Shingles
Shingles, also known as herpes zoster, is a reactivation infection caused by the chicken pox virus. It causes a painful rash.
Shingles is a localized infection caused by the same varicella-zoster virus (VZV) that led to chicken pox. Once you have recovered from chicken pox, usually as a child, the virus stays in the body, lying dormant in specific nerve cells, causing no problems or symptoms. The virus can reactivate at some point due to a weakened immune system. It multiplies along nerve fibres just under the skin, which leads to fluid-filled blisters in a rash called shingles.
The VZ virus can lay dormant forever, but it will reactivate for about 20 per cent of people who have had chickenpox. Shingles itself is not contagious. Most people who get shingles will get better and not get it again but it is possible to get shingles more than once.
Who is at risk?
- If you have had chickenpox, you are at risk of getting shingles
- The risk increases after age 50
- About 1 in 3 people will experience shingles in their lifetime
- By age 85, 1 in 2 will have had shingles
Symptoms
The first signs of shingles are usually tingling or a burning pain in an area supplied by infected nerves. This will occur three to four days ahead of a rash which looks, unsurprisingly, just like chicken pox. Small blisters containing the virus form from the rash and last two to three weeks. Shingles can appear in many places on the body; blisters commonly show up on the face or trunk, and may occur on the buttocks or genitals.
Severe pain is the most significant effect of shingles, and it can last several months or longer. Postherpetic neuralgia (PHN) is pain, headaches and nerve problems that occur as a complication of shingles. PHN lasts for at least 30 days but can continue for months, or years.
Treatment
Treatment for shingles is focused on pain-reduction and limiting secondary infection. One of the best treatments is to start antiviral medicines within the first 72 hours after the appearance of the rash. This will clear up the rash and reduce the risk of PHN. For shingles, standard pain killers are often not very effective, so other strategies may be used. These include anti-inflammatories, Capsaicin, Aspirin cream or Lidocaine. Steroid injections and nerve blocks have also been used.
Immunization
The most effective way to avoid shingles is to never get chickenpox. It may be too late for an adult, but children are protected with their routine childhood vaccinations.
A second option is a shingles vaccine. This lowers the risk of shingles and can prevent long-term pain after shingles. The Shingrix vaccine provides 97% protection in the 50 – 69 age group and 91% protection in the over 70 age group. Shingrix will be given as 2 doses 2-6 months apart at a cost per dose. For adults not immunized against chicken pox, the varicella vaccine is recommended.