Symptoms of Shingles:
The symptoms of shingles are a common one. They include fever, headache, muscle pain, sore throat and cough.
Other symptoms may include confusion, memory loss, depression and difficulty concentrating.
In some cases the symptoms of shingles do not appear until days after the initial attack. However, in most cases they occur within 2 weeks of the initial attack.
Symptoms of Shingles:
Shingles is caused by the varicella zoster virus (VZV). This is the same virus that causes chickenpox.
In most cases shingles occurs in people that have not been vaccinated with the chicken pox vaccine or had chickenpox as a child.
The virus remains dormant in the body after a person has had chickenpox. It can re-activate years later as shingles.
Once the virus has become active it begins to travel along nerve pathways. This causes a rash of painful blisters to appear, typically on one side of the body. These blisters then break and an itchy rash may develop. The virus then becomes dormant again and may remain in the body for the rest of the person’s life.
Shingles can be very painful. It can also be very itchy.
It is not usually dangerous but may be very distressing for some people. The most effective treatment for shingles is antiviral medication such as acyclovir. This reduces the duration and severity of the symptoms. It also shortens the time that the virus remains active in the body. This is important because it reduces the risk of developing postherpetic neuralgia.
Shingles is contagious, but only once the rash has developed. It is possible to catch the virus while the rash is active but before symptoms begin.
Fortunately the infection is not usually passed on unless blisters are present. If you think you have come into contact with someone with shingles avoid touching the affected area and wash your hands after touching them.
It is possible to get shingles more than once. However, a person cannot get chicken pox if they have had shingles.
Stages of Shingles:
The rash may develop in several stages. Typically it starts with small itchy red spots.
These spots may be normal skin color, red, purple or brown in color. They may be raised or flat to the touch.
The rash will then typically worsen. This can cause the red spots to join together to form narrow red lines.
These lines may extend over the entire body. Blisters may then appear and break releasing a thick fluid.
The rash may then begin to clear up. This can cause the skin to become very dry and resemble cracked earth.
It may begin to peel or crack as it heals.
The rash should begin to heal within 2 to 4 weeks. Once healed it will leave faint red or brown marks on the skin that persist for many months or even years.
These marks are known as post-herpetic neuralgia lesions.
Shingles is most common in older people and the elderly. The risk of getting shingles increases as people age.
This is because the immune system becomes weaker as people age.
The elderly have a higher risk of developing post-herpetic neuralgia. This is why it is recommended that people in their 70’s and 80’s receive the shingles vaccine whenever possible.
There is no cure for shingles, but it can be treated. Antiviral medication can help to reduce the duration and severity of the rash.
Treatment can help to prevent complications such as postherpetic neuralgia which can be a long lasting condition. It may cause a permanent, persistent pain in the area where the rash occurred.
This can be very disabling. Fortunately it is rare.
It is recommended that you seek medical advice if you think that you have shingles or have been exposed to someone with shingles.
The virus that causes shingles remains in the body after an attack. It may become active again at a later date causing further attacks.
It is possible to reduce the frequency and severity of future attacks through the use of antiviral drugs. These drugs include acyclovir, famciclovir and valacyclovir.
These drugs can also help to prevent the virus becoming active while you are taking them.
These drugs have few side effects and are generally very safe. They are available as tablets or liquids that can be taken by mouth.
Treatment generally lasts from three to six months.
If you develop severe pain, skin sensitivity or problems with your vision you should seek medical advice. These problems can indicate a more serious complication.
It is important to remember that most people who have shingles do not develop complications. In the vast majority of cases it is easy to treat and will heal by itself within a few weeks.
It is best to try to maintain your normal level of activity. If the rash involves the eye, mouth or genitals you should not do things that would aggravate these areas.
Pain relievers such as paracetamol or ibuprofen can help to relieve the pain and lower the fever.
Do not take aspirin. This can increase the risk of bleeding.
It is important not to scratch the rash. This can cause open sores (ulcers) in the skin which increase the risk of developing post-herpetic neuralgia (long-lasting nerve pain).
It is also important to try to maintain good fluid intake. This helps to prevent the rash from cracking and allows it to heal faster.
You can cool the skin with creams or lotions. You can also apply calamine lotion to relieve itchiness or cool cloths to relieve pain and swelling.
