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What are shingles?

Shingles (herpes zoster) is an often very painful reactivation of childhood chicken pox (varicella zoster), typically affecting adults older than age 45, and has affected over half of all adults above the age of 60.  When a child has chicken pox, the rash, fever, cough, and fatigue clears up over a number of weeks, and health is restored.  Remnant virus particles not destroyed by the immune system can lie dormant in the nerve roots close to the spine for decades.  If the virus is reactivated at a later date, it travels along nerve pathways often to the skin.

Why would the chicken pox virus suddenly reappear decades later? 

There is no clearly defined reason why the virus appears much later in life as shingles.  A normal reduction in immune response with age is thought to be a contributing factor. Other factors, such as illness, stress or medications, can perhaps trigger a reactivation of the virus; more often, no identifiable reason can be cited.

What are the symptoms?

Usually, the first noticeable symptom of shingles is a burning, stabbing or shooting pain, which may be apparent for up to a week before a rash outbreak.  In more classic cases, over a three- to five-day period, a densely clustered bright red rash erupts.  Occasionally, no rash appears which makes a specific pain diagnosis difficult. 

Typically, the symptoms only occur on one side of the body following along the single nerve path where the virus has been activated. This is called a "dermatomal pattern" and is a key sign in diagnosing shingles. The rash may occur, for example, as blisters along one side of the face or neck, or wrapping around the torso from back to front in a relatively narrow swath.  Unlike the initial case of childhood chicken pox, shingles induces more pain than itching.  An outbreak of shingles is usually relatively short-lived (6-10 weeks without any treatment) especially in adults over 50 years old.

What is postherpetic neuralgia (PHN)?

Although the shingles rash heals, the after effects of the outbreak can linger for months or years. Sometimes the nerves become severely or permanently damaged creating a painful chronic condition known as postherpetic neuralgia which can last 2-3 years, and sometimes much longer.  The pain is identical to that experienced during a shingles outbreak:

• sharp, burning, or deep aching
• extreme sensitivity to touch and temperature change
• itching and numbness

The chances of developing postherpetic neuralgia increases with age. PHN constitutes a significant case of chronic pain in the elderly. 

Is shingles or postherpetic neuralgia preventable?

The best way to prevent postherpetic neuralgia is to seek comprehensive medical treatment immediately if there is an outbreak of shingles.  

Whether or not you've already had chicken pox, there is some evidence that a shingles vaccine for adults (similar to the chicken pox vaccine for children) may be useful in boosting the immune system. The vaccine may decrease the incidence of shingles and, if this is true, may drastically reduce the risk of postherpetic neuralgia or reduce the severity of duration of pain if PHN develops.  Also, making good lifestyle choices that enhance a healthy immune system can lessen the chances of a shingles outbreak.

Anyone over the ago of 40 should consider getting the vaccine, whether or not they have experienced shingles (or chicken pox) already.

What treatment options are available?

• Anti-viral medications to alleviate symptoms, shorten the shingles outbreak, and decrease chances of PHN.
• A short course of steroids which are most effectively administered by "sympathetic block" in which anesthetic and steroid is injected around the affected nerve root to inhibit further nerve damage by the virus.
• Simple self-care options, such as cold compresses; avoiding heat as well as tight or itchy clothing, such as wool; diet changes such as vitamin C and E supplements, increasing fruit and vegetable intake, and reducing sugar intake.

Please note that an outbreak of shingles can cause chicken pox in anyone who has not had chicken pox.  While the rash is present, you should avoid contact with those with weakened immune systems, newborns, and pregnant women.  Lastly, shingles cannot be passed from one person to another.