CONDITIONS

Zoster (Varicella) virus

ZOSTER (VARICELLA) VIRUS

The varicella-zoster virus causes chicken pox and shingles. Shingles is characterized by a painful, burning rash accompanied by nerve pain. Shingles can only be caused by previous exposure to the varicella-zoster virus, the virus that causes the chickenpox. Once introduced into the body, the varicella-zoster virus remains dormant in the body for the rest of a person’s lifespan, even if treatment for the initial infection was successful. A weakened immune system can allow the virus to re-activate itself, causing the characteristic burning rash of shingles.

Unlike chickenpox, shingles is not contagious. A person with shingles can only pass the varicella-virus on to a young individual who has never been exposed to the virus before. That individual will develop chickenpox, not shingles. An estimated 25% of the adult population will develop shingles during their lifespans. Shingles usually occurs in individuals over the age of 50 or in younger individuals with an otherwise compromised immune system. As age increases, so does the severity of the symptoms. According to the National Institute of Health, the “burden of illness” is double among individuals greater than 70 as compared to those 60-69 years old.

A variety of treatments are available to help lessen the severity of shingles symptoms, but there is currently no cure. Most adults affected by shingles will make a full recovery, though many will develop a condition known as post-herpetic neuralgia (PHN), which results in persistent nerve pain lasting months or years after the initial rash.

What Causes Zoster (Varicella) virus

The varicella-zoster virus causes shingles, the same virus responsible for the childhood illness known as the chickenpox. The body never fully rids itself of the varicella-zoster virus even after the initial chickenpox infection subsides; the virus lay dormant in the body for the remainder of a person’s lifetime. When the immune system is significantly compromised or the body is under stress, the varicella-zoster virus can reactivate. This causes the burning and painful rash we know to be shingles.

The damage done by the varicella-zoster virus to nerves is what causes postherpetic neuralgia (PHN), lasting pain after the initial shingles rash.

Risk Factors For Zoster (Varicella) virus

The following factors affect your risk of developing Shingles:

  • Shingles mainly occurs in individuals over the age of 50.
  • Previous exposure to the chickenpox virus. Shingles can only occur in those who have had previous exposure to varicella-zoster, the chickenpox virus.
  • Immune health. HIV/AIDS patients or those with severely compromised immune systems are at a much higher risk of developing shingles.
  • Exposure in utero. Infants whose mothers were infected with the chickenpox virus during the late stages of pregnancy are at an increased risk of pediatric shingles, a rare form of the disease.

Diagnosing Zoster (Varicella) virus

In most cases, shingles can be diagnosed with a simple physical exam and medical history. The lesions are characteristic enough that most physicians will be able to easily recognize them without further testing.

In cases where shingles does not present itself in the typical way, or in cases with special circumstances, doctors may take a scraping of the affected tissue and sending the sample to a laboratory to be analyzed. The laboratory will be able to check for antibodies against the varicella-zoster virus, the presence of which indicates shingles.

Symptoms of Zoster (Varicella) virus

he signs and symptoms of shingles usually affect only a small section of one side of your body.

 

These signs and symptoms may include:

  • Pain, burning, numbness or tingling
  • A red rash that begins a few days after the pain
  • Fluid-filled blisters that break open and crust over
  • Itching

Some people also experience:

  • Fever and chills
  • General achiness
  • Headache
  • Fatigue

Pain is usually the first symptom of shingles. For some people, it can be intense. Depending on the location of the pain, it is sometimes be mistaken for a symptom of problems affecting the heart, lungs, or kidneys. Some people experience shingles pain without ever developing the rash.

Most commonly, the shingles rash develops as a stripe of blisters that wraps around either the left or right side of your torso. Sometimes the shingles rash occurs around one eye or on one side of the neck or face.

Prognosis

Many cases of shingles resolve themselves in 2-3 weeks. More stubborn cases may require a longer period of healing time or intervention with anti-viral medications. The pain during this period can be mild or severe. Many people report lingering nerve pain after the rash has subsided, lasting up to several months or years (known as postherpatic neuralgia, or PHN).

Living With Zoster (Varicella) virus

The following tips can help make living with shingles easier:

  • Talk to a doctor about all treatment options. Choosing the right treatment option can help you limit the progression of your symptoms.
  • Consider pain management therapy if you suffer from post-shingles nerve pain known as postherpatic neuralgia. Learning to manage your pain can lessen the effect it has on your personal life and relationships.
  • Avoid possible skin irritants like hot showers, cold weather, wind, and cold water. These may potentially worsen your shingles rash.
  • Resist scratching and picking at your rash. This can interfere with the healing process of the skin, causing the rash to last longer and potentially result in permanent scarring.
  • Try not to pass on the virus. People infected with shingles can pass on the virus to young children and those who have not yet been exposed to the chicken pox virus.
  • Join a support group. There are more than a million Americans suffering from shingles at any given time. Sharing with others who have your condition can help you better adapt to living with shingles.

