What is shingles?

Shingles is a painful viral infection of the nerve roots. The virus moves along the nerve fibres and affects cells of the skin, resulting in a skin rash. It is caused by the herpes varicella-zoster virus, the same virus that's behind chickenpox. The virus is never fully cleared from the body and shingles occurs when the virus reactivates.

What does the shingles rash look like?

Pain, itching, tingling, burning are all symptoms of shingles that may occur several days before the outbreak of the rash. Starting as small blisters on a red base, with new blisters continuing to form for three to five days, shingles is painful. If you think you have shingles, seek medical advice as soon as possible.

Signs of shingles

The first symptoms of shingles appear one to four days before the rash. These early warning signs are usually felt in the location where the rash will develop:

• Itching
• Tingling
• Burning
• Pain

Other symptoms of shingles

While the localised pain and rash are the tell-tale signs of shingles, other symptoms may include:

• Fever
• Chills
• Headache
• Upset stomach

What causes shingles?

The varicella zoster virus is the culprit behind both chickenpox and shingles. The first time someone is exposed to the virus, it causes the widespread, itchy sores known as chickenpox. The virus never goes away. Instead, it settles in nerve cells and may reactivate years later, causing shingles.

Diagnosing shingles

A doctor can usually diagnose shingles just by looking at the rash. If you have shingles symptoms, seek medical advice even if you think you've never had chickenpox. Many childhood cases of chickenpox are mild enough to go unnoticed, but the virus can still linger and reactivate. To reduce the risk of complications, it's important to start treatment as soon as possible.

How long does shingles last?

Shingles blisters usually scab over in seven to 10 days and disappear completely in two to four weeks. In most healthy people, the blisters leave no scars, and the pain and itching go away after a few weeks or months. But people with weakened immune systems may develop shingles blisters that do not heal in a timely manner.

Who's at risk of shingles?

Anyone who has ever had chickenpox can get shingles, but the risk increases with age. Chickenpox is so common in childhood that around 9 out of 10 adults will have had it. Shingles is most common in over 50s and less common in children. Other risk factors include:

• Stress – physical or emotional
• A weakened immune system
• Bone marrow or organ transplant recipients

Is shingles contagious?

You can't catch shingles from someone with the condition. However, it is possible for a person who has never had chickenpox to catch chickenpox from fluid from the blisters of someone with shingles.

Can shingles cause chronic pain?

In some people, the pain of shingles may linger for months or even years after the rash has healed. This pain, due to damaged nerves in and beneath the skin, is known as postherpetic neuralgia. Others feel a chronic itch in the area where the rash once was. In severe cases, the pain or itching may be bad enough to cause insomnia, weight loss, or depression.

Other complications of shingles

If the shingles rash appears around the eye or forehead, it can cause eye infections and temporary or permanent loss of vision. If the shingles virus attacks the ear, people may develop hearing or balance problems. In rare cases, the shingles virus may attack the brain or spinal cord. These complications can usually be prevented by commencing treatment for shingles as soon as possible.

Ramsay Hunt Syndrome

Another shingles complication is Ramsay Hunt syndrome, which affects some nerves in the head. This is thought to affect around one in 20,000 people each year. Symptoms include earache, hearing loss, dizziness, vertigo, tinnitus, loss of taste and Bell's palsy  (paralysis of the face). Ramsey Hunt syndrome is usually treated with antiviral medication and corticosteroids.

Treatment: Antiviral medication

While there is no cure for shingles, antiviral medications such as aciclovir, valaciclovir and famciclovir may be recommended to reduce the severity and length of an attack. Prompt treatment can also reduce the risk of developing postherpetic neuralgia.

Treatment: Rash relief

Over-the-counter pain killing medication and anti-itch lotions, such as calamine, can relieve the pain and itching of the shingles rash. An antihistamine may help prevent itching at night. If the pain is severe or the rash is concentrated near an eye or ear, seek prompt medical advice. Additional medications, such as corticosteroids, may be prescribed to reduce inflammation.

Home care for shingles

Colloidal or oatmeal baths are an old standby for relieving the itch of chickenpox and can help with shingles as well. To speed up the drying out of the blisters, try placing a cool, damp flannel on the rash (but not when calamine lotion or other creams have been applied). If your doctor gives you the green light, stay active while recovering from shingles. Gentle exercise or a favourite activity may help keep your mind off the discomfort.

Shingles vaccine

People in their 70s are offered a vaccination to protect against shingles. The Department of Health says the Zostavax vaccination programme will prevent 38% of the 30,000 cases seen every year in people over 70. Additionally, those who get the jab but still go on to develop shingles can expect to see a 55% reduction in symptoms.

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