Herpes zoster infection, or shingles, is the reactivation of the same virus that causes chickenpox, also known as varicella-zoster. Shingles is characterized by a painful blistering rash that can appear anywhere on the body. Since 98 percent of adults in the U.S. have had chickenpox, all of them are at risk to develop shingles. In the U.S., there are approximately 1 million cases of shingles per year. Of those cases, about half occur in people 60 years of age or older. There are two stages of shingles, the earliest being the prodromal stage.
Prodromal Stage
Three or four days before the rash appears, the early stage of shingles, called the prodromal stage, begins with symptoms that resemble those of the common cold, and may include headache, nausea, general achiness, abdominal pain, fatigue, fever and chills. As shingles progresses, more severe symptoms begin to develop.
Eruptive Stage
The next stage is called the eruptive stage. According to the Mayo Clinic, pain is usually the first symptom. For some, it can be excruciating and may include burning, itching, numbness or tingling in the area where the rash will form. The pain may be felt penetrating from front to back, especially in the chest or face. In the absence of a rash, these symptoms can be confusing for both patients and physicians, so that the disease may be mistaken for an ulcer pain, heart attack, migraine, appendicitis or a lower back disorder. For most people, the pain associated with the rash decreases as it heals.
Rash
A few days after burning and tingling occurs, a rash consisting of fluid-filled blisters on a red base appears on the skin, which is highly inflamed and tender. A slight touch can be extremely painful. Typically, shingles rash occurs on one side of the body in a band-like distribution and may wrap around one side of the chest. The blisters are clear. It takes two to four weeks before the blisters will no longer contain the virus.
Treatment
Antiviral drugs such as acyclovir, valacyclovir, or famciclovir, in combination with tapering doses of steroids, are used to treat shingles. These can significantly decrease long-term nerve pain, but they do not decrease pain duration or produce a more rapid resolution of the rash.
