When the virus becomes active again, you may get symptoms such as rash, upset stomach, headache, fever, and chills. These symptoms are often preceded by warning signs (the prodrome) such as sensitivity, itchiness, numbness, or pain in the days before the rash appears. The rash produces painful, fluid-filled blisters, and you’ll feel tingling or burning sensations.
When the varicella-zoster virus enters its “quiet” phase after chickenpox, it remains dormant in certain nerves. The shingles rash will break out in the areas of the body connected to those nerve cells. As a result, only one section or one side of the body is often affected. Common sites for the rash include the chest, back, buttocks, neck, and sometimes the face and scalp.
The most common complication of shingles is postherpetic neuralgia. This occurs when the nerve pain associated with shingles persists beyond one month, even after the rash is gone. It is a result of irritation of the nerves of sensation by the virus. The pain can be severe and debilitating. Postherpetic neuralgia occurs primarily in people over the age of 50 and affects 10%-15% of people with shingles. There is evidence that treating shingles with antiviral agents can reduce the duration and occurrence of postherpetic neuralgia.
The pain of postherpetic neuralgia can be reduced by a number of medications. Tricyclic antidepressant medications (amitriptyline [Elavil] and others), as well as antiseizure medications (gabapentin [Neurontin], carbamazepine [Tegretol], pregabalin [Lyrica]), have been used to relieve the pain associated with postherpetic neuralgia. In 2012, the FDA approved the use of gabapentin enacarbil (Horizant), previously used for the management of restless legs syndrome, for the treatment of postherpetic neuralgia. Capsaicin cream (Zostrix), a derivative of hot chili peppers, can be used topically on the area after all the blisters have healed, to reduce the pain. Lidocaine pain patches (Lidoderm) applied directly to the skin can also be helpful in relieving nerve pains by numbing the nerves with local lidocaine anesthetic. These options should be discussed with your health care professional.
Chickenpox must be prevented in order to prevent shingles. A vaccine for chickenpox is now available and it is hoped that immunized individuals will be less likely to develop shingles in later life.
The risk of spreading shingles is low if the rash is covered. People with shingles should keep the rash covered, not touch or scratch the rash, and wash their hands often to prevent the spread of shingles. Once the rash has developed crusts, the person is no longer contagious.
Yes. A single dose of herpes zoster vaccine called Zostavax is recommended for adults 60 years of age and older whether or not they report a prior episode of shingles. Zostavax does not treat shingles or post-herpetic neuralgia (pain that persists after the rash resolves) once it develops.
Shingles is not usually dangerous to healthy individuals although it can cause great misery during an attack. Anyone with shingles on the upper half of their face, no matter how mild, should seek medical care at once because of the risk of damage to the eye. Very rarely, shingles can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis) or death. For about one person in five, severe pain can continue even after the rash clears up. This pain is called post-herpetic neuralgia. As people get older, they are more likely to develop post-herpetic neuralgia, and it is more likely to be severe.
A person must have already had chickenpox in the past to develop shingles. A person can not get shingles from a person that has it. However, the virus that causes chickenpox and shingles can be spread from a person with active shingles to a person who has never had chickenpox or been vaccinated through direct contact with the rash. The person exposed would develop chickenpox, not shingles. The virus is not spread through sneezing, coughing or casual contact. A person with shingles can spread the disease when the rash is in the blister-phase. Once the rash has developed crusts, the person is no longer contagious. A person is not infectious before blisters appear or if pain persists after the rash is gone (post-herpetic neuralgia).
Anyone who has recovered from chickenpox may develop shingles, including children. However, shingles most commonly occurs in people 50 years old or older. The risk of getting shingles increases as a person gets older. People who have medical conditions that keep the immune system from working properly, like cancer, leukemia, lymphoma, and human immunodeficiency virus (HIV) infections, or people who receive drugs that weaken the immune system, such as steroids and drugs given after organ transplantation, are also at greater risk to get shingles.
When the itchy red spots of childhood chickenpox disappear and life returns to normal, the battle with the virus that causes chickenpox seems to be won. But for all too many of us this triumph of the body’s immune system over the virus that causes chickenpox is only temporary. The virus has not been destroyed, but lays low, ready to strike again later in life. This second eruption of the chickenpox virus is the disease called shingles.
“I was having exams at college and I got a rash in a band around my waist. I first thought it was chickenpox, but I’d had that years before and instead of itching, this time the spots were very painful,” recalls a young woman who had shingles in her twenties.
The young woman’s memory was correct. She had had chickenpox as a child. You cannot develop shingles unless you have had an earlier bout of chickenpox, and everyone who has had chickenpox is at risk for shingles. The woman had the typical symptoms of shingles, this common neurological disorder: more pain compared to chickenpox but less itching. Her age was unusual, however. While young people do develop shingles, the disease most often strikes in later years.
Scientists call the chickenpox/shingles-causing agent varicella-zoster. Varicella is a Latin word meaning “little pox” to distinguish the shingles virus from smallpox, the highly contagious and often fatal scourge that disfigured or killed millions of people, especially during the Middle Ages. Zoster is the Greek word for “girdle”; shingles often produces a girdle of blisters or lesions around the waist. This striking pattern also gives the disease its common name: the word shingles comes from cingulum, the Latin word for belt or girdle.
About 10 percent of normal adults can be expected to get shingles during their lifetimes, usually after age 50. The incidence increases with age so that shingles is 10 times more likely to occur in adults over 60 than in children under 10. Most people who get the condition develop immunity to the shingles virus and will not get the disease again, however, shingles may recur in some individuals. These cases usually involve people with declining or compromised immune systems, such as those infected with HIV or receiving chemotherapy.
A person who is suffering from a disease that damages the immune system, or who is taking anticancer drugs that suppress the immune system, is a prime candidate for an attack of shingles. Even among healthy individuals, temporary depression of the immune system because of stress, a cold, and even sunburn may be associated with an attack of shingles.
Youngsters whose mothers had chickenpox late in pregnancy — 5 to 21 days before giving birth — are also vulnerable to shingles. Sometimes these children are born with chickenpox or develop a typical case within a few days (see section entitled “Do Women Have Special Risks from Shingles” for more information).
As early as 1909 a German scientist suspected that the viruses causing chickenpox and shingles were one and the same. In the 1920′s and 1930′s the case was strengthened. In an experiment, children were inoculated with fluid from the lesions of patients with shingles. Within 2 weeks about half the children came down with chickenpox. Finally in 1958 detailed analyses of the viruses taken from patients with either chickenpox or shingles confirmed that the viruses were identical.
This study also proved that a person with shingles can pass the virus to individuals who have never had chickenpox, but these individuals will develop chickenpox not shingles. A person with chickenpox cannot communicate shingles to someone else. In order for people to develop shingles they must already harbor the virus in their nervous system, and for those who do harbor the shingles virus, having contact with someone with chickenpox will not trigger shingles. Additionally, a person with shingles cannot communicate shingles to another individual.