Shingles (Herpes Zoster)

Shingles (herpes zoster) refers to a painful skin rash caused by the varicella-zoster virus, which belongs to the herpes virus family. If the affected person comes into contact with the varicella-zoster virus for the first time, chickenpox (varicella) occurs. Characteristic of herpes viruses is that they remain in certain parts of the nervous system despite having survived the infection. If they are activated again, this results in shingles. Vaccination against chickenpox also does not provide reliable protection.

Both chickenpox and shingles are highly infectious to people who have not yet come into contact with the virus. Any age group can be affected by shingles, although older or immunocompromised patients (such as tumor patients or those infected with HIV) are more susceptible. Shingles most commonly occurs between the ages of 50 and 70.

The trigger for shingles (zoster) is an infection with the varicella-zoster virus. If initial contact occurs, the patient contracts chickenpox (varicella). Once the disease has been contracted, the virus moves along the nerve pathways to the nerve roots and remains there in a stage that doctors call "dormant". More than 95 percent of all adults have this virus, which can be reactivated later in life. If this is the case, the virus moves back along these nerve pathways to the skin and triggers the clinical picture there.

Zoster can also be caused by a weakened immune system. The main risk group includes HIV-infected persons, patients taking chemotherapy or immunosuppressants or suffering from malignant tumours.

Furthermore, factors such as stress, a severe flu and sun exposure can be triggering.

• In the early stages, in addition to the classic symptoms such as tiredness and fatigue, shingles has a burning sensation on the nerve tracts. These spots (dermatomes) are mainly found in the torso area, where they run in a belt shape from the spine towards the sternum. The pain triggered by shingles, as well as the subsequent skin rash, usually only occur on one side of the body, depending on the course of the affected nerve tracts.
• After two to three days, the characteristic skin rash also appears. This manifests itself as small blisters on a swollen and reddened surface. The rash is similar to chickenpox, but is confined to a specific area.
• The peak of the rash is reached after about two to seven days. Blisters burst open and small sores develop, which over time become covered in scabs that fall off after two to three weeks.
• Along with the rash, fever may also occur.
• In some cases, there may also be swelling of the surrounding lymph nodes.
• Some patients may still suffer from pain, called nerve pain (postzosteric neuralgia), in the once affected area of the body weeks or months later. This pain usually occurs when treatment was too late or inadequate. Age is also a decisive factor. Especially older people suffer from this pain lasting months to years.

The medical history is often sufficient to diagnose shingles. Together with the characteristic half-sided, clearly demarcated rash, the doctor can quickly conclude that shingles is present. In most cases, no further tests are needed.

However, if the doctor is not sure about the diagnosis, the viruses of shingles can be detected by a wound swab or antibodies against the virus in the blood. But even this method is not 100 percent reliable, because people who have had chickenpox in childhood always show antibodies in their blood. The doctor must also rule out an underlying disease that weakens the immune system and can therefore be the trigger for shingles.

If shingles is suspected, a doctor should be consulted immediately. Afterwards, medication should be taken as soon as possible in order to prevent the viruses from multiplying (viral drugs such as aciclovir or brivudine). These measures shorten the course of the disease and prevent possible secondary damage and nerve pain.

It is also important that the medication is taken within a few hours. Painkillers can be used to relieve any pain that may occur.

If the treatment is given too late, the affected person will still have to deal with severe and persistent nerve pain (postzoster neuralgia) weeks later. Such pain is usually treated with strong painkillers combined with antidepressants that promote analgesic effects.

Drugs that are actually used to treat epilepsy (antiepileptic drugs) can also be helpful. These include the active ingredients carpamazepine or gabapentin. Ointments containing a local anaesthetic or capsaicin can also provide pain relief.

Normally, shingles heals within a few weeks in patients with an undamaged immune system. In older people, secondary pain is more common. In this group, up to 70 percent suffer from postzosteric neuralgia.

In rare cases, the following complications may occur:

• Scarring
• If the eyes are affected, scarring of the cornea may occur.
• Infestation of the facial nerves can cause hearing loss, paralysis of the facial muscles (facial paresis) and loss of the sense of taste.
• Generalized herpes zoster is when the entire body is affected. This form of shingles mainly affects people with a weak immune system and can lead to life-threatening organ damage.

If the first contact with the varicella-zoster virus always occur chickenpox. This is also the case in adulthood. Therefore, if there is no chickenpox disease, any contact with people with shingles should be avoided.

People who are at increased risk of contracting the severe form of shingles can consider preventive treatment. This must take place within four days of contact with an infected person. Pregnant women and immunocompromised persons (cancer, chemotherapy, immunosuppression and AIDS) are at increased risk. There is the option of a one-time infusion containing antibodies against the varicella-zoster virus (zoster immunoglobulin) or a seven-day treatment with a drug that stops viruses from multiplying (virustatic agent).

People who have a normally intact immune system but have not been vaccinated against chickenpox can be vaccinated within three days of a supposed infection (active immunization). This vaccination does not promise 100% protection against shingles, but if it does occur, it runs much more smoothly.