SHINGLES

Have you had chickenpox before? If yes, then there’s a good chance the virus is still at large in your body which increases your risk of having shingles.

What is Shingles?

Shingles (a.k.a herpes zoster) is a viral infection characterized by painful skin rashes with blisters. Most often than not, the rash is usually localized as a single stripe that wraps around either the left or the right side of body or face.

What causes Shingles?

Shingles result from the reactivation of varicella-zoster virus (VZV) after chickenpox infection.

Only those who have previously had chickenpox can have shingles later in life. With that notwithstanding, those who have received the varicella vaccine rarely develop shingles later in life.

After treatment of chickenpox, the virus may remain inactive in peripheral nerve cells. It can remain there for decades without showing symptoms.

When it reactivates, it travels from the nerve body to the endings in the skin, producing blisters. The immune system eventually eliminates the virus from most locations, but it remains dormant in the ganglia adjacent to the spinal cord (called the dorsal root ganglion) or the trigeminal ganglion in the base of the skull.

What causes the reactivation is unknown but there are some risk factors such as old age, poor immune function, and having had chickenpox before 18 months of age.

Blisters of shingles almost always appear on a strip of the skin over the infected nerve usually on one side of the body. This strip of skin, the area supplied by nerve fibres from a single spinal nerve region, is called a dermatome.

How do shingles spread to another person?

Shingles cannot be spread from one person to another.

However, the varicella-zoster virus can be spread by direct contact with fluid from the blisters of a person with shingles at the active stage with someone who has never had chickenpox.

In these cases, the infected person would develop chickenpox, not shingles.
Note that, before the blisters develop and after the crusts form, the person is said not to be contagious.

What are the signs and symptoms of shingles?

1. Usually, the first symptom before the blisters is a pain. During the 2 or 3 days before shingles develop, most people may have tingling, burning, or itching sensation on a strip of skin.
2. This is followed by a red rash.
3. Development of a stripe of blisters that wraps around one side of the body especially the trunk. Sometimes blisters can occur around one eye or on one side of the neck or face.
4. Itching.

Some people also experience:

1. Fatigue
2. Fever
3. Headache
4. Swollen glands (lymph nodes)

How Long Does Shingles Last?

Shingles blisters usually scab over in 7-10 days and disappear completely in about two to four weeks. In most healthy people, the pain and blisters disappear early leaving no scars. In contrast, people with weakened immune systems may develop shingles blisters that do not heal early.

Who is at risk?

Anyone who has ever had chickenpox can develop shingles.

However there are some factors that increase the risk, and they are;

• Ageing. Shingles are more common in people older than 50years old. Some experts estimate that about half the world population over 80 years will develop shingles.
• Immunocompromised. Conditions that weaken your immune system, such as HIV/AIDS and cancer increase the risk of developing shingles.
• Certain medications. Chemotherapy for cancer patients, prolonged use of steroids, etc.

How to diagnose shingles?

1. Shingles can be diagnosed clinically by the patient’s presenting symptoms and clinical history.
2. Blood test for VZV-specific IgM antibody. This appears only during chickenpox or shingles but not while the virus is dormant and asymptomatic.
3. Rarely, samples from the blisters are taken for analysis or skin biopsy is done to confirm the diagnosis.

 

 

What are the complications of shingles?

Though shingles often resolve without any major complication, there are several potential complications that can arise from shingles if left untreated. These include;

1. Postherpetic neuralgia (PHN):

This is the most common complication of shingles. For some people, shingles pain continues long after the blisters have resolved. This condition is known as postherpetic neuralgia, and it occurs when damaged nerve fibers send confused and exaggerated messages of pain from your skin to your brain. It rarely occurs in people under 40 years of age but common in people above 60 years.

2. Ophthalmic shingles:

Shingles in or around the eye can cause painful eye infections that may result in vision loss.

3. Neurological disorder:

Depending on which nerves are affected, shingles can cause an inflammation of the brain (encephalitis), facial paralysis, or hearing loss. This results in a syndrome known as Ramsay Hunt syndrome.

4. Skin infections:

If shingles blisters are left untreated, bacterial skin infections may develop and result in serious skin infection.

How to prevent shingles?

The main prevention measure is vaccination. Vaccination is in two forms, which include:

• The chickenpox (varicella) vaccine and
• The shingles (varicella-zoster) vaccine.

Chickenpox vaccine

The varicella vaccine (Varivax) is a routine childhood immunization to prevent chickenpox. It is also recommended for adults who’ve never had chickenpox.

Shingles vaccine

Examples of shingles vaccine are; Zostavax and Shingrix.

• Zostavax, which was approved by the Food and Drug Administration (FDA) in 2006, is a live attenuated vaccine which provides protection against shingles for about five years. Zostavax isn’t recommended until age 60.

• Shingrix is the preferred alternative to Zostavax and was approved by the FDA in 2017. Shingrix a nonliving vaccine made of a virus component and offers protection against shingles beyond five years.

The most common side effects of the shingles vaccine are pain, tenderness, swelling, redness and itching at the injection site, and sometimes headaches.

How to manage shingles

There’s no cure for shingles, but early diagnosis and treatment with antiviral drugs can speed healing and reduce the risk of complications.

These antiviral medications include:
• Acyclovir (Zovirax).
• Valacyclovir (Valtrex).

Other supportive management may be needed depending on the presenting symptoms.

• Pain management.
• Steroids.

Patients are advised not to scratch lesions to reduce the risk of transmission and also increase healing time.

Avoid physical contact with other people, particularly immunocompromised people and infants aged under one year to decrease transmission.

Avoid creams or dressing that will cause irritation.

Studies have it that adult with latent shingle infection who are exposed intermittently to children with chickenpox receive an immune boost. This periodic boost to the immune system helps to prevent the development of shingles in older adults.

Epidemiology

Rate of developing Shingles usually increases with age ranging from about 1.2 to 3.4 per 1,000 person‐years among younger healthy individuals, increasing to about 3.9–11.8 per 1,000 person‐years among those older than 65 years.

According to a study in North Carolina, “black subjects were significantly less likely to develop zoster than white subjects.”

There is no strong evidence for a link to family history. A 2008 study showed that people with close relatives who had shingles were twice as likely to develop shingles themselves, but a 2010 study found no such link.

In one study, it was estimated that 26% of those who contract shingles eventually developed complications. Postherpetic neuralgia arises in approximately 20% of people with shingles. A study of 1994 California data found hospitalization rates of about 2.1 per 100,000 people/years, rising to about 9.3 per 100,000 people. Among these were years for ages 60 and up.