Shingles

What is Shingles?

Shingles is a painful rash brought on by the herpes zoster virus. Herpes zoster is better known as chicken pox, but shingles is a very different ailment, to say the least. Shingles represents a recurrence of the herpes zoster virus’ effects on the body, and carries with it symptoms of severe itching, pain, and far worse depending upon the severity of shingles. Shingles brings with it fever, blistering and malaise.

Shingles is caused by the same virus that causes chicken pox ‘coming back’. A very small sample of the virus can hide out in the body until it decides to rear its ugly head again, and this is what causes shingles. While chicken pox is primarily a contagious nuisance, shingles can actually be dangerous.

Who gets Shingles?

Shingles can affect anyone who has been previously infected with the herpes zoster virus. This means that unless one has suffered from a previous case of chicken pox, they are highly unlikely to suffer from shingles in the future. Shingles has a tendency to affect certain individuals more readily than others, however.

Age plays a significant role. The statistics surrounding shingles, collected by various organizations, indicate that the chance of the herpes zoster virus manifesting again in an individual. The reasons for this are plural. First, herpes zoster always stands some risk of recurring. The odds of this simply increase as one lives a longer period of time. This is a matter of math and probability. However, there is an intervening factor that tends to correlate with age, and that’s the weakness of the immune system. As people age, their immune systems and ability to respond to threats grows progressively weaker. Ordinarily, the herpes zoster virus is passively suppressed by the immune system, but it seems that recurrence is linked to immunosuppression. Thus, any individual that is of such an age as to suffer immunosuppression and anyone suffering from an ailment that lowers the ability of their immune system to fight off infection is far more likely to suffer from shingles.

Men and women are equally likely to suffer from shingles. Children only very rarely suffer from shingles. There are no prevailing genetic factors that apply to shingles beyond the weakness of the immune system; if one is naturally inclined for one reason or another to suffer from a weakened immune system, then the are more likely to suffer from shingles at some point in their life.

What causes Shingles?

Shingles is caused by the herpes zoster virus. Herpes zoster is a very common virus that many individuals carry. Herpes zoster is related to varicella zoster, the virus behind chicken pox, which is very common among children. Chicken pox is known for being very contagious, and children are frequently kept home from school, or sent home if they are not kept away from the classroom. Even so, chicken pox has a tendency to break out in groups, as it is highly contagious. It is frequently thought that one can only get chicken pox once, but this is not entirely true: the body develops an immunity to the varicella zoster virus, and chicken pox may only recur if the immune system should lapse in its duties holding the virus at bay or if the virus should mutate in some way. This contributes in some rare cases to a second case of chicken pox, which is much worse than the first. Even more common than this, however, is a case of shingles much later in life. When varicella zoster returns, it comes to be known as herpes zoster.

Some viral infections are ‘chronic’. A chronic infection (or a chronic anything, really) is one that does not go away. It cannot be cured and it is not going to go away on its own. Many viral infections are chronic. HIV, for instance, is a chronic infection. Current medical science notwithstanding it cannot be reliably cured. The best one can hope for with a chronic ailment is remission, in which the symptoms or relevance of the virus or condition are rendered null. Herpes zoster does not seem to be a chronic condition. While the virus remains in the system, its period of inactivity between initial infection and the original symptoms of chicken pox seem to be entirely distinct from its returning as shingles. This means that herpes zoster goes through what is known as true dormancy.

When herpes zoster activates again, it has generally spent quite some time ‘hiding out’ in the body’s spinal fluid. Its release indicates that the immune system has ceased, for whatever reason, to contain it effectively. This allows symptoms to begin anew. Shingles is not contagious as-such, and one cannot ‘catch’ shingles from someone suffering from it. However, individuals that are presenting symptoms of shingles are still very contagious, and those in close contact with them run a very real risk of contracting herpes zoster, and then chicken pox. Thus, while one cannot ‘catch’ shingles, shingles is still a contagious condition.

What does Shingles cause?

