Shingles is a fairly harmless, but very painful skin disease. It manifests itself as a red rash and small, fluid-filled itchy vesicles that form a sort of belt. Shingles is most common in the area of the abdomen or waist. It is caused by reactivation of the chickenpox virus.
Cause
People can have shingles from the herpes zoster virus. This is the same virus that causes chickenpox. If a person has had chickenpox, this virus remains inactively present in the body throughout life. Sometimes, the virus can become active again after many years. This usually happens if someone has a poor immune system. Shingles is highly contagious: by having contact with the fluid from the vesicles, a person who has not had chickenpox so far, can get chickenpox. After infection, it takes thirteen to eighteen days before the first symptoms occur.
Symptoms
Shingles causes the following signs and symptoms:
- Itch or pain in a part of the face, torso or limbs.
- Red spots and vesicles emerge after some days. Sometimes few, sometimes dozens. During one week, there may be coming new vesicles. The size of the spots and vesicles can vary.
- The pain can be severe.
- The patient can feel flu-like and have mild fever.
- Sometimes, shingles cause just itch and pain, without spots or vesicles.
- In case of shingles on the face, the eye can get inflamed.
Diagnosis
The diagnosis of shingles can often be based on the clinical picture, how it looks, the typical shape and pain. Some vesicular fluid is sometimes taken to be examined under the microscope or grown on the virus, but usually that’s not needed.
Treatment
In healthy people with not too extensive shingles, it is not necessary to start treatment. Without medication, the shingles disappear on its own after approximately a month. In patients with an impaired immune system, it’s wise to take antiviral drugs. These patients can be seriously ill with fever and general symptoms and should sometimes even be admitted to the hospital for an infusion of antiviral medication.
Also when the infection breaks out around the eye, it’s wise to start with antiviral tablets. The ophthalmologist often examines the eyes and an antiviral eye cream is added to the treatment. If the infection is located around the ear, prednisone is sometimes given to prevent damage to hearing and to the facial nerve.
If necessary, painkillers are prescribed and sometimes creams that prevent the vesicles to be infected with bacteria. A sprinkle powder or an ointment is usually given for the itch.
Severe and painful shingles can be combated with neural therapy (by injection in the lower back). This therapy is intended to reduce swelling of the nerve, to combat acute pain and to prevent the occurrence of a permanent neural inflammation, which may cause symptoms for many years. Neural therapy is given by an anesthesiologist.
There is a vaccine available that halves the probability of having shingles.
Prognosis
Shingles usually resolve on its own in one to two weeks. Afterwards, the skin remains spotty for a few weeks. Shingles usually causes no scars, unless the patient has been scratching. Long-term problems remain occasionally: the site remains spotty or numb or the patient continues to suffer from itch or sometimes severe pain. These residual symptoms mainly occur in the elderly. Rarely, a patient gets shingles for a second time.
Considerations
- Leave the skin alone as much as possible.
- The patient can take a shower or bath.
- To protect the clothes or prevent abrasion, the patient can cover the vesicles with soft wound gauze.
- Wash hands with water and soap after touching the vesicles. The vesicles are contagious until they dry.
- Try to avoid infecting babies, pregnant women and people with severely impaired immune systems. They may be extra ill from shingles.
- In pregnant women who never had chickenpox, the virus can harm the unborn child during the first three months of pregnancy.
