Shingles (herpes zoster)

What is shingles and why is it called that?

Shingles is a viral infection caused by the herpes virus type 3 (Varicella Zoster Virus, VZV), which remains in the body after chickenpox and can become active many years later.

It has been proven that after chickenpox, also called varicella, the herpes virus remains latent in the nerve cells of the body and can be activated at any age, most often after the age of 50. Stress, weak immunity, age, chronic illness, infectious diseases (e.g. demodecosis) and trauma can be triggers for activation of the virus.

This disease is called “shingles” due to the fact that its rashes are often located along the course of nerves, wrapping around the patient’s body, creating band-like formations. It is important to remember that this virus is not transmitted from person to person under the same conditions as chickenpox, but it can be dangerous for immunocompromised people.

The very first signs of the disease are itching, burning and tingling at the site of future rashes. After a few days, characteristic blisters appear, which soon burst, forming crusts. The rashes usually appear on one side of the body and can be localized on the back, abdomen, chest, face and even in the eye or genital area.

What you need to know about herpes zoster

This virus causes inflammation in the nerve endings through which the infection spreads, and manifests itself as painful rashes, usually located on one side of the body, which gives the disease a characteristic appearance – strip-like rashes. It is important to note that herpes zoster is quite contagious, and the virus can be transmitted from person to person, especially in the presence of open vesicles.

The symptoms of the disease can range from mild to very severe. In some cases, herpes zoster can lead to complications such as postherpetic neuralgia, which further emphasizes the importance of timely diagnosis and treatment. If you feel burning, tingling, or see the appearance of painful rashes, it is important to see a doctor immediately to avoid spreading the virus and minimize the risk of complications.

How is shingles transmitted?

Shingles is transmitted through direct contact with the affected skin, especially when blisters appear on the skin. This is important because the virus can be transmitted even before the rashes are visible, when they are not yet visible but the virus is already active in the body.

Herpes zoster can infect other people, especially those who have never had chickenpox, because chickenpox and herpes zoster are caused by the same virus. Therefore, a person infected with herpes zoster can pass the virus to others, making the disease easily susceptible in families and in public places.

The main modes of transmission are:

• Contact with open vesicles on the skin.
• Coughing, sneezing, and other ways of transmitting the virus through saliva.
• Sexual contact if the rashes are in the genital area.

Symptoms of shingles

Herpes zoster symptoms can vary depending on the severity of the disease and its localization. In the early stages of the disease, a person may feel itching, burning, tingling or pain in the area where the rashes will later appear. These symptoms usually precede the appearance of characteristic fluid-filled blisters.

After the blisters burst, crusts form in their place. The healing process can take from a few weeks to two months, depending on the patient’s health and the treatment used.

Symptom	Description
Burning, pain, or itching 🔥	These sensations usually occur at the onset of the disease in the area where the rash will later appear.
Appearance of blisters 💧	A few days after the burning sensation, blisters filled with fluid start to form on the skin.
Bursting of blisters and scab formation 🦠	The blisters burst, and crusts form in their place. This process is part of natural healing.
Persistent pain 💥	After the rash disappears, pain may persist for weeks or even months (postherpetic neuralgia).
Fever and headache 🤒	In rare cases, shingles may be accompanied by a fever and headache.

Who gets shingles most often

Certain factors increase the likelihood of herpes zoster. The main ones include:

• Age: People over 50 are at greater risk because the immune system weakens with age.
• Immunodeficiency states: diseases such as HIV, cancer, and taking drugs to suppress the immune system (e.g., after organ transplantation) may contribute to virus activation.
• Stress and chronic illnesses: prolonged stress, overwork and chronic illnesses can weaken the immune system and trigger a recurrence of the virus.
• Poor hygiene and frequent infections: poor diet, vitamin deficiencies and poor hygiene can contribute to the development of the disease.

Diagnosis of shingles

What are the main signs of shingles and how to identify shingles? Diagnosis of herpes zoster is primarily based on the characteristic symptoms of the disease and clinical examination of the patient. The doctor can recognize herpes zoster by the appearance of rashes – fluid-filled vesicles usually appear along the course of nerve fibers and are the main signs.

However, additional tests may be performed to confirm the diagnosis and rule out other diseases:

• Laboratory tests: analysis of scrapings from affected skin, PCR (polymerase chain reaction) or virologic tests can confirm the presence of herpes virus type 3.
• Antibody test: it detects the presence of antibodies to the herpes virus, which may indicate that you have had chickenpox or that the virus has been activated in your body.
• Blood tests: may be useful to rule out other diseases and to assess the immune system.

It is important to note that if herpes zoster is suspected in the eye or genital area, further evaluation may be performed to rule out complications such as uveitis or nerve damage.