There are a number of symptoms attached to shingles, and they can vary wildly. Shingles is siginifcantly different, however, from chicken pox. While both shingles and chicken pox are caused by a zoster virus, their symptoms are disparate. Both chicken pox and shingles form a red rash, and itching alongside pain is common with both. In addition to the rash, a fever is likely to present itself as the body’s immune system tries to fight the virus off. However, this is where the similarities end.

The first symptoms of shingles are a fever and headache. These are a result of the body’s immediate immune response to the resurgeance of the virus. The body raises its own temperature in response to detected foreign pathogens in an attempt to destroy them with the change in temperature; this is the reason for the red flushing of the skin and local increase in temperature accompanying inflammation in response to an infection of the skin. This fever and headache is accompanied with a powerful malaise. No other identifying symptoms present at this stage, however, making it very easy for shingles to be misdiagnosed initially as a case of the flu, or some other common fever.

Accompanying the fever is a sensation in the skin, frequently described as a pain or burning sensation. In addition to this is a ‘pins and needles’ feeling, as might be associated with a foot or limb that has fallen asleep and is waking up. This is the first unique and possibly-identifying symptom of shingles that can be presented and used to identify shingles for what it is. The pain tends to vary from patient to patient. Some report a throbbing sensation as though they were suffering from severe inflammation, and others report the pain as stabbing and spiking intermittently. All tend to report fluctuations of pain, and a sensation that grows alternately better and worse, regardless of how it presents itself as a form of pain.

The next stage of shingles most typically begins after 24-48 hours. However, it may exceed this. It is less common that a case of shingles take longer than 24-48 hours to progress past the initial stage, but it does happen, and it may take as long as three weeks for the next stage of symptoms to present itself.

The next stage of symptoms is the signature rash. When this rash begins, shingles can frequently be identified for what it is if one can confirm prior infection with herpes zoster. The rash most frequently appears on the trunk of the body, especially the front and sides. It may also appear on the limbs and extremities, and even the face. The rash may spread somewhat from its initial location, but tends to gravitate toward one side or the other; it will not cross the midline of the body. While this rash is a common signature symptom, it is entirely possible for the herpes zoster virus to present itself without causing the rash, or indeed any outward symptoms. This is called ‘zoster without herpes’ and is fairly uncommon.

The rash eventually forms blisters. These blisters are filled with serous exudate, a form of pus. The blistering is painful in and of itself, and pain comes with each individual blister. The pain associated with these blisters is generally much more severe than the pain associated with the rest of the rash. Over time, the blisters fill with proper blood, and following this crust over. The crusting over of the blisters represents their termination, and they generally cease to cause pain after they have been crusted over. The blisters are done with when the crusts should fall away on their own.

The malaise, fever and headache associated with shingles does not tend to clear up until the rash does. However, once the rash has cleared, postherpetic neuralgia may set in. This is the most severe symptom of shingles and what it is known for: even after the rash has vanished entirely along with the fever, the pain does not necessarily end. Postherpetic neuralgia may persist for a very long period of time. It will wear off over time, but it can take as long as a year, or more in rare cases. This can require ongoing pain management and constitutes an excellent reason to seek immediate and aggressive treatment in most cases.

There are a number of other symptoms that may accompany shingles in rarer cases, depending in large part upon where the disease should present itself. Between one tenth and one quarter of all cases feature herpes zoster invading the orbit of the eye, as a result of the virus’ invasion of the trigeminal nerve. This can result in conjunctivitis and, in more severe cases, loss of vision. A similar episode should occur if the herpes zoster virus should infect the ears, as this may result in dizziness and hearing loss. The virus can spread anywhere in the body that has nerves to attack.

While this is secondary and almost trivial relative to the remainder of the symptoms, the blisters and subsequent crusting-over and flaking off of the crusts can result in pain of their own and subsequent bleeding and scarring. While this is generally not the case, it remains a possibility, and the possibility of an open sore brings with it the possibility of a secondary infection. A secondary infection, especially one that may occur while an individual is immunocompromised (which the presentation of shingles can indicate) can be very uncomfortable and can become actually, truly dangerous if it is not properly managed, depending upon what bacteria is involved and causing it.

