Anyone who has had shingles knows that it can be a painful experience. The virus that causes shingles (medical term: Herpes Zoster), the varicella virus, is the same virus that causes chicken pox. (Not the same virus that causes genital herpes or oral herpes.) It is estimated that 1 in 3 Americans will get shingles at some point in their life and there are one million new cases each year in the United States. Once someone has developed chicken pox, the virus remains dormant (inactive) in a nerve cell in your body. Because the virus remains dormant in a nerve, when it reactivates it can crop up anywhere on the body. If the virus reactivates, shingles can develop: it’s usually found on a single area of the body along a nerve.

It is not clear what “reactivates” or “awakens” the virus. Triggers for reactivating the virus can be a temporary weakness in your immunity due to an infection, trauma, stress, and certain medications; any of these can cause the virus to multiply and move along the nerve fibers towards the skin surface.

How does shingles progress? Initially, an affected individual may feel burning, itching, tingling, or extreme sensitivity on the skin which is limited to one area of the body. These symptoms may develop for several days before a rash on the skin develops. The rash appears as small blisters on inflamed skin limited to one area of the body. The blisters will initially appear clear and then will crust over and develop into scabs: this process from the original rash to scabs can take two to three weeks. The rash is usually associated with pain which can last long after the original rash has cleared. The skin eruption can occur anywhere on the skin but is most common on the face, trunk, arms and legs. If the eye is affected, permanent eye damage can result and an ophthalmological examination is necessary.

How is shingles diagnosed? A dermatologist can usually look at the appearance of the rash and make the diagnosis. A laboratory test can be performed if confirmation is necessary.

How is shingles treated? In an ordinary healthy individual, shingles can clear on it’s own in several weeks. If the diagnosis is made within 72 hours of the rash appearing, then an oral anti-viral medication can be effective. Cool compresses may provide soothing relief from the blisters. Patients may experience pain from the onset of the rash and may require pain medication along with an anti-viral medication. The individual may also experience itching, numbness, and tingling after the rash clears. It is well known that the earlier treatment is started, the better the outcome. If there is significant swelling and pain, a corticosteroid may be prescribed in addition to the anti-viral medication.

What is post-herpetic neuralgia? [ Post = after; herpetic = having to do with herpes, the type of virus that causes shingles; neuralgia = pain originating within a nerve cell.] Individuals can develop pain, numbness, itching, and tingling long after the initial rash resolves. These symptoms may be treated with pain relievers or other oral medications. This neuralgia can last for months or years, and is more common in older patients.

There is a vaccination against the shingles virus. On March 24, 2011, the Food and Drug Administration (FDA) approved the use of Zostavax, a live attenuated virus vaccine, for the prevention of shingles in individuals 50 to 59 years of age. In 2006, Zostavax had already been approved for use in individuals 60 years of age and older. Its most common side effects are redness, pain and swelling at the site of injection, and headache. The vaccination is also recommended for those who have never had shingles. In one study, this immunization decreased the incidence of shingles by more than 70%, and those who develop symptoms have milder symptoms than those who have not been vaccinated. This vaccine is highly recommended: anyone who has experienced the pain associated with shingles would agree.

Once a person develops shingles, the virus can spread to other individuals by direct skin contact: one person to another. The blisters may break and the fluid can be contagious.  A newborn or other person having decreased immunity is at the highest risk of contracting the virus from another individual. If the person has not previously been exposed to the virus, they will develop “chicken pox”, not shingles.  Shingles occurs only as a re-emergence of the virus, so it can only develop in a person who has already had chicken pox and still has the virus in affected nerve cells.