Shingles: symptoms, treatment, contagious, cause

Shingles symptoms include rash, itching or a painful burning sensation on the skin. Shingles or herpes zoster is a viral infection, which is characterized by inflammation of certain nerves: the sensory ganglia. This is accompanied by a red skin rash and fluid-filled blisters. The complaints arise in a sharply defined skin area on one side of the body. Anyone who has ever had an infection with the chickenpox virus can develop shingles. Shingles normally heals spontaneously. Treatment for shingles focuses on symptom relief. You can use paracetamol against pain if necessary. Sometimes virus inhibitors are prescribed for shingles. Complications can occur in people whose immune system is weakened.
  • What is shingles
  • Who can get shingles?
  • How often does it occur in the Netherlands?
  • Is shingles contagious?
  • Symptoms of shingles
  • Pain and itching
  • Balls that dry up and become crusts
  • Postherpetic neuralgia
  • Risk factors
  • Age
  • Weakened immune system
  • Undergoing cancer treatments
  • Taking certain medicines
  • Complications of shingles
  • Diagnosis and treatment
  • Treatment shingles
  • Symptom control
  • What to do with heavy and painful shingles?
  • Diadynamic current (DD) in acute herpes zoster
  • Can shingles be found?

What is shingles

Shingles or herpes zoster is a disease caused by reactivation of the herpes zoster virus, also known as varicella zoster virus, chicken pox virus, varicella virus, zoster virus, or human herpes virus type 3 (HHV-3). This results in a sudden painful rash that is accompanied by blisters with fluid-filled blisters (blisters).
Chickenpox / Source: Camiloaranzales, Wikimedia Commons (Public Domain)
Chicken-pox
Someone who has had chickenpox in his life - mostly in childhood - will never completely lose the cause of chickenpox, the Varicella zoster virus, because the virus remains present in certain nerve cells in the spinal cord during sleep. About one in five people who have been infected with chickenpox, the virus is reactivated later in life. This mainly occurs with a reduced resistance of the body. Because of this the virus sees the chance to become active again, after which it manifests itself as shingles.

Who can get shingles?

Anyone who has ever had an infection with the chickenpox virus can develop shingles. Shingles mainly occurs in the elderly and people with reduced resistance. It is rarely seen in children.

How often does it occur in the Netherlands?

The average annual incidence was 320-330 per 100,000 in the 1998-2001 period. The incidence was slightly higher for women than for men. The incidence increased with age (source: RIVM).

Is shingles contagious?

Almost everyone has experienced an infection with the chickenpox virus. People who have never experienced this, and in practice they are often children, can be infected with the virus by a person suffering from shingles. Particularly when blisters are present on the skin, infection can occur due to the moisture released from the blisters or through the air.
Dangerous for newborns and babies
Varicella infections can be dangerous for newborns and babies. That is why people with active shingles should avoid contact with young children. Elderly people who come into contact with children who suffer from a chickenpox infection can develop a shingles due to this contact.

Symptoms of shingles

Pain and itching

Shingles arise in the catchment area of ​​one nerve. This keeps the inflammation on one side of the body and the affected area is clearly defined. This affected skin area is called dermatoma. The first symptoms of shingles are often extreme sensitivity or pain in a wide band or belt on one side of the body, such as the trunk. Shingles can also manifest in a leg, arm, neck, genital area or on one side of the face. The sensation may include itching, tingling, burning, constant pain, or pain. (Sometimes you may feel as if ants or insects are crawling on or under the skin (formation)). If these symptoms appear on the face, especially around the eyes, immediate medical attention is required, as inflammatory processes can occur in the eye that can lead to permanent damage. Other non-specific symptoms that may occur are fever, chills, headache, itching, and swollen lymph nodes.

Balls that dry up and become crusts

The skin turns red a few days after the pain develops and blisters filled with clear fluid appear, which can be itchy and painful. The vesicles dry out after about 10 days. The rash disappears when the scabs fall off. Scars may remain.

Postherpetic neuralgia

Some patients develop postherpetic neuralgia, which is a long-standing localized pain after going through shingles. It appears that no less than 15% of people with shingles develop postherpetic pain. The majority of cases of long-term nerve pains occur in elderly patients and after shingles in the face.

Risk factors

Anyone who has ever had chickenpox can develop shingles at some point. Factors that can increase the risk of developing shingles are:

Age

Shingles is most common in people over 50 years old. The risk increases with age. Some experts estimate that half of people 80 and older have shingles.

Weakened immune system

Diseases that weaken your immune system, such as HIV / AIDS and cancer, can increase the risk of shingles.

Undergoing cancer treatments

Radiation or chemotherapy can lower your resistance to diseases, which can lead to shingles.
Use of certain medicines increases the chance of shingles / Source: Stevepb, Pixabay

Taking certain medicines

Drugs to prevent rejection of transplanted organs can increase the risk of shingles, as well as prolonged use of steroids such as prednisone.

