Shingles is a painful rash of small blisters that appear on one side of the body, often in a band on the chest and back. It’s caused by a virus called varicella zoster. This is the same virus that causes chickenpox.
Shingles occurs when the virus that causes chickenpox re-activates itself in your body.
After you've had chickenpox, the virus stays in nerve cells in your spinal cord for the rest of your life. Usually, the virus lies dormant and doesn't cause any problems. But if your immune system, which normally protects your body against infection, is weakened, the virus can become active again. If this happens, it causes shingles.
Shingles is very common – one in five people are affected at some point in their life. It can affect you at any age, but it's more common in people over 50.
The first symptom of shingles is often oversensitivity or a painful burning sensation in the affected area, usually your chest. A rash will then develop. The rash usually appears as a band, following the route of a nerve supply to your skin.
At first, it consists of small red raised spots. The spots then turn into small blisters filled with a cloudy fluid. These blisters dry up after five to seven days and gradually form scabs. The scabs drop off within two to three weeks but it can take longer for the skin to totally heal.
The pain caused by shingles is often severe and may stay after the rash has gone.
Shingles can lead to a number of complications.
Because the virus affects your nerves, the pain may continue after the rash has cleared, sometimes lingering for weeks, months or even years. This is called post-herpetic neuralgia. It's more common in older people and in people who had a severe rash.
Shingles can affect the skin around your eyes (ophthalmic zoster). This can give you red and streaming eyes (conjunctivitis) and may damage your eyes or affect your vision. If you have shingles around your eyes you may need to see an ophthalmologist (a doctor who specialises in eye conditions).
Shingles can sometimes affect your ears. It can cause earache, dizziness, deafness and paralysis on one side of your face. This is called Ramsay Hunt syndrome. The pain tends to go away within 48 hours, but post-herpetic neuralgia or permanent nerve damage may occur.
Encephalitis (inflammation of your brain) is a very rare complication of shingles. It causes fever, seizures and confusion.
Developing shingles while you're pregnant won't harm your baby. However, if you have symptoms of shingles and especially chickenpox, or if you come into contact with someone who has chickenpox while you're pregnant, contact your GP or midwife.
Shingles occurs when the varicella zoster virus that causes chickenpox re-activates itself in your body.
There are a number of things that make re-activation of the virus more likely, including:
Shingles isn't infectious in the same way as chickenpox, where the virus can be passed on to other people through coughs and sneezes. However, the virus can be passed on by direct contact with fluid from shingles blisters, until they dry up and crust over. This can cause chickenpox in people who haven't had chickenpox or the chickenpox (varicella) vaccine. If you have shingles, try to avoid contact with babies, pregnant women and people who have a weakened immune system.
Shingles isn't triggered by contact with someone who has chickenpox.
If you recognise the symptoms of shingles developing early on, contact your GP as soon as possible. Early treatment can make the symptoms less severe, and reduce your risk of complications.
Tests aren't usually needed to diagnose shingles, because the type and location of the rash is very easy to spot. However, sometimes scrapings may be taken from a blister and analysed under a microscope, or you may need a blood test to identify the virus and confirm the diagnosis.
You will need urgent medical treatment if you develop other symptoms, such as a high fever. You must also see your GP if you get shingles while pregnant or have a weakened immune system.
Often the symptoms of shingles are mild and you won't need any medical treatment. However, the symptoms can be controlled, especially if it's treated at an early stage.
Keep the rash clean and dry to reduce your risk of developing a bacterial infection. Don't use sticky dressings or antibiotic creams or ointments (topical antibiotics) as these may irritate your skin. Cover your rash, so that the virus is less likely to spread. Avoid work, school or day care if you have a rash that's weeping and can't be covered.
Antiviral medicines, usually taken as tablets, can help to control the symptoms of shingles if you take them in the early stages of the illness. They help control the rash and minimise damage to your nerves; this reduces the likelihood of post-herpetic neuralgia.
Your GP may prescribe you an antiviral medicine, particularly if they see you soon after you first develop symptoms (within about 72 hours), if you have any complications or if you're over 50.
The pain of shingles may be relieved by taking over-the-counter (non-prescription) painkillers, but if it's severe your GP might prescribe more powerful drugs. Always read the accompanying consumer medicine information leaflet and if you have any questions, ask your pharmacist or GP for advice.
Wet dressings and ice packs can also help control the pain. You can try using capsaicin creams if other treatments don't work or aren't suitable. Talk to your GP or pharmacist for more advice.
If you develop, or are at an increased risk of, post-herpetic neuralgia, your GP may prescribe additional medicines, for example amitriptyline, which acts on your nerves and can help control the pain.
In Australia there's a vaccine available to prevent shingles and post-herpetic neuralgia. If you're over the age of 50, see your doctor about receiving this vaccine.
There's also a vaccine for chickenpox, which protects you from catching the varicella zoster virus in the first place. The National Health and Medical Research Council (NHMRC) recommends vaccination for all children at 18 months. One dose of this vaccination is free of charge to all eligible children at 12 to 18 months of age as part of the Immunise Australia Program.
The Immunise Australia program also provides a free ‘catch-up' vaccination for children between 10 to 13 years old who haven't yet been vaccinated or had chickenpox. This free vaccination is available from local doctors and immunisation clinics. Talk to your GP for more information.
Those aged over 14 years who are not immune to chickenpox should be vaccinated. This is especially recommended for certain groups of people including healthcare workers, child care workers, teachers and people in contact with others who have a reduced immune system. This is to protect individuals from catching chickenpox from an infected carer. You can talk to your GP for more information.
If you haven't had chickenpox and come in contact with a person with the illness, you can still benefit from vaccination to prevent chickenpox developing if you get vaccinated within three to five days of exposure.
If a pregnant woman, a person with a weakened immune system or a newborn baby comes into contact with someone who has chickenpox and they've never had it before, they need to see a GP as soon as possible. The GP can then prescribe the appropriate treatment.
Immunise Australia
http://www.immunise.health.gov.au/
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Last published: 30 July 2011
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