Health Focus Archive
also called herpes zoster, gets its name from both the Latin and
French words for belt or girdle and refers to girdle-like skin
eruptions that may occur on the trunk of the body. The virus that
causes chickenpox, the varicella zoster virus (VSV), can become
dormant in nerve cells after an episode of chickenpox and later
reemerge as shingles. Initially, red patches of rash develop into
blisters. Because the virus travels along the nerve to the skin,
it can damage the nerve and cause it to become inflamed. This
condition can be very painful. If the pain persists long after
the rash disappears, it is known as post-herpetic neuralgia.
individual who has had chickenpox can develop shingles. Approximately
300,000 cases of shingles occur every year in the United States.
Overall, approximately 20% of those who had chickenpox as children
develop shingles at some time in their lives. People of all ages,
even children, can be affected, but the incidence increases with
age. Newborn infants, bone marrow and other transplant recipients,
as well as indivduals with immune systems weakened by disease
or drugs are also at increased risk. However, most individuals
who develop shingles do not have any underlying malignancy or
other immunosuppressive condition.
erupts along the course of the affected nerve, producing lesions
anywhere on the body and may cause severe nerve pain. The most
common areas to be affected are the face and trunk, which correspond
to the areas where the chickenpox rash is most concentrated. The
disease is caused by a reactivation of the chickenpox virus that
has lain dormant in certain nerves following an episode of chickenpox.
Exactly how or why this reactivation occurs is not clear, however,
it is believed that the reactivation is triggered when the immune
system becomes weakened, either as a result of stress, fatigue,
certain medications, chemotherapy, or diseases, such as cancer
or HIV. Further, it can be an early sign in persons with HIV that
the immune system has deteriorated.
signs of shingles are often vague and can easily be mistaken for
other illnesses. The condition may begin with fever and malaise
(a vague feeling of weakness or discomfort). Within two to four
days, severe pain, itching, and numbness/tingling (paresthesia)
or extreme sensitivity to touch (hyperesthesia) can develop, usually
on the trunk and occasionally on the arms and legs. Pain may be
continuous or intermittent, usually lasting from one to four weeks.
It may occur at the time of the eruption, but can precede the
eruption by days, occasionally making the diagnosis difficult.
Signs and symptoms may include the following:
tingling, or severe burning pain
patches that develop into blisters
dense, deep, small blisters that ooze and crust
is usually not possible until the skin lesions develop. Once they
develop, however, the pattern and location of the blisters and
the type of cell damage displayed are very characteristic of the
disease, allowing an accurate diagnosis primarily based upon the
tests are rarely necessary, they may include the following:
culture of skin lesion.
examination using a Tzanck preparation. This involves staining
a smear obtained from a blister. Cells infected with the herpes
virus will appear very large and contain many dark cell centers
blood count (CBC) may show an elevated white blood cell count
(WBC), a nonspecific sign of infection.
in antibody to the virus.
almost always resolves spontaneously and may not require any treatment
except for the relief of symptoms. In most people, the condition
clears on its own in one or two weeks and seldom recurs.
wet compresses may help reduce pain. If there are blisters or
crusting, applying compresses made with diluted vinegar will make
the patient more comfortable. Mix one-quarter cup of white vinegar
in two quarts of lukewarm water. Use the compress twice each day
for 10 minutes. Stop using the compresses when the blisters have
baths and lotions such as colloidal oatmeal baths, starch baths
or lotions, and calamine lotion may help to relieve itching and
discomfort. Keep the skin clean, and do not re-use contaminated
items. While the lesions continue to ooze, the person should be
isolated to prevent infecting other susceptible individuals.
when the crusts and scabs are separating, the skin may become
dry, tight, and cracked. If that happens, rub on a small amount
of plain petroleum jelly three or four times a day.
antiviral drugs acyclovir, valacyclovir, and famciclovir can be
used to treat shingles. These drugs may shorten the course of
the illness. Their use results in more rapid healing of the blisters
when drug therapy is started within 72 hours of the onset of the
rash. In fact, the earlier the drugs are administered, the better,
because early cases can sometimes be stopped. If taken later,
these drugs are less effective but may still lessen the pain.
