Shingles: What It Is, Causes, Symptoms, and Treatment

Shingles, also known as herpes zoster, is a viral disease that occurs when the varicella zoster virus, which remains dormant in certain nerve roots after chickenpox, is triggered by various factors.

The underlying mechanism of shingles is generally the negative impact on the functioning of the immune system. In individuals with a strong immune system, the development of shingles is a rare occurrence. This condition, which can follow a malignant course, can present with a wide range of symptoms.

What is Shingles?

Shingles is a secondary infection caused by the varicella zoster virus, typically characterized by vesicular lesions confined to a specific area. This virus causes chickenpox in children and other young individuals during the initial infection. After chickenpox resolves, the virus can remain dormant in the nervous system for many years. Shingles occurs when these dormant viruses are reactivated.

Shingles is a disease caused by viruses, characterized by red skin rashes and blisters that lead to pain and a burning sensation.

Symptoms of Shingles

The rashes generally tend to develop on one side of the body, and the most common areas affected are the torso, neck, and face. Shingles cases typically improve within 2-3 weeks.

What Causes Shingles?

Shingles is more common in individuals over 50, but it can occur at any age. Approximately half of people over the age of 80 will experience shingles at least once in their lifetime. The chickenpox vaccine has not reduced the frequency of shingles. Most patients do not have any immune system issues; however, it is more common in people with a weakened immune system.

Although not frequent, shingles can recur. Around 4% of patients will experience a second outbreak. Shingles relapses are more common in individuals with weakened immune systems.

Shingles occurs when the virus that remains dormant after a previous chickenpox infection is reactivated. This reactivation causes localized inflammation and a rash in the skin area corresponding to the affected nerve. Pain is felt through the nerve cells that are affected by the inflammation.

There are several factors that may trigger shingles:

Emotional stress
Diabetes (Sugar disease)
Use of immune-suppressing medications (e.g., corticosteroid treatment)
Chronic conditions
Underlying cancer
Radiation therapy and surgical interventions

The exact cause for recurrent shingles is not fully understood, but it is believed that various conditions affecting the immune system are one of the most significant contributing factors. Individuals receiving chemotherapy or radiation (radiation therapy) for cancer treatment, people living with HIV/AIDS, organ transplant recipients using immunosuppressants, and those taking high doses of corticosteroids are among the groups most at risk for shingles due to the negative impact on their immune system.

In healthy individuals, shingles is usually localized to a specific area and is less painful, while in older adults and those with weakened immune systems, the disease tends to be more severe.

What Are the Symptoms of Shingles?

Shingles initially presents with symptoms such as fever, headache, and fatigue. Before the rash appears in the affected area, there may be abnormal skin sensations like itching, tingling, and sometimes pain. These symptoms can be mistaken for conditions causing pain, such as muscle pain, heartache, kidney pain, appendicitis, or migraines. Within 3-5 days, painful, swollen, red bumps appear, followed shortly by small fluid-filled blisters grouped together. A burning sensation is common in these rashes.

In younger individuals, the thoracic region (upper part of the torso) is commonly affected, while in older women, the sacral area (tailbone) is often involved, and in older men, the area around the eyes may be affected.

The pain accompanying the lesions is often described as sharp or stabbing. In younger individuals, the pain is mild, and sometimes it may not be present at all. In older individuals, pain is almost always present and can be intense.

In individuals with a normal immune system, all lesions usually resolve within 2-4 weeks. The healing lesions typically leave no scars. Pain usually resolves as the rash heals. However, sometimes persistent and chronic pain known as postherpetic neuralgia may develop. In such cases, treatments recommended by neurologists or pain specialists may be beneficial.

Risk Factors for Developing Postherpetic Neuralgia:

Advanced age
Intense pain before or at the onset of the rash
Severe rash
Involvement of the head and tailbone areas

Shingles can affect the face, eyes, back, and hip regions.

Shingles on the Face and Eyes

Although shingles typically affects the torso and back, it can also affect the face unilaterally. A significant portion of these cases occurs in elderly men. Shingles lesions near the ear, particularly on the face, can lead to serious health issues such as hearing loss and the involvement of facial muscles, so caution is advised.

When shingles affects the eye area, it is called ophthalmic herpes zoster, and this condition affects approximately 10% of individuals with shingles. Lesions in the eyelids, forehead, and upper nose can cause various problems such as a burning sensation, pain, swelling, and blurred vision. Even after the rash subsides, pain in the eye may persist due to nerve involvement during the illness. Over time, this pain may decrease.

If left untreated, ophthalmic herpes zoster can lead to long-term vision loss and permanent damage to the cornea. It is recommended that individuals with eye-related shingles symptoms are aware of these signs and seek medical attention as soon as possible. Starting treatment within the first 72 hours after symptoms appear is crucial in preventing unwanted complications.

A typical presentation includes severe swelling and rash affecting half of the face, including the eye area and extending to the scalp. Lymph node swelling near the ear may accompany the rash.

The ear, like the eye, is another sensory organ that can be affected by shingles. Hearing loss, severe pain in one ear, dizziness, and taste loss are symptoms of Ramsay Hunt Syndrome, a condition caused by shingles that requires urgent treatment.

Facial shingles generally takes longer to resolve, averaging 2-4 weeks, compared to shingles on the torso.

Oral lesions can be extremely painful and may interfere with eating.

Shingles on the Back and Hips

Shingles rashes usually appear on the upper torso and around the waist. Lesions on the back typically appear along a line on one side of the lower back. In addition to the back, shingles lesions can also occur on the hips. Unlike other areas, lesions on the hips may start with sudden itching, tingling, and pain.

Is Shingles Contagious?

Classic, localized shingles lesions are not highly contagious. Unlike chickenpox, shingles is not typically spread through airborne droplets. However, the virus in the fluid-filled blisters is contagious, and contact with the lesions can sometimes transmit the virus. Once the lesions dry and scab over, they are no longer contagious.

If the Varicella Zoster Virus is transmitted to someone who has never been exposed to it, they may develop chickenpox.

It is recommended that individuals avoid touching the lesions and maintain good hand hygiene, as the virus can spread through contact with the lesion fluid.

Shingles patients should avoid contact with individuals who have weakened immune systems or are pregnant.

How is Shingles Diagnosed?

The diagnosis of shingles is generally made based on the typical appearance of the lesions and clinical symptoms. In cases where diagnosis is difficult, additional tests may be used. The Tzanck test involves examining the fluid from the lesions under a microscope to identify multinucleated giant cells. Another diagnostic method is measuring the levels of antibodies against the virus in the patient. PCR testing is the most reliable diagnostic test for shingles, as it can detect viral genetic material in the lesions.

Shingles Treatment

Antiviral medications such as Acyclovir, Valacyclovir, and Brivudin are prescribed for the treatment of shingles. These medications help speed up the healing of the lesions and control the pain. In addition to antiviral drugs, anti-inflammatory medications may be used to control pain and swelling. For long-term or severe pain, narcotic painkillers, anticonvulsants, and topical anesthetic medications may be prescribed. Antihistamines are effective in relieving itching caused by shingles.

Shingles generally improves within a few weeks. If there is no improvement in symptoms within 10 days despite treatment, it is advised to consult your doctor again.

Last Updated Date: 12 April 2021

Publication Date: 12 April 2021

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