Dear Alice,

What are shingles?

— Construction worker

Dear Construction worker,

Shingles, or herpes zoster, is a painful rash of small, fluid-filled blisters that eventually dry out, form a crust, and sometimes leave scars. Shingles derive from the varicella-zoster virus (the same virus that causes the chickenpox). Almost one third of Americans will develop shingles at some point, and there are approximately one million new cases annually in the United States. Although two thirds of shingles patients never experience nerve pain, it’s important to treat the virus as soon as possible — not only can shingles spread on your own body, it is also contagious to those who have never been exposed to the chickenpox virus.

Shingles symptoms include:

  • Red, itchy rash with fluid-filled blisters, often on one side of the abdomen or near an eye.
  • Pain, tingling, burning, and itchiness.
  • Fever or chills.
  • General achiness, fatigue, headache, and upset stomach.

Note that symptoms do not always manifest simultaneously. For example, some shingles sufferers experience pain without the rash, or vice versa. Make sure to be as descriptive as possible when discussing any symptoms with a health care provider. S/he may examine tissue or a culture from active blisters for laboratory testing to ensure an accurate diagnosis.

If left untreated, shingles can lead to serious nerve damage and pain that can last for months to years, including vision loss, neurological problems, and skin infections. Treatments include analgesics and antiviral drugs prescribed by a physician. Usually, most varicella-zoster viral organisms are destroyed following a bout of the chickenpox in childhood. However, some of these organisms can survive and lay dormant in the body for years, manifesting later in life as shingles during times of immune weakness. For this reason, shingles can more severely affect individuals with chronic illness, people taking immunosuppressive drugs, and those over the age of 50 with compromised immune systems. Individuals with active shingles outbreaks are contagious and should avoid direct contact with newborn babies, pregnant women, and those who have weakened immune systems. Shingles is spread through direct physical contact with open sores or blisters.

Fortunately, there are two vaccines that can keep the virus at bay. First, there’s the chickenpox vaccine, called Varivax, which most children receive during routine pediatric immunization appointments. Adults who have never had the chickenpox are also recommended to receive this vaccine. For individuals age 50 and over, the Food and Drug Administration (FDA) has also approved the use of the shingles vaccine, called Zostavax. Although neither of these vaccines guarantees immunity, they can both help to reduce the onset, duration, and severity of outbreaks. Washing your hands well and often can also help prevent infection.

If you’re experiencing symptoms, interested in being vaccinated, or if you would like to learn more about shingles, contact your health care provider. For more general information, check out the Center for Disease Control and Prevention’s shingles website.


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