Herpes Zoster (Shingles)
What is herpes zoster?
Herpes zoster (shingles) is a painful skin rash caused by the varicella-zoster virus (VZV). This is the same virus that causes chickenpox. After a person has chickenpox, the virus remains inactive in the nerve cells. Years later the virus can become active again. If it does, a red rash or small blisters occur, usually on one side of the body, spreading along a nerve pathway where the virus was inactive. On some occasions, even after the rash is gone, the pain may continue for a prolonged time, a complication called postherpetic neuralgia (PHN). People who receive the chickenpox vaccine also have a small risk of herpes zoster, although it appears to be less than the risk following an actual chickenpox infection. People with a weak immune system are at greater risk of getting shingles. Almost half of the cases occur in people older than age 60.
The incidence of herpes zoster occurring in children is low, but the risk of acquiring this disease increases with age. Children who have weak immune systems may experience the same, or more severe, symptoms as adults. Children most at risk for herpes zoster are those who had chickenpox during the first year of life or whose mothers had chickenpox very late during pregnancy.
What are the symptoms of herpes zoster?
Herpes zoster most often occurs on the trunk and buttocks. However, it may appear on the arms, legs, or face. The following are the most common symptoms:
Pain, burning, tingling, or itching on one part of your face or body
Rash, which can appear up to 5 days after and first looks like small, red spots that turn into blisters
Blisters which turn yellow and dry
Rash which usually goes away in 2 to 4 weeks
Rash is usually localized to one side or part of the body
Fever, chills, headache, nausea
PHN can cause pain for weeks, months, and rarely even years after the rash resolves
The symptoms of herpes zoster may resemble other skin conditions. Always consult your health care provider for a diagnosis.
How is herpes zoster diagnosed?
Your health care provider will ask about your medical history and do a physical exam. Diagnosis may also include:
What is the treatment for herpes zoster?
Immediate treatment with antiviral drugs may help lessen the duration and severity of some of the symptoms. These antiviral medications (acyclovir, famcyclovir and valacyclovir) are more effective the sooner they are started. Ask your health care provider about over-the-counter pain relievers. If your pain is severe, your provider may prescribe stronger pain medication. Use of medication will be determined by your doctor based on factors including duration and severity of the symptoms.
How can I prevent herpes zoster?
The CDC recommends vaccination at age 60or older for everyone. If you have questions about shingles or if you should receive the shingles vaccine, talk with your health care provider. The vaccine (Zostavax) is approved for use at age 50 as well, but current CDC guidelines do not recommend routine vaccination between 50 and 59 years old. The herpes zoster vaccine has been shown in clinical trials to reduce infections by one half, and to reduce PHN by two thirds. Even if you have had shingles, you can still get the vaccine to help prevent future occurrences of the disease. The vaccine is effective for at least 6 years, but may last longer.
- Akin, Louise, RN
- MMI board-certified, academically affiliated clinician