Shingles-Herpes Zoster

SHINGLES-HERPES ZOSTER

What is a Shingles-Herpes Zoster?

Shingles is an infection from a varicella zoster virus that leads to painful blisters or rashes in a one specific area on the skin. Chickenpox is also caused by the varicella zoster virus, a member of the herpes family of viruses. The virus can remain inactive in the nerve tissue even after recovering from the chickenpox at an early age. Shingles is a reactivation of this chickenpox virus but only in one nerve root. Anybody can catch it but mostly older people or people with weak immune systems are particularly affected so it is recommended to get vaccinated.


Shingles may occur anywhere on the body but the chest or torso are often affected. It develops just in one area or on one side of the body, although it may go from front to back where the skin is affected by the nerve tissues. Sometimes the affected skin areas remain slightly darker or lighter than the surrounding skin.


An episode of shingles usually lasts 2-4 weeks. The affected skin hurts initially before the rash appears. Later on a blister-type skin rashes spread like a belt where the pain is. It may keep hurting for some time after the rash has gone and this condition is called post-zoster neuralgia or post-herpetic neuralgia.


The shingles are not contagious. Person can’t get shingles from someone who has shingles. But a person can catch chickenpox from someone who has shingles if that infected person has not had chickenpox before.


Symptoms of shingles

Shingles may occur anywhere on the body. It develops just in one area or on one side of the body where the skin is affected by the nerve tissues. The rash usually develops at the chest or torso but may appear on the face, eyes and ears. Some of common symptoms are listed below:


Symptoms before rash appear are:

  Pain

  Burning

  Itching

  Tingling


Symptoms after rash appear are:

  Red colored rash in one area or on one side of the body

  Clusters of small fluid-filled blisters

  Fever

  Fatigue Chills

  Headache

  Joint pain


Symptoms after rash appear are:

  Usually older people or people with weak immune systems have severe conditions

  Widespread rashes and blisters as in chickenpox

  Vision loss due to infection at eyes

  Bacterial skin

  infections


Causes of shingles

Shingles is caused by the varicella zoster virus, a member of the herpes family of viruses. The virus can remain inactive in the nerve tissue even after recovering from the chickenpox at an early age. Shingles is a reactivation of this chickenpox virus but only in one nerve root. Anybody can catch it but mostly older people or people with longer physical and emotional stress or people with weak immune systems or people suffering from HIV, cancer or people taking particular medicines or steroids for a longer time are particularly affected.


How is shingles diagnosed?

Family doctors or dermatologists may diagnose shingles by the appearance of the skin. They may gather more information about patient’s medical condition by examining and knowing following things:


  By doing the physical examination of affected skin.

  By knowing about the patient's symptoms & possible triggers.

  By knowing about the medical history of the patient.


Skin Test:   Sometimes, a doctor will use a skin biopsy to confirm a diagnosis. Doctor or Lab will take a small sample of affected skin or some of the fluid from the blisters to examine under a microscope. This procedure can be helpful to find out if skin is infected with the virus and to rule out other medical conditions.


Treatment of shingles

Unfortunately, currently there isn’t a cure for shingles but it usually clears in 2 to 4 weeks and rarely returns. Depending on symptoms and the severity of shingles, doctors may recommend a variety of medications, therapies and other treatment options that can help to successfully manage the symptoms of shingles.


Medications:   Painkillers and antiviral drugs are given together by doctors to manage shingles symptoms. Fever reducing drugs are given to manage high temperatures. Here are some of these medications that are prescribed by doctors during shingles episodes.


Pain killers:   These medications are helpful to reduce pain, swelling and ease nerve pain. These medications are mostly taken as pills and sometimes as IV.

   Acetaminophen ( Cortef )

   Oxycodone ( Roxicodone )

   Oxycontin

   Tramadol ( Ultram )

   Ibuprofen (anti-inflammatory drug)

   Naproxen (anti-inflammatory drug)

   Prednisolone (anti-inflammatory drug)

   Lidocaine (anesthetic drug)

   Capsaicin (active component of chili peppers)

   Amitriptyline (to ease nerve pain neuralgia)

   Imipramine (to ease nerve pain neuralgia)

   Nortriptyline (to ease nerve pain neuralgia)

   Gabapentin (to ease nerve pain neuralgia)

   Pregabalin (to ease nerve pain neuralgia)


Antiviral medicines:   These medications are helpful to stop viruses from multiplying to reduce severity, prevent complications and shorten the shingles episode. The medicines are the most effective when started within 72 hours of first pain or burning felt. The medicines will give good results when they are taken before the blisters appear. These medications should be considered only if the patient's age is over 60, patient has a weak immune system, patient has infection near eyes, head or neck area, patient has severe pain or rash.

   Famciclovir

   Valacyclovir ( Valtrex )

   Acyclovir ( Zovirax )


Lifestyle management:   Person should take the following steps to reduce symptoms as well as risks related to shingles:

  Take your prescribed medications regularly.

  Take vitamin and mineral supplements to control skin infections.

  Avoid as much direct contact as possible with people.

  Apply calamine lotion on the infected area of the skin.

  Apply cool and wet compresses on infected areas of the skin as well as take soothing baths to reduce pain.

  Take bed rest until the fever goes down.

  Get on loose-fitting cotton clothes to reduce irritation on the affected area of skin.

  Do not scrub the affected skin area with sponge while taking a bath or shower.


Prevention of shingles

Zostavax and Shingrix are 2 available vaccines to reduce the likelihood of developing shingles.

Shingrix is given by injection into the upper arm in two doses separated by two to six months. Two doses of Shingrix are 90% effective in preventing shingles. Shingrix is recommended for all people over 60 even if they have received the previous shingles vaccine (called Zostavax) or had shingles in the past.

Vaccines have some mild one to two days side effects including injection site pain, redness, swelling, fatigue, headache, body aches and nausea.


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