The Centers for Disease Control and Prevention estimates that nearly 1
in 3 people in the United States will get shingles at some point, and
1 million new cases are diagnosed annually.
Caused by the chickenpox virus, “shingles represents a reactivation
of the virus, typically affecting patients who have a compromised immune
system because of age, disease or other factors,” said Alex Akhondi,
MD, FACP, associate program director of internal medicine residency at
Shingles causes a painful skin rash and can be accompanied by flu-like symptoms.
What is shingles?
The virus that causes both shingles and chickenpox is called the varicella-zoster
“The primary infection of VZV results in chickenpox, which is characterized
by different-looking rashes on the face, trunk and limbs, and usually
occurs during childhood,” Akhondi said. Chickenpox affects people
during a short period of time while it’s active, but the virus continues
to lay dormant in the body throughout the patient’s life.
Shingles occurs when the dormant virus suddenly reactivates and causes
new symptoms. The exact mechanisms that prompt this are not completely
understood, but it occurs in patients with weakened immunity.
Shingles is much less contagious than chickenpox, and the virus can be
spread only through direct contact with the rash. Someone with shingles
cannot pass the rash itself to someone else, but they can pass the virus
to someone who has never had chickenpox. For example, a child who has
never been exposed to the virus can catch chickenpox from a parent with
shingles, but the child can’t catch shingles.
Anyone who has had chickenpox is at risk for developing shingles. However,
some people may have had chickenpox unknowingly. “Many people get
mild forms of chickenpox as children, with only a cough and cold-like
symptoms and/or a mild rash. Therefore, they may have had chickenpox at
some point and not known it until shingles developed,” Akhondi said.
The biggest risk factor for shingles is a compromised immune system, and
the risk increases with age. The CDC reports that approximately half of
all shingles cases occur in people 60 or older. It’s recommended
that most people above this age get vaccinated.
Symptoms and stages
“The rash is painful, localized and shaped like a band,” Akhondi
said. The location of the rash can appear anywhere, but typically it’s
contained to one side of the body or the face.
From start to finish, shingles usually lasts between two to four weeks,
but the timeline can vary between patients. Some severe cases can last
longer than a month.
While the length of time differs, shingles tends to develop in three distinct stages:
1. Before the rash appears
Patients will begin to feel the rash before it shows up on the skin. “It’s
an unusual sensation — it can feel like pain, burning, tingling
or itching. A few hours or days later, the rash appears in the same place,”
Akhondi said. These symptoms can last for up to five days.
2. The rash
Once the rash appears, it presents as a cluster of painful, red blisters
that are filled with fluid and may feel wet/moist to the touch. This stage
typically lasts seven to 10 days, and Akhondi says the first few days
tend to be the most painful and uncomfortable. Patients are contagious
during this period.
After about a week, the rash begins the healing process and scabs/crust
form over the blisters. The scabbing usually heals within one to three
weeks, but it can take up to a month for the skin to completely return
to normal. Once the rash is entirely scabbed over and no new blisters
appear, patients are no longer contagious.
Besides a rash, other symptoms may occur, especially within the first two
stages of the disease, including: Headache or dizziness/lightheadedness;
light sensitivity; fever and chills; joint pain, body aches and fatigue
“Shingles is treated with specific antiviral medications that suppress
the disease and lessen the duration of symptoms, but the virus cannot
be eradicated from the body completely,” Akhondi said.
Patients with shingles should seek medical care as soon as possible because
antiviral medications are most effective when taken early. Some people
may also need medication to manage the pain/itching, but keeping the lesions
dry and clean can help limit those symptoms.
A complication of shingles is post-herpatic neuralgia (PHN), which causes
the patient to continue to feel pain at the rash site even after the rash
has healed. This occurs as a result of the virus damaging the nerve cells.
PHN usually lasts one to two months but occasionally can continue for over
a year. It can be treated with neuropathic pain medication and most commonly
occurs in patients older than 60.