Shingles treatment

Treatment of herpes zoster is aimed at reducing symptoms, shortening the duration of the disease and preventing complications. The main methods of treatment are:

Pharmacy remedies for the treatment of shingles

The drug	Type	Dosage	Estimated price	Description
Acyclovir (Zovirax)	Antiviral drug	200 mg – 25 tablets.	145-155 UAH	The main drug for the treatment of herpes zoster. Slows the multiplication of the virus and accelerates healing.
Valacyclovir (Valtrex)	Antiviral drug	500 mg – 10 tablets.	180-250 UAH	Effective in the early stages of the disease. Reduces the intensity of symptoms and accelerates recovery.
Famciclovir (Famvir)	Antiviral drug	250 mg – 7 tablets.	350-450 UAH	The drug used to treat herpetic infection reduces the duration of the disease and its manifestations.
Ibuprofen (e.g., Nurofen)	Analgesic	200 mg – 20 tablets.	20-40 UAH	Used to relieve pain syndrome in herpes zoster. It has antipyretic and anti-inflammatory effect.
Paracetamol	Analgesic	500 mg – 20 tablets.	15-30 UAH	Used to relieve pain and reduce fever. Effective for mild pain and fever.
Lidocaine ointment	Local anesthetic agent	5% – 30 grams	40-60 UAH	It is used for local anesthesia. Relieves itching and pain in the area of rashes.
Hydrocortisone ointment	Кортикостероидное средство	1% – 15 grams	30-50 UAH	Used to reduce inflammation and itching, but should only be prescribed by a doctor.

IMPORTANT: All medications should only be prescribed by a doctor.

Folk remedies for shingles

Here are some folk remedies that are traditionally used to alleviate the symptoms of herpes zoster:

Herbal Remedy	How to Use	Effectiveness
Tea Tree Oil	Apply a few drops of the oil to the affected areas of the skin using a cotton pad.	Helps reduce inflammation and promotes healing, but does not replace antiviral treatments.
Aloe Vera	Apply fresh aloe gel to the affected areas several times a day.	Reduces inflammation, speeds up wound healing, but does not have antiviral activity.
Garlic	Chew a garlic clove or apply its paste to affected areas (but avoid prolonged skin contact to prevent irritation).	May improve the condition slightly, but there is insufficient scientific evidence of its effectiveness against herpes.
Lavender Oil	Apply a few drops of lavender oil to the affected areas of the skin.	Helps relieve pain and itching but does not eliminate the virus itself.
Calendula Tincture	Use calendula tincture to wipe the affected areas of the skin.	Helps alleviate symptoms but does not have antiviral activity.

Should we trust folk remedies?

Folk remedies for herpes zoster may only be useful for relieving symptoms such as itching, pain and inflammation, but they cannot completely replace mainstream herpes zoster treatment, which should include antiviral medications. At this time, there is no scientific evidence to support the effectiveness of folk remedies in the complete treatment of herpes. It is important to remember that in the absence of proper treatment, the disease can cause complications such as postherpetic neuralgia or eye damage.

Recommendations:

1. Do not replace the main drugs with folk remedies: The use of folk methods should only be an addition to the main treatment prescribed by the doctor.
2. Consult your doctor: Before using folk remedies, especially if you are on medication, it is important to consult your doctor to avoid possible side effects or interactions.
3. Use folk remedies with caution: Some substances can cause allergies or skin irritation, so it is important to test them on a small area of skin before use.

In general, folk remedies can relieve symptoms, but the main treatment for herpes zoster should be based on antiviral therapy.

Possible complications of shingles

Complication	Description	Treatment
Postherpetic neuralgia (PHN)	Chronic pain that persists after the rash has disappeared, often at the site of localization. It may last for weeks or months.	Use of gabapentin, pregabalin, capsaicin creams, antidepressants (e.g., amitriptyline).
Ophthalmic herpes (eye lesions)	The virus can infect the eye nerves, causing inflammation of the cornea or other parts of the eye, which can lead to vision loss.	Antiviral drugs (acyclovir, valacyclovir), topical drugs (eye drops with corticosteroids), antibiotics in case of secondary infection.
Bacterial skin infections	Secondary infections arising from scratching the vesicles or breaking their integrity, leading to purulent inflammation.	Antibiotics to treat bacterial infections, hygiene practices.
Neurological complications	Rare but severe complications such as meningitis, myelitis, or encephalitis, which affect the central nervous system.	Intensive therapy with antiviral drugs, hospitalization, supportive therapy.
Internal organ damage	The virus can affect internal organs such as the lungs (pneumonitis) or liver (hepatitis), especially in immunocompromised people.	Hospitalization, intensive treatment with antiviral drugs, supportive therapy in hospital conditions.

Известы случаи

Prevention

Prevention of shingles includes both strengthening the immune system and protection from factors that contribute to the activation of the virus:

1. Vaccination:
   • There is a vaccine against herpes zoster that is recommended for people over the age of 50. Vaccination helps to reduce the risk of the disease and reduce the severity of symptoms when the disease occurs.
   • Children and adults who have not had chickenpox in childhood should also be vaccinated against chickenpox, as chickenpox is the cause of herpes zoster.
2. Strengthening the immune system:
   • A proper diet with enough vitamins and minerals, regular exercise and enough rest help keep your immune system at a high level.
   • Avoiding stress and depression, as they weaken the immune system and can trigger an outbreak of the virus.
3. Personal hygiene:
   • It is important to keep the skin clean and avoid contact with open blisters on the body of a sick person. Contact with people who have recently had chickenpox should also be avoided.

