At first, the rash looks like little bumps. In 2 to 3 days, you may see fluid-filled blisters. They grow bigger and pop open. Then a hard crust forms on top of them. After a few days, the scabs fall off.
An antiviral medicine is most useful when started in the early stages of shingles (within 72 hours of the rash appearing). However, in some cases your doctor may still advise you have an antiviral medicine even if the rash is more than 72 hours old – particularly in elderly people with severe shingles, or if shingles affects an eye.
Shingles is contagious to people who have not previously had chickenpox, as long as there are new blisters forming and old blisters healing. Similar to chickenpox, the time prior to healing or crusting of the blisters is the contagious stage of shingles. Once all of the blisters are crusted over, the virus can no longer be spread and the contagious period is over.
Shingles is due to a reactivation of varicella zoster virus (VZV) within a person’s body. The disease chickenpox is caused by the initial infection with VZV. Once chickenpox has resolved, the virus may remain inactive in nerve cells. When it reactivates, it travels from the nerve body to the endings in the skin, producing blisters. Risk factors for reactivation include old age, poor immune function, and having had chickenpox before 18 months of age. How the virus remains in the body or subsequently re-activates is not well understood. Exposure to the virus in the blisters can cause chickenpox in someone who has not had it before, but will not trigger shingles. Diagnosis is typically based on a person’s signs and symptoms. Varicella zoster virus is not the same as herpes simplex virus; however, they belong to the same family of viruses.
Shingles is a skin rash characterised by pain and blistering which usually appears on one side of the face or body. Tender, painful skin, tiredness, headache and photophobia may occur 2 to 3 days before the skin turns red and breaks out in tiny fluid-filled blisters.
The first symptom of shingles is often extreme sensitivity or pain in a broad band on one side of the body (see Figure 1 for an example of dermatomes, areas where individual nerves from the spine function). The sensation can be itching, tingling (oversensitivity or a pins and needles sensation), burning, constant aching, or a deep, shooting, or “lightning bolt” pain. If these symptoms appear on the face, especially near the eyes, seek medical help immediately. Other nonspecific symptoms that can occur at the same time are fever, chills, headache, and itching.
RZV is stored at refrigerator temperature. Transport of refrigerated vaccines is described in detail in the CDC Storage and Handling Toolkit, available at www.cdc.gov/vaccines/hcp/admin/storage/toolkit/storage-handling-toolkit.pdf, pages 35–36.
It is safe to be around infants and young children, pregnant women, or people with weakened immune systems after you get the shingles vaccine. There is no documentation of a person getting chickenpox from someone who has received the shingles vaccine (which contains varicella zoster virus).
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Desensitisation of the affected skin patch: if the skin tends to be very sensitive to cold, for example, the application of ice may desensitise the area. Or if touching causes pain, a hard rubbing can lessen the sensitivity.
^ Colebunders R, Mann JM, Francis H, et al. (1988). “Herpes zoster in African patients: a clinical predictor of human immunodeficiency virus infection”. J. Infect. Dis. 157 (2): 314–18. doi:10.1093/infdis/157.2.314. PMID 3335810.
Durable, insulating and protective cedar shake shingles are gaining popularity across the USA. This material is resistant to storms and can be either 18” or 24” long. As for design, cedar shingles fade gradually from natural wood tone to a silver-like tone. Different types are available: hand-split resawn shakes, tapersplit shakes or tapersawn shakes.
The shingles vaccine is very safe. There is no evidence that it can cause shingles. Common reactions to the vaccine may include soreness, redness, swelling, itching, or a rash where the vaccine was given. Headache may also occur.
If shingles is suspected, it should be treated as soon as possible with acyclovir/valacyclovir and adequate pain management. This reduces the duration of the episode and the risk of developing complications including PHN.
The aims of treatment are to limit the severity and duration of pain, shorten the duration of a shingles episode, and reduce complications. Symptomatic treatment is often needed for the complication of postherpetic neuralgia. However, a study on untreated shingles shows that, once the rash has cleared, postherpetic neuralgia is very rare in people under 50 and wears off in time; in older people the pain wore off more slowly, but even in people over 70, 85% were pain free a year after their shingles outbreak.
