THE SKIN CENTER

The Skin Center

Doctor’s View:

ZOSTER

Nili N. Alai, MD, FAAD and DENA THOMPSON, B.S., M.S.

Shingles, or herpes zoster, is a very common painful, blistering viral rash that is caused by reactivation of the chicken pox virus called Varicella Zoster Virus (VZV).  Shingles occurs in people who have previously been infected with or vaccinated against the chicken pox virus at some point in their lives. Shingles usually occurs as a unilateral pain, burning, or tingling and blistering rash extending in a line pattern from the spinal nerves or facial nerve roots. Common shingles areas include the face, abdomen, back, buttocks, and chest. Red patches form in a belt-like pattern across these areas, and then become small blisters that may be similar in appearance to chicken pox. The rash which clears on its own within two to three weeks, begins to clear after the blisters break and dry into scabs. 

Once people have had a single bout of chicken pox, the virus lies dormant in the spinal cord or facial nerve roots.  It is thought that when a person has an overall weakened immune system or when their immunity to the varicella virus begins to wane, the virus can reactivate and presents as shingles. Although shingles may happen at any age, it is most common in the 5^th-6^th decades of life. Typically, shingles usually occurs most commonly in older adults over the age of 60 or those who are immunosuppressed like in HIV, AIDS, or cancer.  

Most people only get shingles once in their life. While it is not impossible to get shingles more than once, a recurrence would as probable as getting struck by lightning twice. 

Shingles is often a severely painful skin condition. Some people may have pain in the general area days to weeks before the onset of the blisters. The most important clue to shingles diagnosis is unilateral pain and blisters on the skin. A typical shingles eruption never crosses the midline of the body and occurs only on one side: right or left. Extremely rare cases of shingles may become diffuse and spread to the entire body in patients with a very compromised immune system like rheumatoid arthritis patients on multiple drugs including prednisone and methotrexate.

Common symptoms experienced with shingles include flu-like symptoms like chills, fever, and fatigue, along with abdominal and back pain when those skin dermatomes are involved.  In some cases, when the virus has affected the facial area, people can experience loss of eye motion, drooping eyelids, taste problems, facial pain, headache, and hearing loss. 

Effective treatments are available to help lessen the impact of shingles. For best prognosis and fastest recovery, early start of oral antiviral pills is most important. All shingles cases will eventually resolve with or without treatment.

Treatment started at the earliest stage of symptoms is helpful in shortening the duration and severity of the symptoms. Oral antihistamines like Benadryl may be used for itching, as well as oatmeal baths and calamine lotion. Analgesic medications like ibuprofen (Advil or Motrin), Tylenol, or Vicodin can be used for severe pain. 

The most difficult complication of shingles tends to be the residual pain that may last in the area for months or years. Chronic pain lasting more than six weeks after the onset of shingles is called post-herpetic neuralgia (PHN). Antiviral medications including acyclovir (Zovirax) if given within the first 48-72 hours of the occurrence of symptoms, can help reduce the length and severity of post-herpetic neuralgia. Additional treatments are available for PHN.

Shingles is generally not contagious to those who have had chicken pox. Rarely, it may cause problems in pregnant women, infants, immunocompromised individuals, or people who have never had chicken pox. Touching the blisters or blister fluid may cause transmission of the varicella virus.

Varicella Zoster virus is not “curable” because the virus stays dormant in the body for life. Once someone is initially exposed to the varicella virus, an immunity develops which generally prevents a second bout of typical chicken pox. However, this immunity may fade over time making older adults more prone to a later onset of a limited recurrence of the chicken pox virus as shingles.

Testing for shingles may include viral cultures, Tzanck prep ( microscopic exam and staining of skin), and blood testing for titers of antibidies to the varicella virus.

Shingles prevention steps include vaccination. There is a U.S. FDA approved vaccine (Zostavax) for adults age 60 and greater to help lessen the risk of shingles. Zostavax is a live attenuated vaccine and therefore carries a small risk of shingles when administered. There is also an U.S. FDA approved chicken pox vaccine called Varivax used primarily in single dose for children between 12 and 18 months of age, or older who have not had chicken pox.

Shingles