Shingles, also known as herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus, which is the same virus that causes chickenpox. The reactivation after dormancy in adulthood causes extremely painful rash which is avoidable by awareness and vaccination. Here are a few things everyone must know about Shingles.
What is Shingles?
Shingles is a viral disease caused by the same virus that causes chickenpox, also known as the Herpes Zoster virus. The virus remains dormant in the nerve tissue of the spinal cord and brain after one has had chickenpox in childhood. The immune cells of the body keep it in check for decades until it may become reactivated, usually in later adulthood.
Who is at risk to get Shingles?
Anyone who has had chickenpox may be at risk for shingles.
Commonly, there is an increased risk of shingles with senescence (aging; age>50) and other causes that lead to weakening of the immune system, like some medications (immunomodulators, long-term steroid therapy, anti-cancer medications etc.), cancers, or infections, but may also occur in healthy children and younger adults. It also occurs in people with comorbidities like diabetes, cancer, HIV, chronic obstructive pulmonary disease, asthma, post trauma immobilized patients, post stroke, autoimmune disease, inflammatory bowel disease, cardiovascular issues, etc. Researchers have identified smoking as a risk factor as well.
What are the symptoms of shingles?
Symptoms may vary in intensity.
The first symptom to appear is usually a burning or tingling sensation. It may sometimes start with pain occurring in a band-like distribution, restricted to only one side of the body in the torso (around the waist, chest, stomach, or back). Symptoms do not occur on both sides or cross the midline.
A vesicular rash, that are typically fluid-filled bubbles or blisters, usually follows the prodromal symptom. The vesicular rash forms a cluster, rather than being randomly scattered. In a few instances, the rash may also appear on one side of the face, around the eye or on the forehead. The rash may not develop all at once and may develop in several stages over a period of 2-5 weeks.
The fluid-filled blisters burst and develop a sore in due course of time. The healing occurs after there is formation of scab or crust over the rash.
Is Shingles Transmissible/ Contagious?
Shingles does not spread from person to person, it occurs in people, typically older adults who have had chickenpox in the past. The period of infectivity starts 1-2 days before onset of the rash and lasts until the rash has crust and scab formation over it, which may take 2–4 weeks.
People who have not had chickenpox in the past may become infected and develop chickenpox if they touch the rash. People who have had chickenpox already are not at any risk.
Healthcare workers and handlers of patients are at an increased risk of coming in contact with the fluid from the rash blister and must use appropriate personal protective measures like wearing gloves, gown and mask. People without prior infection or immunity to varicella zoster (chicken pox) infection must avoid contact with patients.
Does everyone who has chickenpox get Shingles?
No, not everyone will develop shingles later in life if one has had chickenpox. Declining immunity may be a cause of shingles. It is impossible to know who may or may not develop it.
How is Shingles Diagnosed?
In most patients, diagnosis is made clinically by assessing the site and character of the rash and associated symptoms.
Polymerase Chain reaction (PCR) is used for definitive diagnosis in patients with suspected shingles without rash in the early stages.
What is the treatment for Shingles?
There is no treatment for shingles, however, antiviral medications (like acyclovir, valacyclovir, famciclovir) when started early (within 72 hours of first symptoms) may help reduce the duration and severity by reducing the replication of the virus.
How is Shingles managed?
The most difficult symptoms are the painful rash and itching.
To reduce the pain, one may try:
- Using a cool compress over the area
- Taking over-the-counter pain relief medications like ibuprofen
- Using a topical pain-relieving cream (to use over the rash) containing capsaicin
To reduce the itching, one may try:
- Applying some calamine lotion
- Requesting the doctor for an antihistaminic medication
Health experts recommend maintaining cleanliness and covering the shingles rash with sterile bandages as a precaution against infection and direct contact.
What are the complications of shingles?
- One of the most painful complications is postherpetic neuralgia. As the name suggests, it is a persistent pain in the site after the blisters/rash heal.
- If you do not treat and keep the blisters clean, secondary skin infections may occur.
- Sometimes shingles may cause rashes to appear around the eye, which may lead to a painful infection that sometimes ends in a loss of vision.
- Other neurological complications may include encephalitis (inflammation of the brain tissue), facial paralysis, or difficulty in hearing.
How long does one need to stay off work or school when one develops shingles?
A person will only get chickenpox by coming in direct contact with the shingles sores, so under clothing it is safe. The healing may take a few days to a few weeks.
How can we prevent Shingles?
Your best bet is to get vaccinated.
Shingles arise from viral reactivation during periods of weakened immunity, thus maintaining a healthy immune system can be beneficial, although it does not guarantee the prevention of shingles, but may decrease the risk.
Eating a nutritious, balanced diet, regular exercise, stress reduction, and getting adequate quantity and quality of sleep may help the immune system to function optimally. However, the immune system as with everything does deteriorate with aging.
Is there a Vaccine we can take to prevent shingles?
As of April 2023, Shingrix vaccine is available in India for people aged 50 and older. Shingrix is a non-live, recombinant subunit vaccine that helps prevent shingles.
It is recommended for adults above 50 years of age. It requires 2 shots, two to six months apart.
REFERENCES:
- “Shingles: Answers to Common Questions | Holland Hospital.” Www.hollandhospital.org, www.hollandhospital.org/healthy-life/articles/peter-christensen-do/shin…. Accessed 6 Mar. 2024.
- Bilodeau, Kelly. “Answers to Common Questions about Shingles.” Harvard Health, 1 Apr. 2022, www.health.harvard.edu/diseases-and-conditions/answers-to-common-questi….
- “Frequently Asked Questions about Shingles (Herpes Zoster) - NFID.” Https://Www.nfid.org/, www.nfid.org/frequently-asked-questions-about-shingles-herpes-zoster/.
- INVC. “Shingles Vaccination in India.” INVC, invc.co.in/shingles-vaccination/india. Accessed 6 Mar. 2024.
- Patil, Anant, et al. “Herpes Zoster: A Review of Clinical Manifestations and Management.” Viruses, vol. 14, no. 2, 19 Jan. 2022, p. 192, www.ncbi.nlm.nih.gov/pmc/articles/PMC8876683/, https://doi.org/10.3390/v14020192.