Staying in cool surroundings can help to relieve the pain and lower the fever.
Avoid sun bathing or spending a long time in the sun until the rash has healed.
A tetnus vaccine can reduce the risk of contracting tetnus. This is a bacterial infection that can occur following an animal bite or scratch.
It can be fatal in rare cases.
It is important to have a tetnus vaccine if you have a cat or dog, or if you spend a lot of time in the countryside or walking in remote areas. The vaccine is normally only routinely recommended for children over the age of seven years.
If you are bitten or scratched by an animal, it is important to clean the wound thoroughly with large amounts of water and soap. You can also seek immediate treatment at your doctor’s surgery.
Tetnus is not the only infection you need to be concerned about. Some animals carry other organisms that can cause infection.
If you think you have been exposed to the bodily fluids (saliva, blood, pus) of an animal such as a cat or dog you should seek immediate medical assistance.
If you are bitten or scratched by any other animal (such as a bat) or human, you should also seek immediate medical assistance. Other animals and humans can carry organisms that can cause infection and serious complications.
Your doctor can assess the risk of infection and whether any treatment is required.
In the majority of cases you should be able to answer the questions posed by your doctor. If you find this difficult they may examine the wound or rash and perform some simple tests.
If they think you need further tests or treatment they will advise you about this.
There are three main types of complications that can arise following shingles:
1. Complications caused by the virus
All the complications described in this section are rare and occur in less than 1% of people who suffer from shingles.
If you have undergone treatment the risk of developing a complication is greatly reduced.
Viral skin infection
The virus that causes shingles (herpes zoster) can also infect the skin and cause an ordinary skin infection. This is known as a viral skin infection.
It usually causes a thin area of dead skin (necrosis) which may look like a bruise.
It can take months for a skin infection to develop after you have had shingles, but it is more common in people who are immunocompromised (have a compromised immune system).
A skin infection in someone who is immunocompromised can be a sign of a more serious condition due to the virus spreading and infecting deeper layers of skin or organs.
This complication is described below in the section on PHN.
Herpes zoster ophthalmicus
Ocular disease caused by shingles affecting the eye is known as herpetic ophthalmicus (triggered by herpes zoster) and is more common in people who are immunosuppressed.
The most common symptom of this complication is a sudden onset of pain, redness and/or swelling in one or both eyes. These symptoms can be very severe.
Complications arising in the eye itself are less common, but can lead to sight-threatening issues if not treated.
Post-herpetic neuralgia (PHN)
This is the complication described at the beginning of this article. It is described in more detail below.
Development of shingles elsewhere
A very small number of people (especially the elderly) who get shingles on one side of their body develop it on the other. Although this is rare, it is more common in people with a weakened immune system and can lead to widespread skin damage and complications.
Sources & references used in this article:
- An unusual case report of covid-19 presenting with meningitis symptoms and shingles (R Packwood, G Galletta, J Tennyson – Clinical practice and cases …, 2020 – ncbi.nlm.nih.gov)
- Mechanisms of pain and itch caused by herpes zoster (shingles) (AL Oaklander – The Journal of Pain, 2008 – Elsevier)
- Preventing shingles: symptoms, treatment and management (I Peate – British Journal of Healthcare Assistants, 2010 – magonlinelibrary.com)
- Studies on shingles. Is the virus ordinary chickenpox virus? (REH Simpson – Lancet, 1954 – cabdirect.org)
- The complete DNA sequence of varicella-zoster virus (AJ Davison, JE Scott – Journal of General Virology, 1986 – microbiologyresearch.org)
- SHINGLES In An Unwelcome Encore. (E Zamula – FDA consumer, 2001 – elibrary.ru)
- Shingles (zoster) (HM Lilie, SW Wassilew – Contributions to microbiology, 1999 – books.google.com)
- Herpes zoster (shingles) and postherpetic neuralgia (P Sampathkumar, LA Drage, DP Martin – Mayo Clinic Proceedings, 2009 – Elsevier)
- Intravenous vitamin C in the treatment of shingles: results of a multicenter prospective cohort study (M Schencking, C Vollbracht, G Weiss… – … medical journal of …, 2012 – ncbi.nlm.nih.gov)