Shingles is an infection of the nerves that supply the skin, causing a painful rash of small blisters. It is caused by the virus Varicella zoster, which also causes chicken pox.

After a person has had an attack of chicken pox, the virus can remain dormant in certain nerves, sometimes to be reactivated later to cause shingles.

Causes of shingles

Chicken pox infection is very common in children. Its effects usually are mild and once children have had it, they are immune to further infection. However, the virus remains in the body for life. Normally, it lies dormant in some nerve fibers but any decline in the immune system may allow the virus to reappear in adulthood as shingles. In this form, it is a much more serious and debilitating illness.

Shingles can affect adults at any age but the likelihood of an outbreak increases with age. Re-activation is common in elderly people and in people whose immune system has become weakened. The immune system may be weakened by:

• Illnesses, especially AIDS
• Chemotherapy treatment for cancer
• Radiation therapy
• Drug treatment after organ transplants
• Periods of increased stress
• Excessive alcohol intake

What are the common symptoms and complications of shingles?

The first symptom to appear is a general sensitivity or burning sensation on the skin in the affected area. After a few days, a rash begins to erupt. It appears as a band, following the route of a nerve under the skin. At first, the rash consists of small red spots and a general reddened skin below; the spots then grow into blisters. The blisters dry after a few days become crusted and gradually form scabs. Once the scabs have fallen off, a small pock-mark may be left.

Shingles is often a very painful condition. As the virus damages the nerves, the pain may continue after the rash has cleared, sometimes lingering for weeks, months or even years.

Shingles during pregnancy can be particularly serious. Pregnant women suffering from chicken pox or shingles run a higher than normal risk of contracting pneumonia. In some cases, an unborn child exposed to Varicella zoster can be damaged or may be miscarried.

Encephalitis (inflammation of the brain) is a rare complication of shingles. It is very serious and requires emergency treatment. The symptoms include:

• High fever
• Mental confusion
• Loss of memory
• Tiredness or exhaustion

How to recognize shingles

No test is needed to diagnose shingles as it is an easily recognizable skin disease. However, if the doctor is unsure, a test to identify the Varicella virus can be performed and antibody levels measured in the blood.

Medication

All cases of shingles should be seen by a doctor. The severity and duration of an attack of shingles can be significantly reduced by immediate treatment with antiviral drugs. The earlier the treatment begins the more effective it is. These Antiviral drugs can be taken to combat the disease in its most active stage. They can also be taken to prevent an infection in people with a weak immune system. They will help control the rash and minimize the damage to the nerves, thus reducing the likelihood of lingering pain. Pain relieving drugs may also help.

Managing the effects of shingles

Although there is no cure for shingles, the symptoms can be controlled, especially if treated at an early stage before the blisters begin to appear. Shingles can be very painful and itchy, it is not generally dangerous to healthy individuals and it usually resolves without complications. The rash and pain usually go away within 3 to 5 weeks. Most attacks resolve spontaneously, but there may be lingering pain, especially in the elderly, which should be discussed with a doctor. Persons with shingles on the upper half of the face should seek medical attention immediately as the virus may cause serious damage to the eyes. Most people who have shingles have only one bout with the disease in their lifetime.

The National Institute of Neurological Disorders and Stroke is currently conducting research aimed at developing new treatments for and preventing the painful conditions of shingles.

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