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All About Shingles

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Updated June 09, 2014

Shingles is a painful rash that is more common after age 60. It is caused by a reactivation of the same virus that causes chickenpox.

The following are some quick facts about shingles:

  • The lifetime risk of shingles is 10% to 20%.
  • In the United States, approximately 300,000 to 600,000 cases are reported yearly.
  • Less than 5% of the cases occur in children under 14 years of age.
  • The most important risk factor for the developing shingles is increasing age.
  • A well-defined risk factor is a compromised immune system.

Shingles and Chickenpox?

The rash of shingles is caused by a reactivation of the varicella-zoster virus. This is the virus that causes chickenpox. After a person has been infected with the varicella virus, the virus travels back into the body and waits. For various reasons, the virus can reactivate, travel down the nerve to the skin, and cause the shingles rash.

Causes of Shingles

Conditions that can reactivate the varicella virus and cause shingles include:
  • Illness
  • Trauma
  • Bereavement
  • A suppressed immune system
  • HIV infection
  • Cancer - especially leukemia or lymphoma
  • Drugs that suppress the immune system including steroids
  • Chemotherapy
  • Organ transplant

Appearance of Shingles

The first symptoms of shingles are usually itching, tingling, or significant pain with just a light touch. This pain occurs on one side of the body in a band-like area called a dermatome. During this time, people often experience headache, sensitivity to light, and fatigue, but rarely fever. One to five days later, the rash starts as an area of redness that progresses quickly to clusters of fluid-filled blister. These blisters can continue to form for three to five days. The blisters fill with pus, pop, and then crust over. It usually takes two to four weeks for the blisters to heal. Scarring and skin discoloration often occur.

Diagnosis of Shingles

Shingles is often diagnosed based on the appearance of the rash when it is typical. If it is difficult to diagnose, specialized tests might be performed.

Contagiousness of Shingles

Someone who has never been exposed to chickenpox can get it if in close contact with someone who has shingles.

Complications of Shingles

There are many potential complications of shingles, but the most well-known and feared is postherpetic neuralgia, which causes pain for a year or more after the shingles rash is gone.

Treatment of Shingles

Treatment of shingles involves antiviral therapy and often corticosteroids to reduce inflammation.

Prevention of Shingles

In fall 2006, the FDA approved a vaccine called Zostavax to reduce the risk of shingles in people ages 60 and over.

Sources:

Finch, Roger, Dennis Maki, Allan Ronald. "Varicella-Zoster Virus Infections." Infectious Diseases, 2nd edition. Ed. Jonathan Cohen, et al. New York: Mosby, 2004. 125-9.

Gnann, John, and Richard Whitley. "Herpes Zoster." The New England Journal of Medicine 347(2002): 340-6.

Stalkup, Jennifer, et al. "Human Herpesviruses." Dermatology. Ed. Jean L Bolognia, MD, et al. London: Mosby, 2003. 1241-4.

Thomas, Sara, and Andrew Hall. "What does epidemiology tell us about risk factors for herpes zoster?." The Lancet 4(2004): 26-33.

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