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Shingles is a type of herpes virus. The herpes viruses are a group of viruses which make up lots of different kinds of illnesses. These include cold sores, genital herpes and chickenpox. Shingles is caused by the chickenpox form of herpes virus (Human Herpesvirus-3 [HHV-3]).
It is estimated that around 90% of adults in the UK will have had chickenpox as a child and are therefore immune. They may have caught the virus and had 'classic' chickenpox, or they may have had no symptoms at the time. The virus then lays dormant in nerves for years.
Shingles is caused by the reactivation of the virus in a specific nerve. This can be due to increased stress or illness weakening the immune system and allowing the virus to take hold again.
When the virus becomes reactivated and causes symptoms, a painful rash is produced along the area of skin that the affected nerve supplies. This is what is classically known as shingles.
Shingles is really common. Around 25% of people will get shingles at least once in their lifetime.
You are more likely to get a flare-up of shingles as you get older. You are also more likely to get shingles if you have a weak immune system. For example, people who have had bone marrow transplants or have HIV are far more likely to suffer from a shingle outbreak than people with 'normal' immune systems.
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If you have shingles, you will get symptoms which evolve over time. This can be split into distinct phases. The first phase is where the virus is multiplying, but no rash has formed yet, and is known as the 'pre-eruptive phase'.
The second phase is where the rash is forming and developing and is known as the 'eruptive phase'.
The final phase is not experienced by everyone, but it's where the rash has resolved, and people have long-term, ongoing pain. This third phase is known as 'post-herpetic neuralgia'.
You may or may not be able to identify something which has caused your immune system to weaken, leading to the shingles (herpes virus) being able to start an infection in your nerve. Whilst the infection is taking hold, there isn’t a rash. You will have other vague symptoms of a viral infection. These include:
You may also have pain along the nerve which is affected. Most people will have some kind of burning sensation, itching, or pins and needles along the area that the nerve normally supplies. Some people, however, have none of these symptoms.
This is the phase where a rash develops. The 'eruption', or rash, is typically made up of small fluid-filled blisters on inflamed skin. These blisters form crusts and dry over a period of around 7 to 10 days, before falling off by about 3 weeks, following the start of the rash.
The skin rash usually is very painful, with a burning sensation and pins and needles. Rarely, people can have the feeling of the rash without any of the blisters. This is known as Zoster Sine Herpete. Generally, it is younger people who tend to get this type of shingles, but it is rare.
We all have a nerve which supplies each side of the body. These nerves only track along very defined spaces – in a line from your spine around to your front. They never cross onto the other side of your body. It is because of this fact that when you get shingles affecting a nerve, the rash stays in the one specific place. It forms a line from your back around to your front and does not cross over onto the other side of your body. However, you can get shingles in more than one nerve at the same time, but this is uncommon.
If you have a weak immune system, you are more likely to have severe forms of shingles. These can last for more extended periods, and cause a more angry rash. If you are immunocompromised, you are also more likely to suffer with post-herpetic neuralgia.
Post-herpetic neuralgia is where people have ongoing pain after suffering shingles, even after the rash has gone away. Around 1 in 5 people who have had shingles will suffer with some kind of post-herpetic neuralgia.
In most people, this type settles within a year. Some people, however, will have it for many years or permanently.
Post-herpetic neuralgia can be very difficult to treat. There is no cure, but the condition can be managed with painkillers. Standard painkillers, such as ibuprofen or paracetamol, do not usually work. If you have ongoing pain after suffering with shingles, then you should see your GP, as they can prescribe painkillers which work better for this type of pain.
Anti-depressants can sometimes be used to treat the pain associated with post-herpetic neuralgia. Still, again, you will need to see your GP to be prescribed them. If your GP is unable to control the pain, they may refer you to a specialist pain clinic.
Some self-help things you can try include wearing comfortable clothing, such as cotton or silk, and using ice packs.
Chronic nerve pain, like post-herpetic neuralgia, can be quite disabling. In rare cases, people will suffer with the pain for long periods, and it can affect their everyday life. Treatments for the pain are aimed at reducing it, rather than eliminating it.
The National Institute for Clinical Excellence is a clinical body in the UK that issues guidance to doctors on how to treat different medical conditions. They have put together an information guide on nerve pain for patients. This includes a list of questions that you can ask your doctor.
There isn’t anything you can do to reduce your risk of getting post-herpetic neuralgia. If shingles is identified early on, and you are started on antiviral medication quickly, then there is a possibility that you are less likely to get it.
At the moment, research done into post-herpetic neuralgia does not show any benefit in getting antiviral medications, but this may change in the future. People who are immunocompromised, or who are older, are more likely to get it than others.
Just under 20% of shingles will involve the nerve which goes over your eye and forehead. This type of shingles is known as ophthalmic shingles. Ophthalmic shingles can cause problems with your eyesight, and as a result, it is important for you to see a doctor the same day that it starts.
If you get shingles affecting the nerve over your eye, this does not necessarily mean that your eye will be affected. Around a quarter of people who have this type of shingles won’t have any issues with their eye. Around 70% of people, however, will end up with the eye being affected in one way or another.
