Herpes Zoster (Shingles)
Herpes zoster, or shingles, is a reactivation of the dormant virus in people who have had chickenpox. Herpes zoster can flare up when our immune system becomes weakened. Advanced age, people with weakened immune systems, bedridden patients, HIV patients, and those with chronic illnesses such as diabetes, SLE, heart disease, kidney disease, cancer, or insufficient sleep, are all at risk of developing the disease. Herpes zoster is common and can affect anyone, regardless of gender or age. We can prevent herpes zoster by being in good health and getting the herpes zoster vaccination.
What causes herpes zoster (Shingles)?
Herpes zoster, or shingles, is due to the reactivation of the varicella-zoster virus (VZR), the causative virus of chickenpox, which became quiescent after recovery from the acute infection. As long as the immunity is strong, the virus remains dormant in the nerve ganglia for decades without manifesting symptoms. However, when immunity is low, reactivation of the latent virus occurs, resulting in nerve inflammation and acute herpes zoster symptoms.
Herpes Zoster and Chickenpox: What is different?
Herpes zoster differs from chickenpox in that the rash or blisters appear in a band or lines instead of dispersing throughout the body as in chickenpox. The rash will only develop along a nerve where the varicella virus hides, starting as redness and progressing to a raised, clear, swollen blister that eventually bursts and flakes off. The most vulnerable regions for herpes zoster are around the waist or along the ribcage on the back, on either side of the face, and in the eyes. Herpes zoster has more severe symptoms than chickenpox and can lead to medical complications if not treated promptly.
What are the symptoms of herpes zoster (Shingles)?
- There is a 1–3-day interval of burning and itching pain along the skin where the red rash later appears.
- Unlike chickenpox, patients with herpes zoster exhibit a red rash and blisters in a band-like distribution, whereas, in chickenpox patients, the blisters disperse widely.
- Herpes zoster patients will experience tingling, sharp pain, or burning pain on the skin. The patient may experience pain from light touch or even the weight of their clothes.
- Blisters follow the rash, rupture, scab over, and eventually drop off.
- The rash might go away in 2 weeks, but the pain in the nerve can persist.
- Some patients may experience herpetic neuralgia without a rash. Anyone experiencing this symptom should seek medical attention as soon as possible for further management.
Additional symptoms of herpes zoster
- Sensitivity to light
What is the complication of herpes zoster (Shingles)?
- Postherpetic neuralgia (PHN): Patients over 50 are more likely to develop postherpetic neuralgia or related nerve pain caused by herpes zoster. Patients will continue to experience pain even after the signs and symptoms of herpes zoster have subsided. Some patients may endure pain for months, years, or even their entire lives. Complications related to herpes zoster can adversely affect the patient's quality of life.
- Zoster Ophthalmicus, Corneal ulcer:Herpes zoster can cause eye inflammation or herpes zoster in the eye if the shingles rash occurs around the eyes. The eye complications are corneal ulcers or retinal inflammation, resulting in eye inflammation, blurred vision, or vision impairment, whereas some patients may experience Ramsay-Hunt syndrome or hemiplegia. As a result, it is vital to consult an ophthalmologist to prevent potential complications.
- Neurological issues: Herpes zoster may result in neurological problems such as facial paralysis, hearing loss, or balance problems.
- Bacterial infection: Herpes zoster can result in secondary bacterial skin infections if improperly handled.
Is herpes zoster contagious?
Herpes zoster, or shingles, is a contagious disease and can be transmitted to those who have never had chickenpox through direct contact with clear blister fluid containing the varicella-zoster virus, particularly those with low immunity, or through inhalation-transmitted shingles. Therefore, patients with herpes zoster should isolate from those who have never had the disease, especially the elderly, young children, or pregnant women.
Is the myth “you will die if herpes zoster wrapped around the body” true?
The myth “you will die if herpes zoster wrapped around the body” is untrue. In some patients, herpes zoster rash can develop simultaneously on both sides of the body, simulating the appearance that it is wrapping around your body, seeming to constrict you and cause death. Most people who die from herpes zoster are secondary to their low immunity and complications that weaken the body and eventually cause death. Patients 50 or over or those with low immunity are most likely to contract it.
Herpes Zoster (Shingles): Treatments and Recommendations
Treatment for herpes zosters is determined by how long the herpes zosters rash persists. If the rash is less than three days, the doctor will prescribe antivirals, such as acyclovir, to help reduce inflammation and pain and aid in the resolution and healing of the rash. The antivirals also aid in the recovery from the disease and reduce the likelihood of herpes zoster complications such as postherpetic neuralgia (PHN). If the rash is more than three days, the doctor will consider other medications in addition to antivirals, including:
- Paracetamol, anti-itch medication, oral or topical antibiotics to relieve itching, pain, and prevent infection.
- Avoid using herbal remedies, inhalers, or any other medications not obtained through a doctor prescription, as it might result in a bacterial infection that exacerbates or slows the healing of the wound and even leave a scar.
- Avoid scratching the wound, trim the fingernails and toenails short to prevent bacterial buildup and stop recurrent bacterial infections.
- Cover any open wounds to keep them from becoming infected.
- Always wash your hands thoroughly and keep them clean regularly.
Herpes zoster (Shingles): Preventions
Herpes zoster is preventable by herpes zoster vaccination, which reduces the chances of getting herpes zoster. In addition, individuals over 50 who have had chickenpox should receive the herpes zoster vaccination to prevent the future development of herpes zoster, including reducing the severity, pain, and chances of complications from the disease. The Herpes zoster vaccine can also be for reducing the chances of contracting herpes zoster as well. The vaccines are as follows:
- Chickenpox vaccine for children aged 12 – 18 months.
- Zoster or Shingles vaccine for adults, of which there are two types:
- Zostavax vaccine, a live attenuated vaccine that reduces the risk of herpes zoster in individuals aged 50 - 59 by 69.8%.
- Shingrix vaccine, a glycoprotein subunit vaccine given in two doses spaced 2–6 months apart, can reduce the risk of contracting herpes zoster by 90 – 97% in individuals aged 50 and up.
Herpes zoster, a vaccine-preventable viral infection
Those who have had chickenpox in the past are always at risk of developing herpes zoster, especially if they are elderly or have a weakened immune system. Herpes zoster can cause an itchy rash and painful blisters, which can have severe complications if left untreated. Those with herpes zoster symptoms should see a doctor as soon as possible for timely and appropriate treatment.
Herpes zoster can be prevented by vaccination, eating healthy foods, getting enough sleep, and exercising regularly to keep the body healthy and maintain the body's natural immunity. Those at risk of contracting herpes zoster can seek insightful advice and get herpes zoster vaccination from a specialist doctor at establishments or hospitals where the vaccine is available.
Dr Siraya Jaijakul
A specialized doctor in infectious disease