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Shingles (Herpes Zoster)

A painful skin rash with blisters in a limited area on one side of the body (left or right), often in a stripe.

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(Source: Wikipedia)

About Shingles

Anyone who has already had chicken pox is at risk of developing shingles later on in life. Both are caused by the same virus, the varicella-zoster virus. This virus stays dormant in the body after a chicken pox infection, but can become active again years later and trigger shingles (also called herpes zoster). It causes an often very painful rash with blisters that usually forms a band across the skin, but normally only affects one side of the body.

It is still possible for people who have been vaccinated against chicken pox to get shingles. But it is estimated that this is not as common as developing it after you have had chicken pox.

Shingles is quite common in older people especially. It can be very unpleasant, but is usually over in about two to four weeks as long as there are no complications... Read more about Shingles

What works? Research summarized

Evidence reviews

Vaccines for preventing herpes zoster in older adults

The virus responsible for chickenpox, varicella zoster virus (VZV), can remain dormant inside nerve cells. Years later, when a person's immunity declines, for example because of aging, the virus may reactivate and travel through the nerve to the skin surface, producing clusters of blisters distributed along the path of the affected nerve, a condition called herpes zoster or shingles. Itching, numbness, tingling or localised pain precede the appearance of skin lesions. The virus causes inflammation of sensory nerves and can cause severe pain which impacts patients' quality of life. The annual incidence of herpes zoster is currently 5.22 episodes per 1000 older adults. This incidence is increasing, in part due to longer lifespan.

Corticosteroids used in addition to antiviral drugs in patients with Ramsay Hunt syndrome

Ramsay Hunt syndrome (also known as herpes zoster oticus) consists of weakness of the face due to infection with the varicella zoster virus.  Five cases arise per 100,000 of the population per year in the US.  It is more common among those over 60 and rare in children. Other symptoms may include severe ear pain and small blisters on the outer ear or in the mouth.  Prompt diagnosis and treatment (ideally within 72 hours of the onset of symptoms) are crucial to secure the best outcomes. In cases where treatment has been started within this time period, facial weakness recovers in up to 75% of patients. Standard treatment is with antiviral therapy (most commonly acyclovir). Corticosteroids are known for their anti‐inflammatory properties and are commonly used together with antivirals to reduce the inflammation in the facial nerve.  This is thought to be the cause of the facial weakness.  The aim of the review was to see if corticosteroids, used at the same time as antiviral drugs, improved outcomes in patients with Ramsay Hunt syndrome.  However the review found no trials matching the inclusion criteria, and no conclusions can be drawn about the effectiveness of using corticosteroids in this way.   It is recommended that high‐quality randomised controlled trials be undertaken to address this issue.

Vaccination for preventing postherpetic neuralgia

Postherpetic neuralgia is a painful condition that occurs in patients after they have been affected by a recurrence of the herpes zoster virus (shingles). The pain may persist for years and is often difficult to treat. Herpes zoster virus vaccination is a possible new approach to prevent herpes zoster and postherpetic neuralgia. We identified a single high quality trial with a total of 38,546 participants, comparing vaccination with placebo. It found a significant reduction of herpes zoster, but did not provide enough direct evidence to draw any conclusion about whether the vaccine is effective in preventing postherpetic neuralgia beyond its effect on reducing herpes zoster. Non‐serious adverse events were more common among vaccine recipients than placebo recipients, but serious ones were rare. More well designed and specialised trials of vaccination for preventing postherpetic neuralgia are required.

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Summaries for consumers

Vaccines for preventing herpes zoster in older adults

The virus responsible for chickenpox, varicella zoster virus (VZV), can remain dormant inside nerve cells. Years later, when a person's immunity declines, for example because of aging, the virus may reactivate and travel through the nerve to the skin surface, producing clusters of blisters distributed along the path of the affected nerve, a condition called herpes zoster or shingles. Itching, numbness, tingling or localised pain precede the appearance of skin lesions. The virus causes inflammation of sensory nerves and can cause severe pain which impacts patients' quality of life. The annual incidence of herpes zoster is currently 5.22 episodes per 1000 older adults. This incidence is increasing, in part due to longer lifespan.

Shingles: Overview

Anyone who has already had chicken pox could develop shingles later on in life. Both are caused by the same virus. A weakened immune system, possibly as a result of a cold, or extreme stress can lead to increased susceptibility to this often very painful rash. It usually takes a total of two to four weeks to clear up completely.

Lasting pain after a shingles infection

Pain that continues for a long time after a shingles rash has disappeared is called postherpetic neuralgia. It is the most common complication of shingles. It is still not clear how it can be prevented or what the best treatment is.Shingles usually causes a rash accompanied by pain in the affected area. The pain usually goes away together with the rash. This is usually the case after two to four weeks. Pain that continues for longer is referred to as “postherpetic neuralgia.” In very rare cases pain can come back after a shingles infection, even if it had already gone away and the rash had healed.The main symptom of postherpetic neuralgia is pain in the nerves (neuralgia). The skin is often overly sensitive and itchy as well. This can make it difficult or painful to wash, turn over in bed, or hold someone in your arms. The pain and itching can be very severe and might even keep you from sleeping.

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More about Shingles

Photo of an adult

Also called: Herpes-zoster, Zoster

See Also: Chickenpox, Postherpetic Neuralgia

Other terms to know:
Varicella Zoster Virus (VZV), Viruses

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