Symptoms that your eye may be involved include:
The nerve which deals with sensation over your forehead and eye is called the trigeminal nerve. This nerve actually supplies sensation to the whole of your face, but it splits, and one part of it is responsible for the forehead and front of your eye. Another part of this nerve goes behind your eye and is responsible for a little patch of skin at the bottom of your nose. If this part of the nerve is affected, you may only notice a small rash at the tip of your nose, but because this nerve goes behind your eye, it can also cause problems with your eye. Again, if you notice that you are having any issues with your eye, or you think that you may have shingles affecting this nerve, it is important to see a doctor the same day.
You may not get issues with the eye straight away in this type of shingles. You may develop eye symptoms weeks after the rash has gone away. If you have had shingles affecting the face and develop eye symptoms within the following months, call NHS 111 for advice.
Most of the time, tests aren’t needed to diagnose shingles. The rash itself is all a doctor needs to see to make the diagnosis.
If you have a weakened immune system and the rash is severe, it can sometimes be challenging to make a diagnosis. In these cases, some samples may be taken from the rash and sent to a lab to investigate further. This test is rarely needed.
As shingles is caused by a viral infection, treatment for shingles is with antiviral medications. These medications reduce the amount of time that you have symptoms for by a few days but don’t treat the underlying cause. Most people who did not get any medication for their shingles would recover within a few weeks with no complications.
For this reason, antiviral medications aren’t needed in everyone who gets the condition. If you are at higher risk of getting complications, then you should have an antiviral medication started as soon as possible. For the best effect, this should be started within 72 hours of developing a rash. If you have had the rash for more than a week, then there is no benefit in starting antiviral medications.
People should be started on antiviral medication if they:
The most commonly used antivirals are acyclovir and valaciclovir. Both should be taken for at least a week, but your doctor may ask you to take them for longer if you have a weak immune system.
The best thing for the rash in shingles is to leave it clean and dry. This allows the blisters to crust over and heal. If possible, leave the rash exposed to air, or with loose cotton clothing over it. You do not need to apply creams or antiseptics.
Most shingles do not need antibiotics. If some of the areas become infected, then you may be prescribed antibiotic cream or oral antibiotics by your GP.
Some signs that a part of the rash is infected are:
If you think that your rash might be getting infected, then you should see your GP. It is rare to get serious infections of shingles rashes.
The shingles rash is infectious until all of the small blisters have crusted over. If your rash is weeping, then it is still infectious.
If someone who is not immune to chickenpox comes into contact with you, then they may develop chickenpox. This means that while you have an actively weeping rash, you should avoid public spaces. In children, chickenpox rarely causes any severe complications.
People with weak immune systems and adults, however, are far more likely to get a severe form of chickenpox which can cause serious complications. You should take extra care to avoid elderly people, immunocompromised people, and pregnant women.
Shingles can be very painful. The good news is that in most people the pain goes away on its own within a few weeks. For this acute period, painkillers like paracetamol and ibuprofen can be taken regularly. Obviously, you should follow instructions on the packet for the number of painkillers you can take etc. If these don’t work, then you should see your GP and they can consider prescribing stronger painkillers.
Medications called steroids are sometimes considered for people with severe pain which is difficult to control. Steroids have several side effects, including increasing your risk of infection.
If the rash has gone, but you are having ongoing issues with severe pain, then your GP might consider prescribing 'neuropathic pain killers', or pain killers which work on your nerves. They may also refer you to a pain clinic to do this.
Most people who have shingles get better without any complications. Of those who have issues, they tend to be more minor, such as scarring from the rash, or development of a small bacterial infection which can easily be treated with antibiotics.
Shingles affecting the face is more likely to cause complications. These can include temporary paralysis of one side of your face, known as a Bell’s palsy.
Rarely, shingles can cause meningitis or inflammation in and around your brain. This can lead to problems, including seizures. These complications are more likely if you are immunocompromised, but even in this group of people, it is rare.
If you are aged over 70 in the UK, then you will be eligible to receive the shingles vaccine. It has been shown in studies that the shingles vaccine reduces the risk of older people getting shingles, and also reduces the likelihood of them developing complications. The NHS website has more information on the shingles vaccine, and who should get it.
The shingles support society is a UK based charity which operates a helpline for people affected by shingles. Their website has a wealth of information on shingles and post-herpetic neuralgia. For a small amount of money, you can buy an information pack. This pack includes information on self-help tips, pain relief options available, and specific information for people with post-herpetic neuralgia.
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Medical terms are often baffling and difficult to fully understand. To help, we have listed some frequently used terms below.
Antiseptics – creams which are used to kill bacteria topically. They are used to stop infection in a wound
Herpes – a group of viruses which cause several conditions. These include cold sores, chickenpox, and shingles
Immunocompromised – someone whose immune system is weaker than would typically be expected. This makes them more prone to getting infections.
Neuropathic pain – pain which comes from the nerves. Also known as 'nerve pain'
Ophthalmic shingles – shingles which affects the nerve overlying the eye. This is a sight-threatening condition and should be evaluated by a specialist eye doctor within 24 hours
Paralysis – where you lose the ability to move a part of the body