What is shingles and how is it treated?

Shingles is an infection of a nerve area caused by the varicella-zoster virus.

It causes a painful rash which occurs along a band of skin supplied by the affected nerve. Symptoms usually resolve within 2-4 weeks.

WHAT IS SHINGLES AND HOW COMMON IS IT?

Shingles is an infection of a nerve. It affects the area of skin supplied by the infected nerve. It is caused by a virus called the varicella-zoster virus. It is this same virus that causes the chickenpox. Anyone who has had chickenpox in the past may develop shingles.

About one in four people develop shingles at some point in their lives. It can occur at any age but it is most common in people over the age of 50 years.

WHAT CAUSES SHINGLES?

Most people develop chickenpox at some stage (usually as a child). The virus does not completely go away after you have suffered from chickenpox and some virus particles remain in an inactive state within the nerve root next to your spinal cord. These particles do no harm there and cause no symptoms. For reasons that are not clear however, the virus may begin to multiply again (reactivate) in later life, often years later WHAT ARE THE SYMPTOMS OF SHINGLES?

The virus usually affects one nerve only, on one side of the body. Symptoms occur in the area of the skin that the nerve supplies. The usual symptoms which are caused by the shingles virus include pain and a rash.

An episode of shingles usually lasts two to weeks. In some cases there is a rash but no pain. Rarely, there is no rash but just a band of pain.

You may also feel you have a high temperature (feel feverish) and feel unwell for a few days.

IS THE SHINGLES VIRUS CONTAGIOUS?

You can catch chickenpox from someone with shingles if you have not suffered from the chickenpox virus before. Most adults and older children have already suffered from chickenpox and so are immune from catching chickenpox again. You cannot develop shingles from someone who has shingles. The shingles rash is contagious (for someone else to catch chickenpox) until all the blisters (vesicles) have scabbed and are dry. Also, if the blisters are covered with a dressing, it is unlikely that the virus will pass on to others. This is because the virus is passed on by direct contact with the fluid from within the blisters.

WHAT COMPLICATIONS CAN OCCUR FROM THE SHINGLES VIRUS?

Most people do not suffer from any complications. Those that sometimes occur include the following postherpetic neuralgia, where the nerve pain of shingles persists after the rash has disappeared; skin infection; eye problems; weakness; and various other rare complications.

WHAT ARE THE TREATMENT OPTIONS FOR SHINGLES?

There are two main aims of treating the shingles virus and these are to ease any pain and discomfort during the episode of shingles and to prevent, as much as possible, complications from developing.

Loose-fitting cotton clothes are best to reduce irritating the affected area of skin. Pain may be eased by cooling the affected area with ice cubes (wrapped in a plastic bag), wet dressings, or a cool bath. A non-adherent dressing that covers the rash when it is blistered and raw may help to reduce pain caused by contact with clothing. Simple creams (emollients) may be helpful if the rash is itchy.

Painkillers – for example, paracetamol, or paracetamol combined with codeine, or anti-inflammatory painkillers (such as ibuprofen), may give some relief. Strong painkillers (such as tramadol) may be needed in some cases.

A tricyclic antidepressant can be used to ease nerve pain (neuralgia) separate to their action on depression; also an anticonvulsant medicine such as gabapentin or pregabalin may also be used to ease neuralgic pain.

Antiviral medicines include aciclovir, famciclovir, and valaciclovir. An antiviral medicine does not kill the virus but works by stopping the virus from multiplying. So, it may limit the severity of the symptoms of the shingles virus. It had also been hoped that antiviral medicines would reduce the risk of pain persisting into PHN.

An antiviral medicine is most useful when started in the early stages of shingles (within 72 hours of the rash appearing). However, in some cases your doctor may still advise you take an antiviral medicine even if the rash is more than 72 hours old - particularly in elderly people with severe shingles, or if shingles affects the eye area.

Antiviral medicines are not advised routinely for everybody with shingles. For example, young adults and children who develop shingles on their tummy (abdomen) very often have mild symptoms and have a low risk of developing complications. Therefore, in this situation an antiviral medicine is not necessary. Your doctor will advise if you should take an antiviral medicine or not.