Singles is caused by the same virus which caused chickenpox in children, varicella zoster virus. Once that illness is completed, the virus lays dormant in the nerve cells. When you get older or your immune system is compromised by illness or medication, the virus reactivates and travels along nerve to cause the classic skin disease of shingles,
In last few weeks I have seen a number of patients with shingles were there has been a delay in diagnosis.
This may not surprising as the first signs of the illness may be headache, fever or fatigue. Sometimes it may be prickly, burning, throbbing, or stabbing sensation in a patch of skin anywhere on the body.
The first rash may look quite innocuous as in this photo below.
The classic description of the progression of shingles rash is from small red bumps (erythematous papules) to clear blisters (vesicles) to small pimples (pustules) which break open and crust over, usually over seven to ten days.
The rash often follows a specific pattern on the skin, and often stop in the midline. It follows the dermatomes for the right or left side of the body. If you want to learn more about dermatomes watch this video.
Shingles can be very painful, it may threaten sight and other senses depending on the affected nerves.
Anyone who has shingles will tell you how uncomfortable it is. Actually, uncomfortable may be an understatement. The bad new is that the pain may persist even when the rash has healed. This is known as post herpetic neuralgia which may perists for several months, and require medication to keep under control. Other complications of shingles include pneumonia, a stroke or brain infection called encephalitis which may be fatal. Some people go on to have recurrent shingles.
Antiviral drugs may help hasten the recovery from shingles, but need to be started early in the course of the illness to be effective, ideally within the first 72 hours of the onset of the rash.
A vaccination (Zostervax) is available which costs about $180 but is subsided by for those between 70 and 79 years. It is recommended for anyone over 60. Vaccination reduced the herpes zoster by 51%, post herpetic neuralgia by 66% and reduces the severity of the pain.
Zostevax is a live vaccination and should not be used if you are immunocompromised. To do so risks a potentially fatal disseminated zoster infection. A potentially safer inactive, recombinant vaccine called Shingrex maybe marketed in Australia in the next few years.
The fluid that leaks from the vesicles does contain the virus, so it may cause infection in those who have no immunity to shingles, that is those who haven’t had chickenpox as a child or been vaccination. Pregnant women, newborns babies and immunocompromised people are particularly at risk. Until the rash has crusted over, it is considered infectious. Keeping the rash covered and washing hands helps reduce the spread of the virus.
If you think you have shingles, see your doctor as soon as possible. You can find out more information about shingles here.