Updated 8 June 2022 | Approved By Dr. Umberto Russo
What are Shingles?Also known as herpes zoster, shingles is a condition caused by the varicella zoster virus (also known as chickenpox). This is a serious illness that causes nerve pain and other potentially significant symptoms. According to the Australian Institute of Health and Welfare (AIHW), one in three Australians will experience shingles . Those over 60 and/or immunocompromised are at the highest risk of developing shingles. The recent report by the AIHW showed that more than 2500 Australians were hospitalised with the condition, especially those over 80 years old. Shingles occurs when the varicella zoster virus is reactivated. Those who have previously had chickenpox will have the virus resting dormant in the body. Once reactivated, the virus affects the nervous system and leads to pain and blistering on the skin.
Shingles SymptomsSymptoms of shingles will vary from person to person and the stage of the condition. Nerve pain and rashes on the skin are typical symptoms reported by those with shingles. Shingles affect areas of the body called dermatomes. These are regions on the skin controlled by certain sections of the nervous system. The three most origins of affected dermatomes include the thoracic (area around the middle of the back and ribcage), cervical (area from the neck to the arms) and trigeminal (the sides of the face) regions .
Stages of ShinglesShingles can develop over three stages called the pre-eruptive, acute-eruptive and chronic phases, leading to a different set of symptoms.
Pre-Eruptive PhaseThe pre-eruptive phase lasts anywhere between 2-10 days. People may experience any abnormal sensations, pain, or discomfort along one or more specific areas of the body (known as dermatomes). Other reported symptoms include headaches, sensitivity to light and fatigue (low energy) .
Eruptive PhaseThe eruptive phase continues the symptoms seen in the pre-eruptive phase. During this stage, red ulcers and blisters begin to form over specific areas on the skin called dermatomes. They fill with fluid before bursting and eventually drying out into scabs . Even though this phase lasts 2-4 weeks, the pain can linger even after the skin has healed.
Chronic Phase (Postherpetic Neuralgia)The chronic phase (also known as postherpetic neuralgia) describes persistent pain that occurs after the eruptive phase of shingles. This complication affects up to 30% of people who have shingles . The pain is often described as a burning, tingling and numbing sensation. These symptoms can be disabling and last for months or even years .
Other symptomsOther symptoms that are associated with shingles include:
- Lack of energy
- Upset stomach
What Causes Shingles?Shingles is caused by the re-activation of the varicella zoster virus. This only occurs in those who have been previously affected by the virus or have had chickenpox. However, those who have not had chickenpox are more likely to contract shingles in adulthood. This virus then targets and leads to inflammation of the nerves. Pain and blisters are developed around the skin that are innervated by the affected nerves . The chances of catching singles are increased due to several risk factors, including:
- Being over the age of 60
- Being immunocompromised
- Not having immunisation against shingles or chickenpox
- Taking medications, such as immunosuppressants.
- Being exposed to someone who has shingles
Is Shingles Contagious?Shingles is contagious. It is more likely to spread to people who have not had an episode of chickenpox or gotten a vaccination against it . The condition is typically spread by direct skin contact or breathing in contaminated droplets in the air. To minimise the spread, it’s essential to:
- Cover up any shingles rashes, blisters and ulcers to prevent skin-to-skin contact
- Avoid touching or scratching the rashes
- Washing your hands frequently, especially if you’ve been diagnosed
Can you get shingles twice?Yes. According to a study by the Australian Prescriber, around 4% to 7% of men and women, respectively, can contract shingles again within an eight year period .
Tests and DiagnosisIf you suspect shingles, you need to contact your GP for an evaluation and treatment plan immediately. They may ask you several medical screening questions and examine the affected areas over the skin to diagnose this condition. In some instances, GP may require further laboratory tests. A swab of the burst blisters or ulcers may be needed for antibody and/or PCR testing to help confirm a diagnosis .
Antiviral MedicationAntiviral medication can help fight against viral infections such as shingles. The medication is most effective when taken within 72 hours after the shingles rash appears. Timely antiviral medicines can help reduce the severity and duration of the condition .
Pain MedicationYour GP may prescribe medication to help address the pain from the shingles, such as anti-convulsants and creams to relieve nerve related pain . Pocket devices called TENS units can be another effective and non-medicated option for pain management.
Shingles VaccinationSince 2016, the Australian National Immunisation Program has made the shingles vaccine available to all Australians over 70 . This is to help reduce the spread of shingles by 50% and additional complications (e.g. postherpetic neuralgia) . Vaccinated individuals who have contracted the illness are more likely to experience milder symptoms.
RecoveryThe blistering and rashes that develop from shingles (also known as the eruptive phrase) will usually resolve within 2-4 weeks . Although most will mostly recover from these symptoms, a minority will experience chronic symptoms (even after the rashes and blistering have healed).
ComplicationsAlthough most people will recover, some develop long-term complications. This is more likely to occur in those over 80 and/or who are immunocompromised . Ongoing pain, known as postherpetic neuralgia, is the most common complication and can last months to years . Other complications include:
- Problems with vision and eye movement
- Facial weakness
- Loss of taste
- Bacterial infections
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- Nair PA, Patel BC. Herpes Zoster. [Updated 2021 Nov 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441824/
- Wehrhahn, M. C., & Dwyer, D. E. (2012). Herpes zoster: epidemiology, clinical features, treatment and prevention. Australian Prescriber, 35(5).