Shingles

Shingles is a skin condition which is caused by the varicella-zoster virus and results in a fever, severe pain and a skin rash. You certainly know about it if you contract this viral infection which is one of the most painful skin conditions.

Shingles is basically, a viral infection in a nerve and the surrounding area which causes itching and intense pain.

Is shingles common?

Around 3 out of 1,000 people in the UK develop shingles each year www.nhs.uk/conditions/shingles.

It can develop in people of all ages but mainly affects middle aged and elderly people. Less likely to develop in children and young adults.

Why is this? One theory is that older people especially the elderly have less effective immune systems which increase their risk of diseases and infection. Plus anyone with a weak immune system due to conditions such as HIV/AIDS.

If you are taking certain types of medication such as corticosteroids or drugs to treat rheumatoid arthritis then these also dampen down your immune system.

Stress is another factor.

Causes of shingles

Shingles is caused by the same virus which is responsible for chickenpox. Most people get chickenpox as children which leave them with lifelong resistance to further outbreaks. The virus remains in a dormant state after the initial outbreak and is kept there by the immune system. But it reactivates later on in life but as shingles rather than chickenpox.

It is reactivated by stress, a poorly functioning immune system or if you have undergone a bone marrow/organ transplant. Age is another factor particularly anyone aged 80 or over who often develop shingles.

Symptoms of shingles

The first sign of a shingles is a burning or tingling feeling in the side of your face or waist which is followed by pain and an itchy rash. It commonly affects the nerves in the upper part of the face or the chest/abdomen although any part of the body can be affected.

These symptoms appear 4 days before the appearance of the rash. They are accompanied by fatigue, muscle pains, fever and a feeling of being under the weather.

These are then followed by pain, often intense, in a nerve (or nerves) within an area of the face or body. This pain varies from a dull throbbing ache to a sharp, stabbing pain. This pain comes and goes and the affected skin is sore and tender to the touch.

This pain affects older rather than younger people.

The rash then develops which takes the form of red blotches which turn into itchy blisters. This rash develops on one side of the body only and around the infected nerve.

These blisters then dry out and develop a crust. They may leave some scarring although this is mild.

Diagnosing shingles

As soon as you experience the first symptoms of shingles then visit your GP. Do this sooner rather than later.

This is particularly important if you are elderly or have a weakened immune system. Or if you are pregnant.

Your GP will diagnose shingles by looking at the rash and hearing about your symptoms. He/she will refer you to a specialist if they feel that you are at risk of complications such as uveitis (inflammation within the eye) or postherpetic neuralgia (severe nerve pain).

You will also be referred if a diagnosis is uncertain: this will depend upon the extent of your shingles. For example, if you are the parent of a child with shingles then you will see a paediatrician.

But if you have a weak immune system or an existing condition which has affected your immune system then you will require careful monitoring. Another situation where a referral is needed is if the condition has affected your movement or bowel/bladder control.

Treatment for shingles

Shingles cannot be cured but it is treatable. Treatment involves dealing with the rash as well as easing the pain.

Skin rash

The skin rash is treated with calamine lotion which is applied to the infected area. Antihistamines can also help. Both of these will ease the itching.

If blisters have formed then cover these with a non-adhesive dressing. Keep the infected areas clean and dry and wear loose cotton clothing.

Ask your GP or pharmacist for advice before you use any medication to ease the rash.

Painkillers

Over the counter painkillers such as paracetamol will deal with the pain caused by shingles. Paracetamol is available over the counter from your local pharmacist but other painkillers such as anti-depressants are available on prescription only.

These also include opioids, anticonvulsants and non-steroidal anti-inflammatory drugs (NSAIDs).

Antiviral medication

This reduces the severity of the symptoms and prevents further spread of the infection. But it does not kill the shingles virus. It is more effective when taken in the first few days before the rash develops.

But it may be prescribed if you are at risk of complications. This also applies to people over the age of 50 and/or with a poorly functioning immune system.

Complications of shingles

These can occur in elderly people or if you have lowered immunity. They include:

  • Encephalitis (inflammation of the brain)
  • Transverse myelitis (swelling of the spinal cord)
  • Loss of pigment in an area of the rash (causes white patches)
  • Infection

Another risk if ophthalmic shingles which affects the cornea of the eye and causes redness and inflammation within the inner part of the eye, e.g. iris.

Ramsay Hunt syndrome is another complication although less well known. It occurs if shingles develops in certain nerves within your head and causes vertigo, tinnitus, earache, hearing loss and paralysis on one side of the face.

Another common complication is postherpetic neuralgia which develops in elderly sufferers. It presents as a severe burning or stabbing pain in the nerve which develops several months after shingles has cleared up.

Peripheral motor neuropathy is another complication which affects elderly sufferers. It is damage to a nerve usually a nerve which is responsible for movement, e.g. arm or leg. This causes paralysis but a full recovery is possible.

Preventing the spread of shingles

Shingles is not contagious but it is possible to transmit this to someone who has never had chickenpox which means that they have no immunity to this disease.

Do not share towels, clothes or bedding; avoid contact sports and swimming. And avoid contact with pregnant women, newborn babies or people with a weakened immune system.