How serious is Shingles?

Shingles is a very serious condition and it can also indicate a very serious underlying condition that allowed it to come about to begin with. Shingles is brought on by the herpes zoster virus which in turn is brought about by the varicella zoster virus, and any incidence of shingles tends to represent a lapse in the immune system’s ability to fight the dormant virus remaining from past varicella zoster infection. When herpes zoster presents itself, it does so in the nerves of the body. Through the nerves it can affect most of the skin, and this is where it presents itself symptomatically, but in attacking the nerves it can cause serious, deep damage. Herpes zoster can damage the nerves related to vision and hearing, which can result in permanent hearing and vision loss. This can be warded off with properly quick diagnosis and rapid treatment, but this is not always an option and herpes zoster is not always rooted out and identified fast enough for his to be effective.

While the damage it can cause is the primary concern, shingles itself is serious for its discomfort and fever alone. These can be out-and-out debilitating even in the most hardened individuals, as shingles has a tendency to hit very hard and very deep. The malaise alone can keep people out of work and unable to function, and the sheer pain (which tends not to respond well to over-the-counter analgesics) can nullify a person’s ability to focus completely, rendering them unfit to work. This is before the contagious nature of the viral infection is even considered, and it does not account for postherpetic neuralgia.

Postherpetic neuralgia is the pain that remains even after the rash associated with shingles has withdrawn and all other symptoms have vanished. Postherpetic neuralgia is the signature symptom of shingles other than the rash, and is the reason it is (quite rightly) feared. Postherpetic neuralgia can persist for a very long time. While it generally does recede, especially with treatment, it can result in extreme discomfort for an extended period of time and even be debilitating for periods as long as a year. Postherpetic neuralgia can be managed, but it is a stubborn pain, and can be unfortunately quite difficult to deal with.

Because shingles is contagious, it is automatically a far more serious condition. While shingles itself cannot spread from person to person, the varicella zoster virus can. A case of shingles for one person can rapidly become a case of chicken pox for someone else, and this can be supremely unpleasant. For individuals who work with large numbers of people or encounter a large number of people each day, this can result in quite severe local outbreaks. Varicella zoster is not dangerous, but it is a nuisance—and it can, unfortunately, lead to shingles. It is thus important to avoid spreading it, although this really should go without saying.

The potentiality of a secondary infection renders shingles even more problematic. However, as this is a secondary infection, it does not apply to all cases of shingles, merely those that result in open sores enabling subsequent infection by a separate pathogen. Shingles is not any more likely to result in a secondary infection than anything else that causes an open sore, but individuals may be more vulnerable to a secondary infection if they are immunocompromised, which the presence and presentation of shingles and shingles symptoms may indicate in an individual.

What does Shingles treatment look like?

Treatment for shingles is unfortunately limited. Most treatment options are merely symptomatic; antiviral drugs available for shingles are limited in their effectiveness, although they can reduce the duration of the rash and the incidence of postherpetic neuralgia. However, the symptoms are best treated with an analgesic and a topical agent such as calamine to help with blister management. Analgesics are unfortunately not completely effective, however, especially not for postherpetic neuralgia, which can be thought of as a rather stubborn pain.

Shingles prevention is possible with immunization, as the varicella zoster virus can be inoculated against. This prevents any incidence of chicken pox as well as herpes zoster. This is an option for concerned individuals with access to private healthcare, but is not yet a matter of routine for most nations that have any form of prescribed vaccination methodology. In the United Kingdom, it is thought that widespread varicella zoster vaccination will result in the lowered exposure and those lowered development of immunity to the virus. Paradoxically, increased exposure to the virus can help insulate the body against later infection and recurrence, which reduces the chance of an incidence of shingles. However, this is merely the thought of one group of public policy makers, and it is still furthermore completely permitted to seek such inoculations.

How do I know if I have Shingles?

Shingles can be visually identified by a medical professional if all accompanying symptoms are present. However, there are cases of shingles that do not involve a proper rash. These cases can be rooted out with a blood test for the herpes zoster virus.

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