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Herpes zoster

Contents of this page:

Illustrations

Herpes zoster (shingles) on the back
Herpes zoster (shingles) on the back
Adult dermatome
Adult dermatome
Shingles
Shingles
Herpes zoster (shingles) - close-up of lesion
Herpes zoster (shingles) - close-up of lesion
Herpes zoster (shingles) on the arm
Herpes zoster (shingles) on the arm
Herpes zoster (shingles) on the chest
Herpes zoster (shingles) on the chest
Herpes zoster (shingles) on the hand and fingers
Herpes zoster (shingles) on the hand and fingers
Herpes zoster (shingles) on the neck and cheek
Herpes zoster (shingles) on the neck and cheek
Herpes zoster (shingles) on the hand
Herpes zoster (shingles) on the hand
Herpes zoster (shingles), disseminated
Herpes zoster (shingles), disseminated
Herpes zoster (shingles) on the back
Herpes zoster (shingles) on the back

Alternative Names    Return to top

Shingles

Definition    Return to top

Herpes zoster (shingles) is a painful, blistering skin rash due to acute infection with the varicella-zoster virus, the virus that causes chickenpox.

See also: Ramsay Hunt syndrome

Causes    Return to top

After you get chickenpox, the virus falls asleep (becomes dormant) in certain nerves in the body. Shingles occurs after the virus becomes reactive in these nerves after many years.

The reason the virus suddenly become active again is not clear. Often only one attack occurs.

If an adult or child is exposed to the herpes zoster virus and has not had chickenpox as a child or received the chickenpox vaccine, a severe case of chickenpox may develop, rather than shingles.

Herpes zoster can be contagious through direct contact in an individual who has not had chickenpox, and therefore has no immunity. Herpes zoster may affect any age group, but it is much more common in adults over 60 years old, in children who had chickenpox before the age of one year, and in individuals whose immune system is weakened.

Symptoms    Return to top

The first symptom is usually one-sided pain, tingling, or burning. The pain and burning may be severe.

Red patches on the skin form, followed by small blisters that look very similar to early chickenpox. The blisters break, forming small ulcers that begin to dry and form crusts. The crusts fall off in 2 to 3 weeks.

The rash usually involves a narrow area from the spine around to the front of the belly area or chest. It may involve face, eyes, mouth, and ears.

Additional symptoms may include:

Exams and Tests    Return to top

Your doctor can make the diagnose by looking at your skin and asking questions about your medical history.

Tests are rarely needed, but may include taking a skin sample to see if the skin is infected with the virus that causes shingles.

Lab tests may show an increase in white blood cells and antibodies to the chickenpox virus but cannot confirm that the rash is due to shingles.

Treatment    Return to top

Herpes zoster usually disappears on its own. You may only need treatment to relieve pain.

Your doctor may prescribe an antiviral medicine called acyclovir. This drug helps reduce pain and complications and shorten the course of the disease. Desciclovir, famciclovir, valacyclovir, and penciclovir are similar to acyclovir and may be also be used.

The medications should be started within 24 hours of feeling pain or burning, and preferably before the blisters appear. The drugs are usually given in pill form, in doses many times greater than those recommended for herpes simplex or genital herpes. Some people may need to receive the medicine through a vein (by IV).

Strong anti-inflammatory medicines called corticosteroids, such as prednisone, may be used to reduce swelling and the risk of continued pain. These drugs do not work in all patients.

Other medicines may include:

Cool wet compresses can be used to reduce pain. Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or calamine lotion, may help to relieve itching and discomfort.

Resting in bed until the fever goes down is recommended.

The skin should be kept clean, and contaminated items should not be reused. Nondisposable items should be washed in boiling water or otherwise disinfected before reuse. The person may need to be isolated while lesions are oozing to prevent infection of others -- especially pregnant women.

Outlook (Prognosis)    Return to top

Herpes zoster usually clears in 2 to 3 weeks and rarely recurs. If the virus affects the nerves that control movement (the motor nerves), you may have temporary or permanent weakness or paralysis.

Sometimes, the pain in the area where the shingles occurred may last from months to years. This pain, called postherpetic neuralgia, can be extremely severe. The elderly are at higher risk for this complication.

Possible Complications    Return to top

Involvement of the facial nerve may cause Ramsay Hunt syndrome, which can lead to loss of movement in the face, hearing loss, loss of taste, and other symptoms.

Other complications may include:

When to Contact a Medical Professional    Return to top

Call your health care provider if you have symptoms of shingles, particularly if you have a weakened immune system or if your symptoms persist or worsen. Shingles that affects the eye may lead to permanent blindness if you do not receive emergency medical care.

Prevention    Return to top

Avoid touching the rash and blisters of persons with shingles or chickenpox if you have never had chickenpox or the chickenpox vaccine.

The chickenpox vaccine may be recommended for teenagers or adults who have never had chickenpox. Medical evidence has shown that older adults who receive the vaccine are less likely to have complications from shingles. Adults older than 60 should receive the vaccine as part of routine medical care.

See: Chickenpox vaccine

References    Return to top

Kimberlin DW, Whitley RJ. Varicella-zoster vaccine for the prevention of herpes zoster. N Engl J Med. 2007;356(13):1338-1343.

American Academy of Pediatrics Committee on Infectious Diseases. Prevention of varicella: recommendations for use of varicella vaccines in children, including a recommendation for a routine 2-dose varicella immunization schedule. Pediatrics. 2007;120(1):221-231.

Urman CO, Gottlieb AB. New viral vaccines for dermatologic disease. J Am Acad Dermatol. 2008;58(3):361-370.

Tyring SK. Management of herpes zoster and postherpetic neuralgia. J Am Acad Dermatol. 2007;57:S136-S142.

Update Date: 6/19/2008

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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