens.

The following people are particularly at risk:

• People aged 50 and over
• People with a weakened immune system
• People undergoing immunosuppressive therapy
• People with certain chronic illnesses that may increase the risk of shingles

Course of the disease

Shingles typically begins with pain, itching or a tingling sensation in a specific area of the skin. A few days later, red patches appear on the skin and quickly develop into small, fluid-filled blisters. These blisters burst and crust over to form scabs that heal within a few weeks. Shingles is usually limited to one side of the body and commonly occurs in the chest area, although it can also affect other parts of the body.

The disease is generally harmless and tends to clear up within two to four weeks with no lasting damage. The characteristic skin rash recedes even without treatment, although it can lead to changes in the skin – such as darkening when exposed to sunlight or a loss of pigment – in some cases. In children, shingles is very rare and generally uncomplicated, whereas adults are more likely to suffer severe pain.

Although the disease is typically harmless, complications can occur in some instances. Herpes zoster is particularly problematic in the facial area, as there is a risk that it may affect the eye. This can lead to serious consequences, such as retinal detachment.

Symptoms

The symptoms of shingles can vary, but the most common are:

• Severe pain, a burning sensation, numbness or tingling in the affected region
• A red rash that appears after a few days
• Blisters that burst and then crust over
• Itchiness
• Fever, headache and fatigue can also occur

In some cases, shingles can lead to complications such as postherpetic neuralgia, a lasting disorder in which pain persists even after the skin rash has healed.
Symptoms usually occur on the chest and torso and less frequently on the neck, arms or legs – and are limited to the area of skin supplied by the affected nerve cord.

Diagnosis

Shingles is generally diagnosed based on the characteristic rash and pain. In the absence of external symptoms that clearly point to herpes zoster, the disease can also be diagnosed by means of lab tests. Even tiny quantities of the varicella-zoster virus, which causes the disease, can be detected by a PCR (polymerase chain reaction ) test. In this technique, a small amount of viral DNA is replicated and analysed. If there are no blisters on the skin, the test can even be performed using a blood sample.

Treatment

The treatment of shingles aims to relieve pain and speed up the healing process. Treatments include:

• Antiviral medications: Active substances such as valacyclovir, acyclovir or brivudine stop viruses from replicating. If possible, treatment should be started within 72 hours of the onset of the rash. The earlier treatment is started, the sooner the course of the disease can be influenced, the symptoms alleviated and the risk of complications reduced. Later treatment can also be helpful. The doctor will decide whether this is advisable on a case-by-case basis.
• Painkillers: from simple analgesics to specialised drugs for nerve pain.
• Caring for the skin rash: use of lotions and cold compresses to relieve itchiness.
• Rest and recuperation: sufficient rest is important to allow the body to heal.
  

Prevention

The prevention of shingles is particularly important for older people. One effective means of prevention is vaccination against the varicella-zoster virus. This vaccination is particularly recommended for people over the age of 50, as the risk of shingles and associated complications increases with age. It is also important to strengthen the immune system by maintaining a healthy lifestyle with a balanced diet and regular exercise.

FAQ: frequently asked questions about shingles