Dr. M.J. Bazos, Patient Handout
About Your Diagnosis
Herpes zoster is also known as shingles. It is an uncomfortable and often very painful outbreak of skin blisters and sores. The condition is caused by the varicella-zoster virus, the same virus that causes chickenpox. After you recover from chickenpox (usually in childhood), the virus remains in your body doing no harm. When you become older, changes in your body allow the virus to become active again. This new disease is different from chickenpox and is called shingles. When you have had a case of chickenpox, you seldom if ever will have chickenpox again; however, 1 in every 10 individuals who have had chickenpox will have shingles. The virus causing herpes zoster (shingles) is already in you from your earlier infection with chickenpox. Therefore, you do not catch shingles nor do you give shingles to someone. However, if you have active shingles and come in contact with an individual who has never had chickenpox, it is possible that the individual can catch chickenpox from your shingles. Remember, it is the same virus that causes chickenpox and herpes zoster (shingles). Although anyone who has had chickenpox can subsequently have herpes zoster (shingles), it is much more common in individuals older than 50 years. Also certain diseases or drugs that lower your natural resistance, such as acquired immunodeficiency syndrome (AIDS), cancer, and steroids, can make you more likely to have shingles. It is rare, but possible, to have additional episodes of shingles during your lifetime. The condition is not curable; anyone having had chickenpox probably has live varicella-zoster virus in their body. At present, we do not have any drugs that can cure this infection, but we do have medications that can shorten the course of the illness, its severity, and most importantly, prevent some of the complications of herpes zoster (shingles).
Living With Your Diagnosis
Herpes zoster or shingles virus lives in the nerves near your spine. When the virus becomes active, it travels along the nerves to the skin. It then breaks out on the skin in groups or bands where the nerve endings are. Thus the rash seldom crosses the midline of the body and is usually confined to a band
going across part of the body. The rash can occur anywhere including the face. Early signs of an outbreak are often vague, consisting of mild itching, tingling, pain, headache, fever, or a flulike syndrome. This is followed by the
rash, which is made up of many small, fluid-filled blisters in groups that dry, scab over, and heal (much like chickenpox) within a few weeks. The amount of pain and discomfort of shingles varies from individual to individual. The usual time from appearance of blisters to healing is usually 1– 2 weeks. Healing in the majority of cases is complete and uneventful. Unfortunately in a significant number of individuals, especially those older than 50 years, the pain associated with these lesions can persist greater than 30 days. This is called postherpetic neuralgia and can be so severe that it interferes with daily activity. Another complication can be secondary bacterial infection of the rash. This occurs through contamination by scratching and can lead to possible infection and deep scarring. Herpes zoster (shingles) infections that occur on the face are of particular concern. These infections can involve the eye and result in serious scarring of the eye and loss of vision. Shingles infections about the face and nose require immediate medical attention and possible referral to an eye doctor.
The main goals of treatment are to decrease the duration of the infection, its discomfort, and to prevent complications such as postherpetic neuralgia and bacterial infection. Until relatively recently, treatment was only for symptoms; however, physicians now have antiviral drugs that actually kill the virus and shorten the infection. The use of these drugs must be started early. Once the infection has been present for 3 or 4 days, the antiviral medication is of little help. These medications include acyclovir, valacyclovir, and famciclovir. The antiviral drugs are effective at decreasing symptoms, but the infection may still be painful and irritating. Your doctor may wish to add other medications and lotions to help lessen the pain and itching. If secondary bacterial infection occurs, you will be given antibiotic medications as well.
The DOs
• Do seek medical attention as soon as you suspect you may have herpes zoster. The antiviral medication must be given within 2 or 3 days of the rash to be helpful.
• Do tell your doctor if you are pregnant; some antiviral medications may not be good for your unborn baby.
• Do take precautions to avoid contact with those who have never had chickenpox because they may become infected from you.
• Do keep the rash clean and notify your doctor if it appears to be infected (pus, increasing redness, not getting better).
• Do see your doctor immediately if the rash is on the face or nose.
The DON’Ts
• Don’t scratch, contaminate, or break the blisters.
• Don’t use home remedies that might make it worse such as detergents, kerosene, etc.
• Don’t wait to see your doctor; the sooner you start antiviral medication, the better.
When to Call Your Doctor
• Anytime the rash is on the face or nose.
• If the pain is not getting better after the rash has healed.
• If the rash appears to have become secondarily infected, i.e., pus, increasing pain, increasing redness.