Complications of shingles

Not receiving medical treatment (in time) increases the risk of complications. Complications of shingles include:
Postherpetic neuralgia (PHN)
PHN is pain that does not disappear within 1 month. It can take months or even years after the shingles have healed. It is more common in people 50 years and older and in people with a weakened immune system due to another disease, such as diabetes or HIV.
Disseminated occurrence (herpes zoster generalisata or disseminata)
Herpes zoster can be disseminated in immunocompromised patients. Hereby a blister-like rash occurs over a large part of the body and this can affect the heart, lungs, liver, pancreas, joints and intestinal tract. The infection can spread to the motor nerves needed to move muscles, which can lead to temporary weakness.
Cranial nerve complications
If shingles affect the nerves of the brain, the following complications can occur:
  • Inflammation, pain and loss of sensation in one or both eyes. The infection can affect your eyesight.
  • Severe ear pain, a rash around the ears, mouth, face, neck and scalp, and movement problems of the face; Ramsay-Hunt syndrome, a condition in which the seventh cranial nerve becomes inflamed. Other symptoms may include hearing loss, dizziness, and ringing in the ears. Loss of taste and dry mouth and dry eyes can also occur.
  • Inflammation and possible blockage of blood vessels, which can lead to a stroke.

Other complications
Other complications may include:
  • Scars and discoloration of the skin;
  • Bacterial infection of the blisters;
  • Muscle weakness in the area of ​​the infected skin before, during or after shingles.
General practitioner with patient / Source: Istock.com/monkeybusinessimages

Diagnosis and treatment

Shingles is usually diagnosed based on the clinical picture. blisters. Sometimes a skin biopsy (removal of a piece of tissue) or an analysis of the bladder fluid makes sense to confirm the diagnosis.
Differential diagnosis
Occasionally, diagnosing shingles can be a challenge for the physician because the clinical picture of this disease can closely resemble one of the following conditions:
  • acne keloidalis nuchae;
  • acneiform outbursts;
  • ulcers (aftomatosis stomatitis);
  • allergic contact dermatitis;
  • cellulite;
  • cnidaria and venomation;
  • contact stomatitis (inflammation in the mouth due to hypersensitivity);
  • ecthyma;
  • erysipeloid;
  • folliculitis
  • human cowpox infection;
  • insect bites;
  • irritating contact dermatitis;
  • lichen striatus (synonymous: BLAISE, Blaschko Linear Acquired Inflammatory Skin Eruption);
  • mucosal candidiasis;
  • chicken-pox
  • wound rose or belroros (erysipelas).
Paracetamol is analgesic and fever-reducing / Source: Martin Sulman

Treatment shingles

Symptom control

Shingles normally heals spontaneously. Treatment focuses on symptom management, such as pain management. You can use acetaminophen and if that does not provide sufficient relief, you can (after consulting your doctor) use diclofenac, ibuprofen or naproxen. A therapy for the blisters is also possible. For example, you can apply a drying ointment (zinc-oxide ointment or paste) to the blisters and, if necessary, you can put a liquid or cream on the skin to reduce itching. In severe cases - if you are early - an antivirus agent (such as aciclovir, valaciclovir or famciclovir) may be prescribed to relieve the symptoms. Anti-viral therapy is mainly started with shingles in the face and in patients with a greatly reduced resistance. It is important to start treatment as soon as possible. Recurrence is rare, but not excluded in people with impaired or reduced immunity.

What to do with heavy and painful shingles?

Severe and painful shingles can be treated with a nerve treatment via an injection layer in the back. This treatment is aimed at reducing swelling in the nerve, combating acute pain and preventing permanent nerve inflammation. The nerve treatment is given by an anesthesiologist who, under local anesthesia, brings a thin needle to the painful nerve near the spinal cord. An anti-inflammatory drug (adrenal cortex hormone) is injected through the needle. This medicine is mixed with an anesthetic fluid, so you will usually not feel much of it. This treatment can take place at the height of the neck, chest, lower back or tailbone and only makes sense within five weeks from the start of the symptoms.

Diadynamic current (DD) in acute herpes zoster

Some physiotherapists treat shingles with diadynamic current, which stops the shingles expansion. This prevents damage to the sensory nerves. Postherpetic neuralgia (PHN) is a complication of a herpes zoster infection, and indicates a very painful condition in the nerve endings of the skin. It is then important to start this treatment as soon as possible after the first symptoms of shingles. The sooner you are there, the smaller the chance of postherpetic neuralgia.
The treatment with diadynamic current consists of placing sponge electrodes on and next to the affected skin area. A direct current (a harmless weak current) then flows through the dermatome. This weak current is noticeable, but it is not really painful. The treatment is carried out according to a strict schedule and the treatment takes place daily. In serious cases also during the weekend. The effect is explained by the strong circulation-promoting effect of the current, as a result of which the nerve receives more antibodies against the virus.

Can shingles be found?

In 2008 it was announced that Dutch people over the age of fifty could be vaccinated against shingles for the first time. The vaccine, Zostavax, halves the chance of someone getting the disease and the chance of patients suffering from severe outbreaks of an outbreak decreases by no less than two thirds. Vaccination costs 150 euros per dose.
The current shingles vaccine reduces the risk of shingles among people over 60 by around 50% in the first years after a single vaccination. However, the effectiveness decreases over the years. The new shingles vaccine based on recombinant subunits is effective in preventing shingles, regardless of the age of administration.1 In principle, the new shingles vaccine can also be given during immune suppression.
Note:
  1. Alies van Lier and Hester de Melker. New shingles vaccine for the elderly. Ned Tijdschr Medic. 2015; 159: A9369

Video: Shingles: What You Should Know About the Sequel to Chickenpox. Jeffrey Brown, DO (April 2020).

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