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Shingles

Definition


Disease: Shingles Shingles
Category: Infectious diseases
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Disease Definition:

The viral infection that causes a painful rash is known as shingles. It usually appears as a band of blisters that wraps from the middle of the back around one side of the chest to the breastbone, but in some cases, the shingles rash may develop around one eye or on one side of the neck or face. However, it could occur anywhere on the body.

The same virus that causes chickenpox, which is the varicella-zoster virus, also causes shingles. After a person has had chickenpox, the virus will lie in nerve tissue near the spinal cord and brain inactively, but after years, it may become active again and cause shingles.

Shingles could be very painful, despite the fact that it’s not a life-threatening condition. In order to reduce the risk of shingles, vaccines are available, and to help shorten a shingles infection and lessen the chance of complications, early treatment is necessary.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

In most cases, only a small section of one side of the body is affected by the signs and symptoms of shingles. Some of those signs and symptoms may be:

  • Itching
  • Numbness, tingling, pain or burning
  • Fluid-filled blisters that break open and crust over
  • A red rash that begins a few days after the pain


Some of the other signs and symptoms of shingles may be:
 

  • Headache
  • General achiness
  • Fatigue
  • Fever and chills


Usually, the first symptom of shingles is pain, which could be intense in some cases. The pain may be mistaken for a symptom of problems that affect the heart, kidneys or lungs, depending on its location. In some cases, people may never develop the rash, but experience the pain nevertheless.

In case someone suspects shingles, they should contact a doctor, especially if:
 

  • The rash is widespread and painful
  • The pain and rash occur near the eyes. This condition could end up causing permanent eye damage if it's left untreated
  • The person or someone in their family has a weakened immune system because of cancer, chronic illness or medications.

Causes:

The same virus that causes chickenpox, which is varicella-zoster, also causes shingles. Shingles may occur in anyone who's had chickenpox, because after recovering from chickenpox, the virus could enter the person’s nervous system and lie there hidden for years. The virus may reactivate eventually and travel along nerve pathways to the skin, where it produces shingles.

Why shingles recurs is still not known. Some believe that it may be because of lowered immunity to infections as people grow older. In older adults and in people who have weak immune systems shingles is more common.

The group of viruses known as the herpes viruses that include the viruses that cause cold sores and genital herpes also include the varicella-zoster virus. This is why shingles is also called herpes zoster. However, the virus that causes cold sores or genital herpes, which is a sexually transmitted disease, is not the same virus that causes chickenpox and shingles.

People who haven't had chickenpox could contract the varicella-zoster from anyone who has shingles, which usually occurs through direct contact with the open sores of the shingles rash. However, once the person becomes infected, he/she won't develop shingles, but chickenpox.

For some groups of people, chickenpox could be quite dangerous. A person will be contagious until their shingles blisters scab over. During this time, they should avoid physical contact with newborns, pregnant women and people who have weak immune systems.

Some of the factors that put people at risk of developing shingles are:

Weakened immune systems:
People who are at higher risk of developing shingles are those with weakened immune systems. Some of the factors that cause the immune system to become weak are:

  • Drugs that are designed to prevent rejection of transplanted organs
  • Cancer or cancer treatments, including chemotherapy and radiation
  • HIV/AIDS
  • Prolonged use of steroids, such as prednisone


Chickenpox:
Shingles could occur in anyone who has had chickenpox.

Age:
The risk of shingles increases with age. The condition is most common in people over the age of 50. It has been estimated that half the people who live to the age of 85, at some point in their lives will experience shingles.

Complications

Complications:

Complications that occur from shingles range from mild, such as minor skin infections, to severe, such as postherpetic neuralgia.

Neurological problems:
Shingles may cause facial paralysis, encephalitis, which is an inflammation of the brain, or hearing or balance problems, depending on which nerves are affected.

Postherpetic neuralgia:
The pain of shingles may continue in some cases long after the blisters have cleared. When damaged nerve fibers send confused and exaggerated messages of pain from the skin to the brain, this condition occurs, which is known as postherpetic neuralgia. Until the pain subsides, the patient may use pain medication, anticonvulsant medications or antidepressants, which provide relief.

Skin infections:
Bacterial skin infections may develop in case the blisters of shingles aren't treated in a proper way.

Vision loss:
Vision loss could be caused when shingles that occurs in or around an eye (ophthalmic shingles), causes painful eye infections.

Treatments:

Even though prompt treatment of shingles can ease pain, speed healing and reduce the risk of complications, but usually, an episode of shingles heals on its own within a few weeks.

Antiviral Medications:
Some examples of oral antiviral medications are valacyclovir, famciclovir and acyclovir. If someone starts taking these medications within 72 hours of the first sign of the shingles rash, they will get the best results.

Pain Relievers:
Someone may need prescription medications because shingles can cause severe pain. Some of those medications may be:
 

  • Anticonvulsants, such as gabapentin  
  • Narcotics, such as oxycodone
  • Numbing agents, such as lidocaine, which could be delivered via a cream, skin patch, gel or spray
     

Prognosis:

Not Available

Expert's opinion

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Consultants Corner

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

Dr. Faisal Dibsi

Dr. Faisal Dibsi Specialist of Otolaryngology - Head and Neck Surgery

Dr . Dirar Abboud

Dr . Dirar Abboud Hepatologist – Gastroenterologist

Dr. Talal Sabouni

Dr. Talal Sabouni UROLOGY AND KIDNEY TRANSPLANT

Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology

Dr. Tahsin Martini

Dr. Tahsin Martini Degree status: M.D. in Ophthalmology

Samir Moussa M.D.

Samir Moussa M.D. ENT Specialist

Dr. Samer Al-Jneidy

Dr. Samer Al-Jneidy Pediatrician
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