Shingles in the elderly

The elderly are one of the most vulnerable groups to the development of herpes zoster. This is due to the natural decline in immune function with age, which contributes to the activation of the latent virus. For older people, it is important to see a doctor in time at the first signs of the disease in order to start treatment as early as possible.

Features of treatment of herpes zoster in the elderly:

• Older patients are more susceptible to complications such as postherpetic neuralgia, making treatment more difficult.
• Antiviral drugs can be prescribed in standard doses, but in case of chronic diseases or poor kidney function, the doctor may adjust the dosage.
• An important point is the reduction of pain syndrome, which can be more pronounced in the elderly.

When to see a doctor?

If you notice symptoms of herpes zoster, such as burning, itching, pain, or blisters on the skin, you should see a doctor immediately. It is especially important to seek help if you suspect that the infection may have spread to your eyes, genitals, or other sensitive areas.

Shingles in children: possible features

Although herpes zoster most often occurs in the elderly, children can also develop the disease. It is important to realize that children are not the main risk group for this disease, as most children contract chickenpox before the age of 12. However, the herpes virus that remains in the body after chickenpox can be activated under any conditions if the child’s immune system is weakened, for example due to illness or stress.

Features of the disease in children:

• The virus can become active after chickenpox if the immune system is weakened.
• The main symptoms are similar to those observed in adults: painful sensations, itching, rashes on the skin.
• Treatment in children will differ in the dosage of medication, and other pain relievers may be used, as children are often more sensitive to pain.

How to help children with shingles:

• Seek medical attention immediately to prescribe appropriate treatment.
• Monitor the child’s condition to avoid complications such as eye or nervous system damage.
• Use topical agents to relieve pain, such as creams with anesthetic ingredients.

What to look for when treating shingles?

When it comes to treating shingles, it’s important to follow a few key guidelines to avoid recurrences and speed recovery:

1. Start treatment as early as possible:
   • The sooner treatment with antiviral medication is started, the sooner the infection will go away and the chance of complications will be reduced. Treatment should be started within the first few days of the onset of symptoms.
2. The use of antiviral medications:
   • It is obligatory to follow the doctor’s recommendations on dosage and duration of the course. Independent discontinuation of the medication may lead to a relapse of the disease.
3. Utilization of local funds:
   • It is important not only to treat the infection, but also to relieve pain symptoms. For this purpose, topical anesthetic ointments and creams as well as antibacterial agents are used to avoid secondary infections.
4. Avoid stress:
   • Stress can be a factor in the activation of the virus. Try to create a comfortable environment for the patient, avoid nervousness and monitor the psycho-emotional state.
5. Immune system control:
   • Maintaining a normal immune system plays a key role in preventing recurrence of the disease. It is recommended to follow a healthy lifestyle, nutritious diet and daily regimen.
6. Monitor the condition of the skin:
   • It is important not only to use antivirals, but also to monitor the condition of the skin. Do not scratch the blisters or disturb their integrity, as this can lead to infection and other complications.

Frequently Asked Questions (FAQ)

How long does shingles last?1. How long does shingles last?

• The duration of the disease is usually 2 to 4 weeks, but postherpetic neuralgia can last longer.

Can shingles come back?2. Can shingles come back?

• Yes, the virus remains in the body after the first episode of illness, and it can reactivate if the immune system is weakened.

Can shingles be prevented?3. Can shingles be prevented?

• To prevent herpes zoster and its complications, the Shingrix vaccine is recommended for healthy adults over the age of 50. The vaccine may also be recommended for people over 19 years of age with weakened immune systems. The vaccination is given in two stages.

Can I get shingles from a sick person?4. Can I get shingles from a sick person?

• Yes, herpes zoster is contagious, especially during active rashes. It is important to avoid contact with the affected skin.
  • If you already have shingles, you can reduce your risk of spreading the virus to others by following a few guidelines:
• Avoid contact with people who are immunocompromised.
• Do not socialize with anyone who has not had chickenpox or has not been vaccinated against it, especially if these people are pregnant.
• Beware of contact with premature babies or babies with low birth weight.
  • Additional Measures:
• Keep the rash covered.
• Do not touch or scratch the rashes.
• Wash your hands often.

What are the dangers of shingles?5. What are the dangers of shingles?

• Herpes Shingles can lead to serious complications such as postherpetic neuralgia, eye damage and visual impairment.

Coolaser Clinic reminds you that herpes zoster is a disease that can have a significant impact on a patient’s quality of life, especially if it is not treated in a timely manner or if it leads to complications. Timely diagnosis and treatment with antiviral medications, as well as compliance with preventive measures, can help to avoid serious consequences.

If you or a loved one suspects shingles, do not delay a visit to the doctor. The earlier you start treatment, the easier it will be to get through this period and avoid further complications.

Sources:

• www.cdc.gov
• medlineplus.gov