Shingles is a reactivation of the herpes zoster virus (varicella-zoster virus, or VZV). This same virus causes the childhood illness chickenpox. The chickenpox virus (varicella) remains in a dormant state in the body in the root of nerves that control sensation. In about 1 out of 5 people, the virus "wakes up," often many years after the chickenpox infection. The virus then travels along a sensory nerve into the skin causing a painful rash known as shingles. Shingles occurs when the virus that causes chickenpox starts up again in your body. After you get better from chickenpox, the virus "sleeps" (is dormant) in your nerve roots. In some people, it stays dormant forever. In others, the virus "wakes up" when disease, stress, or aging weakens the immune system. It is not clear why this happens. But after the virus becomes active again, it can only cause shingles, not chickenpox.
Before a rash is visible, the patient may notice several days to a week of burning pain and sensitive skin. Before the rash is visible, it may be difficult to determine the cause of the often severe pain. Shingles start as small blisters on a red base, with new blisters continuing to form for three to five days. The blisters follow the path of individual nerves that comes out of the spinal cord (called a dermatomal pattern).
The first symptom of shingles is a burning or tingling pain, or sometimes numbness, in or under the skin. Other symptoms include fever, chills, headache, or upset stomach. After several days, a rash of small fluid-filled blisters, reminiscent of chickenpox, appears on reddened skin. The pain associated with shingles can be intense and is often described as "unrelenting."
Also at risk for shingles are people with leukemia, lymphoma, or Hodgkin's disease, and those whose immune systems have been weakened because they are HIV-positive, or have undergone chemotherapy, radiation, transplant surgery with immunosuppression, or treatment with corticosteroids. Moreover, about 5 percent of people with shingles are found to have an underlying cancer, about twice the number of people in the population expected to have undiagnosed cancer.
Antiviral medications are also routinely prescribed in severe cases of shingles or when the eye is affected. Such treatment needs to begin within three days of getting the rash to be effective, so if you suspect you have shingles, see your doctor immediately. For reasons that are not completely understood, some PHN patients get no relief from pain medication, and what works in one case may not be effective in another.
There are several effective treatments for shingles. Drugs that fight viruses (antivirals), such as acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir), can reduce the severity and duration of the rash if started early (within 72 hours of the appearance of the rash). The addition of steroid drugs may have limited benefit in some cases, but studies have not conclusively confirmed the benefit of steroids in combination with all antiviral drugs. In addition to antiviral medication, pain medications may be needed for symptom control.
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