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More InDepth Information on This Condition
Definition
| Causes
| Risk Factors
| Symptoms
| Diagnosis
| Treatment
| Prevention
Definition
Shingles is a painful infection of the nerves and skin.
Risk Factors
These risk factors increase your chance of developing shingles. Tell your doctor if you have any of these risk factors:
- Age: 50 or older
-
Compromised immune system:
- Excessive fatigue
- Physical or psychological stress
- Radiation therapy
Shingles can occur in those with no known risk factor other than age.
Shingles cannot be transmitted from one person to another. But, a person who has never had chickenpox and never received the
varicella
vaccine
could get chickenpox if he came in contact with a person who has shingles.
Symptoms
If you have any of these symptoms do not assume it is due to shingles. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
-
Rash:
- Red, slightly raised band or patch often overlain with multiple small fluid-filled blisters
- Develops on one side of the body or the other, but typically does not cross the midline
- Spread to multiple parts of the body—the so-called “disseminated” zoster (in severe cases)
- Blisters dry out and crust (within several days)
- Affects mostly the torso and face
- Affected eyes (in severe cases), which can seriously threaten vision
- Pain on the skin at the site of the rash (usually severe)
- Tingling or itchiness on the skin, which may start a few days before the rash
- Skin in the affected area is unusually sensitive to touch
- Fever
- Headache
- Tiredness
The rash disappears within three weeks. The pain may continue months or years after the rash has healed. This is called
postherpetic neuralgia (PHN). PHN pain is difficult to treat. It can also be very severe.
Diagnosis
The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor can diagnose the rash by its appearance. Fluids may be drawn from the blisters for testing but this is rare.
Treatment
Shingles cannot be cured. Treatment is focused on:
- Easing symptoms
- Speeding recovery
- Preventing PHN
Itch and Pain Relief
Itching may be relieved by:
- Calamine lotion
- Wet compresses
- Frequent oatmeal baths
Over-the-counter pain relievers:
Your doctor may prescribe drugs to relieve pain that doesn't respond to over-the-counter remedies.
Antiviral Drugs
Certain antiviral medications may control shingles by changing how the virus reproduces in nerve cells. They include:
Antiviral therapy may shorten a shingles episode. But you must start it within 48-72 hours after symptoms first develop. These medications can reduce the severity and duration of PHN. They are for patients with the highest risk for this condition (ie, over 55).
Steroids
Your doctor may also prescribe a short course of oral steroid medication (eg,
prednisone
) if your immune system is functioning normally.
Postherpetic Neuralgia
Taking antiviral medications before PHN develops is the most effective way to reduce its severity.
A variety of other treatments are available:
- Capsaicin
-
Tricyclic antidepressants (may also treat shingles)
- An SSRI (selective serotonin reuptake inhibitor) may also be prescribed.
-
Lidoderm patch—a transdermal form of
lidocaine
(local anesthetic)
- Gabapentin
—an anti-seizure medication (also treats PHN)
- Pregabalin
—approved for PHN
- Transcutaneous electrical nerve stimulation (TENS)—a device that generates low-level pulses of electrical current on the skin's surface
- Nerve blocks—injections near nerves to provide temporary pain relief (used as a last resort)
Prevention
There is no proven way to prevent shingles. Stress and fatigue may contribute to an outbreak. Future cases of shingles should decrease as more children are vaccinated.
The US Food and Drug Administration approved a vaccine (Zostavax) for people over 60 who have had chickenpox. The vaccine decreases the likelihood of getting shingles and the severity if shingles does occur.
Last reviewed August 2010 by David L. Horn, MD, FACP
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