Shingles Frequently Asked Questions
1. What is shingles?
Shingles -- also called varicella-zoster -- is a painful skin disease caused by a reactivation of the chickenpox virus. It is distinctive because it affects only one side of the body. The early signs of shingles usually develop in three stages: severe pain or tingling, possibly itchy rash, and blisters that look like chickenpox.
2. Who gets shingles?
Shingles is very common. Fifty percent of all Americans will have had shingles by the time they are 80. While shingles occurs in people of all ages, it is most common in 60- to 80-year-olds.
3. How can I tell if I have shingles?
The first symptoms usually include burning, itching, or tingling sensations on the back, chest, or around the rib cage or waist. In other cases, it can be the face or eye area that is involved. The affected area can become extremely painful. This is when most people go to the doctor to find out what is causing the pain. In two or three days, a telltale rash develops in a single area on one side of the body. The rash erupts into small blisters. With all these symptoms, it is extremely likely that you have shingles.
4. What causes shingles?
Shingles is caused by a germ called the varicella-zoster virus -- the one that gave you chickenpox when you were a child. As you recovered from chickenpox, the sores and other symptoms healed, but the virus remained. You carry it in the nerve cells around your spine for the rest of your life. The virus can reactivate, especially in the later years of your life when your immunity is less resistant to infections. The virus travels from the spinal nerve cells and follows a nerve path out to the skin. Nerve endings in the skin become inflamed and erupt in a very painful rash.
5. Does stress bring on shingles?
Stress, by itself, does not cause shingles outbreaks. But many shingles patients report they have recently had a stressful event in their lives.
6. I have never had chickenpox. How careful must I be to avoid getting shingles from somebody?
Unlike chickenpox, with shingles, the virus is NOT transmitted by someone breathing or coughing on you. You have to come in contact with the blister fluid itself. Once the blisters scab over, the contagious period is ended. If you never had chickenpox and were exposed to someone with shingles, you could get chickenpox -- not shingles. Ask your doctor whether the chickenpox vaccine would be advisable to prevent your getting chickenpox.
7. Is shingles contagious?
For people who have had chickenpox, shingles is not contagious. However, if you have never had chickenpox, contact with someone who has shingles could give you chickenpox. The fluid from their open blisters is infectious. Your doctor may suggest giving you the chickenpox vaccine if you are exposed to someone with shingles.
8. What is it like to have shingles?
"A burning, tingly feeling is what I noticed first," said an elderly woman describing her symptoms. "I looked in the mirror, and there was a rash on just one side of my back. Then the shooting pains started. Days later, I could hardly stand to have my clothes touching me. I thought maybe I had hives or poison ivy," she said, "until I went to the doctor."
9. Why is shingles so painful?
When the shingles virus reactivates, it travels through nerve fibers, from the spine out to the skin. Inflammation along the nerve path causes the rash. And because the inflammation is in a nerve, it causes pain.
10. Can you get the rash all over your body?
Shingles blisters tend to cluster in one specific area, rather than being scattered all over the body, like chickenpox. The rash erupts along a single nerve path that the virus follows outward from the spine.
11. Are there people who get shingles without a rash?
Some people get the pain but never develop the rash. These cases are much more difficult to diagnose and can be mistaken for other diseases. Your doctor would need to do a blood test to confirm the diagnosis. If there is a rash, but the diagnosis is questionable, skin scrapings from the sores can be used.
12. How long can it take for the symptoms to go away?
A week or two after the blisters erupt, the oozing sores will begin to crust over. The sores are usually gone after another two weeks. The pain usually decreases over the next few weeks, but some patients may have pain for months -- sometimes, for years.
13. Can I get shingles again?
You are not likely to ever get it again. In healthy people, a second outbreak happens very rarely.
14. Is it important to see a doctor?
Yes. First, it is helpful to have your doctor confirm that shingles is the actual cause of the pain. Next, if the doctor can start you on antiviral medication within 72 hours of the outbreak, it reduces the pain and speeds healing.
15. What treatments are there for shingles?
You get shingles when the chickenpox virus reactivates in your nerve cells, which causes nerve damage. Antiviral medication weakens the virus and may reduce the severity of the nerve damage. At the early stage of shingles, a doctor will usually prescribe antiviral pills along with painkillers. Sometimes the pain continues after the sores have healed. This persistent pain may be treated with an anti-seizure drug called gabapentin, pain-numbing patches, and tricyclic antidepressants.
16. Do the medicines cure shingles?
The treatments we have now are a huge improvement over what was available 25 years ago. However, they are not a cure. The antivirals weaken the virus and its effects, but the disease still tends to run its course.
17. Why does the doctor tell you to keep your fingernails cut short?
Secondary bacterial infections can be a problem, so it is very important to keep the affected area clean. Keeping the fingernails well trimmed makes it easier to keep them clean and reduces scratching.
18. What is postherpetic neuralgia?
If the pain is severe and persists for months or years, it is called postherpetic neuralgia. It can be truly debilitating, and unfortunately, it is common in people over 60.
19. What are the other complications?
Outbreaks that start on the face or eyes can cause vision or hearing problems. Even permanent blindness can result if the cornea of the eye is affected. Bacterial infection of the open sores can lead to scarring. In a small number of cases, bacteria can cause more serious conditions, including toxic shock syndrome or necrotizing fasciitis, a severe infection that destroys the soft tissue under the skin. The constant pain, loss of sleep, and interference with even basic life activities can cause serious depression. In patients with immune deficiency, the rash can be much more extensive and the illness can be complicated by pneumonia. These cases are more serious, but they are rarely fatal.
20. Why do we not hear much about shingles if it is so common?
Until relatively recently, shingles got little attention because no effective treatments were available, and nothing was known about prevention. Research is changing all that.
21. Why do some people call shingles "zoster"?
The scientific name for the virus that causes chickenpox and shingles is varicella-zoster virus. "Varicella" is the Latin word for "little pox." The term "zoster" comes from the Greek word for "girdle," which relates to the most common area for a shingles outbreak.
22. Why is the varicella-zoster virus referred to as a herpes virus?
Herpes viruses have two main characteristics: they stay with you for life, and they cause spreading skin eruptions. The virus that causes chickenpox and shingles fits that description perfectly.
23. Why does the virus that causes shingles reactivate in some people?
The virus seems to need a combination of risk factors in order for a reactivation to be triggered. The usual factors are an aging immune system combined with illness, stress, or even sunburn.
24. Why does one person with these risk factors get shingles while another does not?
Doctors cannot always be sure what the trigger is in each case. They don't know why the virus reactivates in one person with these risk factors, while in another person with the same risk factors, it does not. Researchers know that the varicella-zoster virus behaves differently from other viruses, such as the flu virus. Our immune system usually kills off invading germs, but it cannot completely knock out this type of virus. The virus just becomes inactive. Years later, this virus reactivates if your aging immune system is further weakened by any of the other risk factors. If a person has a particularly severe immune deficiency, the shingles can even recur. Researchers would really like to understand why some people are NOT susceptible to shingles.
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