Shingles is a painful, blistery rash in one specific area of your body. Most of us get chickenpox in our lives, usually when we are children. Shingles is a reactivation of that chickenpox virus but only in one nerve root. So instead of getting spots all over the place, the way you do when you have chickenpox, you get them just in one area of your body.
Usually (other than on your head) it will just be on one side of your body, although it may go right round from front to back, following the skin the nerve affects.
The affected skin hurts, and it may start to hurt before the rash appears, and may keep hurting for some time after the rash has gone. You may feel generally off-colour and not yourself.
What are the symptoms of shingles?
The virus usually affects one nerve only, on one side of the body. Symptoms occur in the area of skin that the nerve supplies. The usual symptoms are pain and a rash. Occasionally, two or three nerves next to each other are affected.
The most commonly involved nerves are those supplying the skin on the chest or tummy (abdomen). The upper face (including an eye) is also a common site.
The pain is a localised band of pain. It can be anywhere on your body, depending on which nerve is affected. The pain can range from mild to severe. You may have a constant dull, burning, or gnawing pain. In addition, or instead, you may have sharp and stabbing pains that come and go. The affected area of skin is usually tender.
The rash typically appears 2-3 days after the pain begins. Red blotches appear that quickly develop into itchy blisters. The rash looks like chickenpox but only appears on the band of skin supplied by the affected nerve. New blisters may appear for up to a week. The soft tissues under and around the rash may become swollen for a while due to inflammation caused by the virus. The blisters then dry up, form scabs and gradually fade away. Slight scarring may occur where the blisters have been. The picture shows a scabbing rash (a few days old) of a fairly bad bout of shingles. In this person, it has affected a nerve and the skin that the nerve supplies, on the left side of the abdomen.
Signs of shingles
Images above by Mariegriffiths via Wikimedia Commons
An episode of shingles usually lasts 2-4 weeks. In some cases there is a rash but no pain. Rarely, there is no rash but just a band of pain.
You may also feel you have a high temperature (feel feverish) and feel unwell for a few days.
Is shingles contagious?
You can catch chickenpox from someone with shingles if you have not had chickenpox before. But most adults and older children have already had chickenpox and so are immune from catching chickenpox again. You cannot get shingles from someone who has shingles.
The shingles rash is contagious (for someone else to catch chickenpox) until all the blisters (vesicles) have scabbed and are dry. If the blisters are covered with a dressing, it is unlikely that the virus will pass on to others. This is because the virus is passed on by direct contact with the blisters. If you have a job, you can return to work once the blisters have dried up, or earlier if you keep the rash covered and feel well enough. Similarly children with shingles can go to school if the rash is covered by clothes and they do not feel unwell.
Pregnant women who have not had chickenpox should avoid people with shingles. Also, if you have a poor immune system (immunosuppression), you should avoid people with shingles. These general rules are to be on the safe side, as it is direct contact with the rash that usually passes on the virus.
Can other people catch it?
This one is confusing! Here’s the deal. You can catch chickenpox from other people, but you can’t catch shingles from other people. You only get shingles from a reactivation of your own chickenpox infection in the past.
So if you have shingles, and you come into contact with somebody else, they cannot “catch” your shingles. But if they have never had chickenpox, it is possible that they could catch chickenpox from you. (And if you had chickenpox, and came into contact with somebody else who had never had chickenpox, they could catch chickenpox. But they couldn’t “catch” shingles from your chickenpox.)
To put it another way, no, you don’t “catch” shingles. It comes from a virus hiding out in your own body, not from someone else. But if you have shingles, you may be infectious, as it is possible for people to catch chickenpox from you.
Only people who have never had chickenpox are likely to be at risk of catching chickenpox from your shingles. People who have had chickenpox should be immune from catching it again. If the rash is in a covered area of skin, the risk of anyone with whom you are not in close contact catching chickenpox is very low.
[embedyt] https://www.youtube.com/watch?v=iVqcRjFKch4[/embedyt]How common is it?
Shingles is an infection of a nerve and the area of skin supplied by the nerve. It is caused by a virus called the varicella-zoster virus. It is the same virus that causes chickenpox. Anyone who has had chickenpox in the past may develop shingles. Shingles is sometimes called herpes zoster. (Note: this is very different to genital herpes which is caused by a different virus called herpes simplex.)
About 1 in 4 people have shingles at some time in their lives. It can occur at any age but it is most common in people over the age of 50 years. After the age of 50, it becomes increasingly more common as you get older. It is uncommon to have shingles more than once but some people do have it more than once.
Causes of shingles
Most people have chickenpox at some stage (usually as a child). The virus does not completely go after you have chickenpox. Some virus particles remain inactive in the nerve roots next to your spinal cord. They do no harm there and cause no symptoms. For reasons that are not clear, the virus may begin to multiply again (reactivate). This is often years later. The reactivated virus travels along the nerve to the skin to cause shingles.
In most cases, an episode of shingles occurs for no apparent reason. Sometimes a period of stress or illness seems to trigger it. A slight ageing of the immune system may account for it being more common in older people. (The immune system keeps the virus inactive and prevents it from multiplying. A slight weakening of the immune system in older people may account for the virus reactivating and multiplying to cause shingles.)
Shingles is also more common in people with a poor immune system (immunosuppression). For example, shingles commonly occurs in younger people who have HIV/AIDS or whose immune system is suppressed with treatment such as steroids or chemotherapy.
Antiviral medicines for shingles
Antiviral medicines include aciclovir, famciclovir and valaciclovir. An antiviral medicine does not kill the virus but works by stopping the virus from multiplying. So, it may limit the severity of symptoms of the shingles episode. It had also been hoped that antiviral medicines would reduce the risk of pain persisting into Post Herpetic Neuralgia (PHN). However, the research so far has shown that the current antiviral medicines taken during an episode of shingles do not seem to have much impact on the prevention of PHN. Further research is needed in this area to determine if newer antiviral drugs can prevent PHN.
An antiviral medicine is most useful when started in the early stages of shingles (within 72 hours of the rash appearing). However, in some cases your doctor may still advise you have an antiviral medicine even if the rash is more than 72 hours old – particularly in elderly people with severe shingles, or if shingles affects an eye.
Is there a shingles vaccine?
There is a vaccine against the varicella virus to protect children against chickenpox. The vaccine has reduced the incidence of chickenpox. If fewer people get chickenpox, then fewer people will get shingles later in life.
What about immunisation for older people?
The vaccine against the varicella-zoster virus has been shown in large studies to be effective in reducing the risk of older people developing shingles. The vaccine has been shown to be safe with very few side-effects.
Most people do not get side-effects from the vaccine but you may get a red, sore or itchy area around the injection site. Some people may feel some other side-effects, such as a temperature, aches and pains, a rash or headache. Other side-effects are rare.
Other than the vaccine, there is no way of preventing shingles for somebody who has had chickenpox in the past.
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