Antiviral drug treatment does not seem to reduce the incidence
of post-herpetic neuralgia, but recent studies suggest famciclovir
may cut the duration of post-herpetic neuralgia in half. Side
effects of typical oral doses of these antiviral drugs are minor
with headache and nausea reported by 8-20 % of patients. Severely
immunocompromised individuals, such as those with AIDS, may require
intravenous administration of antiviral drugs.
such as prednisone, may be used to reduce inflammation but they
do interfere with the functioning of the immune system. Corticosteroids,
in combination with antiviral therapy, also are used to treat
severe infections, such as those affecting the eyes, and to reduce
the blisters are healed, some people continue to experience pain
for months or even years (post-herpetic neuralgia). This pain
can be excruciating. Consequently, the doctor may prescribe tranquilizers,
sedatives, or antidepressants to be taken at night. As noted above
attempts to treat post-herpetic neuralgia with the antiviral drug
famciclovir have shown some promising results. When all else fails,
severe pain may require a permanent nerve block.
are non-medical methods of prevention and treatment that may speed
recovery. For example, getting lots of rest, eating a healthy
diet, exercising regularly, and minimizing stress are always helpful
in preventing disease. Supplementation with vitamin B12 during
the first one to two days and continued supplementation with vitamin
B complex, high levels of vitamin C with bioflavenoids, and calcium,
are recommended to boost the immune system. Herbal antivirals
such as echinacea can be effective in fighting infection and boosting
the immune system.
no single alternative approach, technique, or remedy has yet been
proven to reduce the pain, there are a few options which may be
helpful. For example, topical applications of lemon balm ( Melissa
officinalis ) or licorice ( Glycyrrhiza glabra ) and peppermint
( Mentha piperita ) may reduce pain and blistering. Homeopathic
remedies include Rhus toxicodendron for blisters, Mezereum and
Arsenicum album for pain, and Ranunculus for itching. Practitioners
of Eastern medicine recommend self-hypnosis, acupressure, and
acupuncture to alleviate pain.
usually clears up in two to three weeks and rarely recurs. Involvement
of the nerves that cause movement may cause a temporary or permanent
nerve paralysis and/or tremors. The elderly or debilitated patient
may have a prolonged and difficult course. For them, the eruption
is typically more extensive and inflammatory, occasionally resulting
in blisters that bleed, areas where the skin actually dies, secondary
bacterial infection, or extensive and permanent scarring.
an immunocompromised patient usually has a more severe course
that is frequently prolonged for weeks to months. They develop
shingles frequently and the infection can spread to the skin,
lungs, liver, gastrointestinal tract, brain, or other vital organs.
Cases of chronic shingles have been reported in patients infected
with AIDS, especially when they have a decreased number of one
particular kind of immune cell, called CD4 lymphocytes. Depletion
of CD4 lymphocytes is associated with more severe, chronic, and
recurrent varicella-zoster virus infections. These lesions are
typical at the onset but may turn into ulcers that do not heal.
serious complications can result from herpes zoster. Many individuals
continue to experience persistent pain long after the blisters
heal. This pain, called post-herpatic neuralgia, can be severe
and debilitating. Post-herpetic neuralgia can persist for months
or years after the lesions have disappeared. The incidence of
post-herpetic neuralgia increases with age, and episodes in older
individuals tend to be of longer duration. Most patients under
30 years of age experience no persistent pain. By age 40, the
risk of prolonged pain lasting longer than one month increases
to 33%. By age 70, the risk increases to 74%. The pain can adversely
affect quality of life, but it does usually diminish over time.
complications include a secondary bacterial infection, and rarely,
potentially fatal inflammation of the brain (encephalitis) and
the spread of an infection throughout the body. These rare, but
extremely serious, complications are more likely to occur in those
individuals who have weakened immune systems (immunocompromised).
the immune system by making lifestyle changes is thought to help
prevent the development of shingles. A lifestyle designed to strengthen
the immune system and maintain good overall health includes eating
a well-balanced diet rich in essential vitamins and minerals,
getting enough sleep, exercising regularly, and reducing stress.
- • Acyclovir
antiviral drug that is available under the trade name Zovirax,
in oral, intravenous, and topical forms. The drug blocks the
replication of the varicella zoster virus.
- • Antibody
specific protein produced by the immune system in response to
a specific foreign protein or particle called an antigen.
- • Corticosteroid
steroid that has similar properties to the steroid hormone produced
by the adrenal cortex. It is used to alter immune responses
- • Famciclovir
oral antiviral drug that is available under the trade name Famvir.
The drug blocks the replication of the varicella zoster virus.
- • Immunocompromised
state in which the immune system is suppressed or not functioning
- • Post-herpetic
term used to describe the pain after the rash associated with
herpes zoster is gone.
- • Tzanck
in which skin cells from a blister are stained and examined
under the microscope. Visualization of large skin cells with
many cell centers or nuclei indicates a positive diagnosis of
herpes zoster when combined with results from a physical examination.
- • Valacyclovir
oral antiviral drug that is available under the trade name Valtrex.
The drug blocks the replication of the varicella zoster virus.