Shingles (Herpes Zoster)

Shingles, also called herpes zoster, is a disease caused by the varicella-zoster virus, which is the virus that causes chickenpox.

General information
Shingles occurs in people who have had chickenpox and represents a reactivation of the dormant varicella-zoster virus.

The disease generally affects the elderly, although it occasionally occurs in younger and/or immunodeficient individuals, especially under times of severe stress. The first sign is usually a tingling feeling, itchiness, or stabbing pain on the skin. After a few days, a rash appears as a band or patch of raised dots on the side of the trunk or face. The rash develops into small, fluid-filled blisters which begin to dry out and crust over within several days. When the rash is at its peak, symptoms can range from mild itching to extreme and intense pain. Contact with a person with shingles may cause chickenpox (but not shingles) in someone who has never had chickenpox before. This rash is generally limited to one dermatome on the body, which explains its confined appearance.

Treatment
Treatment for shingles includes antiviral drugs, steroids, antidepressants, anticonvulsants, and topical agents. The severity and duration of an attack of shingles can be significantly reduced by immediate treatment with the antiviral drugs acyclovir, valacyclovir or famcyclovir. An antiepileptic gabapentin and a transdermal anaesthetic lidocaine are often used as the first-choice treatments in the postherpetic neuralgia.

Prognosis
Although 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 subside within 3 to 5 weeks. Sometimes serious effects including partial facial paralysis (usually temporary), ear damage, or encephalitis may occur. 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. However, individuals with impaired immune systems, i.e., people with AIDS or cancer, may suffer repeated episodes.

The long term complication is the post-herpetic neuralgia that may cause persistent pain that lasts for years.

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