Screening

Shingles is not regularly screened for because symptoms develop quickly and are relatively recognizable. If you feel that you are experiencing any of the symptoms of shingles, call your doctor.

Prevention

Fortunately, there are available vaccines against the varicella-zoster virus that can decrease the likelihood of developing shingles:

  • The chickenpox vaccine. This vaccine, given to most US children between 18 months and adolescence, helps protect against childhood chickenpox and also against shingles later in life. This is because the virus introduces a weaker form of the virus which is less likely to become active again in the body later in life.
  • The shingles Vaccine. The shingles vaccine is approved by the FDA for use by people ages 50 and over who have had the chickenpox. It has been shown to reduce the frequency of shingles by 50%.

Common Treatment

Treatment for shingles is most effective when begun in the early stages of the disease. Available treatment options include:

  • Oral antiviral drugs. Antiviral drugs work by stopping the proliferation of the virus. These are fairly effective in stopping the progression of singles and have been shown to reduce the risk of postherpatic neuralgia by 50%. Popular oral antiviral drugs used to treat shingles include:
  • Acyclovir
  • Valacyclovir
  • Famiciclovir
  • Oral corticosteroids. Oral corticosteroids can help to decrease swelling and inflammation in areas that are difficult to treat topically, such as the eyelids.
  • Painkillers, such as acetametaphine, ibuprofen, and aspirin, which can help reduce shingles-related pain.
  • Topical antibiotics, to prevent the rash from becoming infected.
  • Topical anti-inflammatory creams, to help ease itching and pain. These creams often include capsasin or lidocaine.

Treatment for postherpetic neuralgia may include:

  • Nerve blocks, powerful pain-killing injections of an anesthetic or corticosteroid
  • Antidepressants, such as amitriptyline.

Opioids, such as tramadol, codeine, oxycodone, and morphine

Complementary and Alternative Treatment

The following treatments may also be helpful in reducing shingles symptoms and pain:

  • Acupuncture, a form of traditional Chinese medicine in which small needles are inserted into the body to restore the flow of bodily energy. Acupuncture has been shown to alleviate both stress and pain symptoms.
  • Transcutaneous electrical nerve stimulation (TENS) therapy, in which an electrical current is run over nerve to treat pain.
  • Mind/body techniques such as Yoga and Tai Chi. These can help control stress, preventing a shingles flare-up and helping to control postherpatic neuralgia pain.
  • Cold or warm compresses on the affected area for 30-60 seconds to help alleviate itching.
  • Turmeric paste. Ayurvedic medicine recommends blending 3 tablespoons of turmeric with 3 cups of water, boiling it into a paste, and then applying it to the affected area.

Care Guide

The following tips can help accelerate your healing process:

  • Eat a healthy, balanced diet. Giving your body the proper nutrition is essential to the healing process.
  • Exercise regularly. Stress can worsen shingles symptoms or trigger an attack. Regular exercise helps to reduce overall stress levels.
  • Start treatment as early as possible. Shingles is most easily treatable when caught early on. Early treatment also is effective in reducing the risk of postherpatic neuralgia.
  • Follow the treatment plan you and your doctor decide on. Stopping the treatment plan before it is due or combining one treatment plan with another can reduce the effectiveness of treatment.
  • Minimize your stress levels. Consider a mind/body technique such as yoga or tai-chi to help manage pain and alleviate stress.

When To Contact A Doctor

If you are experiencing any of the symptoms of shingles, call your doctor as soon as possible. Early treatment is key in managing the disease.

If you are currently being treated for shingles, call a doctor if you experience:

  • Prolonged burning or pain that interferes with the ability to sleep
  • Vomiting
  • Diarrhea
  • Dizziness
  • Visual changes
  • Symptoms that worsen dramatically and rapidly
  • Pain lasts for more than 1 month after the rash clears

Questions For Your Doctor

To find a general practitioner, visit www.healthgrades.com

To find a certified dermatologist, visit The American Academy of Dermatology

To find a neurologist to assist with postherpatic neuralgia nerve pain, visit The American Academy of Neurology

Questions For A Doctor

You may want to ask your doctor the following questions about shingles:

  • How long will it take me to recover?
  • Will I have lasting pain or suffer from postherpatic neuralgia?
  • What treatment options are available?
  • How severe is my case of shingles?
  • What are the side effects for treatment options?
  • Which treatment option is better for me?
  • What can I do to help myself heal faster?
  • Is shingles contagious?
  • Does the shingles medication interfere with any of my current medications/supplements?
  • Is there anything I can do to prevent future flare-ups of shingles?