If the rash with blisters is on a person’s nose or near the eyes, they should be seen by a health-care professional immediately because the virus may spread to the eye and eye damage or vision loss (quick follow-up with an ophthalmologist is recommended).
As with Zostavax, the recommendation is that those who are or will soon be on low-dose immunosuppressive therapy (such as less than 20 mg a day of the steroid prednisone), and those who have recovered from an illness that suppresses the immune system, such as leukemia, can get the vaccine.
Developing shingles while you’re pregnant won’t harm your baby. However, if you have symptoms of shingles and especially chickenpox, or if you come into contact with someone who has chickenpox while you’re pregnant, contact your GP or midwife.
Shingles is not contagious (able to spread) in the sense that people who are exposed to a patient with shingles will not “catch shingles.” Anyone who has already had chickenpox or has received the chickenpox vaccine, and is otherwise healthy, should be protected and at no risk when around a patient with shingles. However, people who have never had chickenpox and have not received the chickenpox vaccine are susceptible to infection by a patient with shingles. These susceptible people, if exposed to the shingles virus, will not develop shingles, but they could develop chickenpox. Such susceptible individuals include babies, young children, and unvaccinated individuals, so people with shingles are actually contagious for VZV infections in the form of chickenpox. Consequently, these individuals may get shingles at a later time in life, as can anyone who has had chickenpox. Covering the rash that occurs with shingles with a dressing or clothing helps decrease the risk of spreading the infection to others. Pregnant women are not unusually susceptible to shingles but if shingles develops near the end of pregnancy, the fetus may be harmed.
^ Weller TH (1953). “Serial propagation in vitro of agents producing inclusion bodies derived from varicella and herpes zoster”. Proc. Soc. Exp. Biol. Med. 83 (2): 340–46. doi:10.3181/00379727-83-20354. PMID 13064265.
Encephalitis is a brain inflammation that causes sudden fever, vomiting, headache, light sensitivity, stiff neck and back, drowsiness, and irritability. Meningitis is an infection that causes inflammation of the meninges that surround the brain and spinal cord. Symptoms of meningitis include high fever, headache, nausea, vomiting, and stiff neck.
The earliest symptoms of shingles, which include headache, fever, and malaise, are nonspecific, and may result in an incorrect diagnosis. These symptoms are commonly followed by sensations of burning pain, itching, hyperesthesia (oversensitivity), or paresthesia (“pins and needles”: tingling, pricking, or numbness). Pain can be mild to extreme in the affected dermatome, with sensations that are often described as stinging, tingling, aching, numbing or throbbing, and can be interspersed with quick stabs of agonizing pain.
People with Bell’s palsy usually don’t need medical treatment, however, drugs like steroids, for example, prednisone seem to be effective in reducing swelling and inflammation are used when medical is necessary. Most people with Bell’s palsy begin to recover within two weeks after the initial onset of symptoms. Full recovery may take three to six months.
Talk with your healthcare provider if you have questions about shingles vaccine. Shingles vaccine is available in doctor’s offices and pharmacies. To find doctor’s offices or pharmacies near you that offer the vaccine, visit Zostavax or HealthMap Vaccine Finder.
As the immune system clears the primary infection, VZV is able to establish a latent infection in nerve roots. Latent virus does not replicate and thus does not continue to stimulate an immune response. Good cellular immunity (mediated by the T-lymphocytes) is important for maintaining this viral latency. If cellular immunity is impaired, however, VZV is able to become active again.
Treatment for zoster ophthalmicus is similar to standard treatment for shingles at other sites. A recent trial comparing aciclovir with its prodrug, valaciclovir, demonstrated similar efficacies in treating this form of the disease. The significant advantage of valaciclovir over aciclovir is its dosing of only 3 times/day (compared with aciclovir’s 5 times/day dosing), which could make it more convenient for people and improve adherence with therapy.
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