One in seven Americans will develop shingles by the age of 85, according to the National Shingles Foundation. Most cases appear after the age of 50, or earlier in people who have medical problems or take drugs that interfere with the immune system. Most attacks resolve completely within two to four weeks and never occur again. Although shingles causes many symptoms, a rash remains its hallmark.
Clinical Features
Shingles rash begins as patches of red, swollen skin which develop, over the course of a few hours into painful, 5 to 10 mm blisters, says Richard J. Whitely, professor of medicine at the University of Alabama Medical School in the 2008 edition of "Harrison's Principles of Internal Medicine." Blisters due to shingles resemble chicken pox, as, indeed, both are caused by the varicella-zoster virus. They are slightly smaller than blisters seen with cold sores or genital herpes, which are caused by a virus in the same family, called herpesviridae.
Time Frame
New blisters appear in crops over the course of three to five days, according to the Centers for Disease Control and Prevention. By seven to 10 days, the blisters spontaneously rupture, giving way to crusts or scabs which are often itchy. Crusts signal that a person is no longer contagious, adds the CDC. Complete healing takes two to four weeks in healthy people, longer in people with other medical problems.
Location
Shingles rash characteristically affects just one side of the body, not both. It usually arises on the trunk and back, hence the name "shingles" which is derived from the Latin word "cingulum," which means belt or girdle. However, shingles rash can strike any surface of the body, including the scalp, face, eyes, ears and mouth.
Associated Symptoms
Shingles rash causes pain which often begins as itching, burning, tingling, soreness or increased sensitivity one to five days before the rash even appears, says the CDC. When the rash does appear, pain increases and may be severe, even disabling. Patients often compare it to being stabbed with an electrified knife. The slightest stimuli---such as the touch of clothing, a breeze or even change in temperature---may be sufficient to set off waves of pain.
Complications
After the rash subsides, it may take months for skin to resume its former appearance, says Whitely. Individuals who scratch or pick at the lesions may become permanently scarred. In other cases, skin exhibits abnormal pigmentation. Patients may experience sensory deficits, such as decreased sensitivity to light touch and temperature. In addition, according to the National Institute of Neurological Disorders and Stroke, 50 percent of people continue to experience skin pain for months or even years, a condition doctors call post-herpetic neuralgia.
Treatment
According to the MayoClinic.com, starting prescription antiviral drugs such as acyclovir, valacyclovir and famciclovir within 72 hours of rash onset decreases its severity and duration, as well as the risk of complications. A doctor can also prescribe antibiotics for rashes that become superinfected with bacteria, or steroids for rashes that affect the eyes, ears or internal organs.
Prevention
In May 2006, the U.S. Food and Drug Administration approved a varicella-zoster virus vaccine, Zostavax, for use in people older than 60 who have already had chicken pox, but not shingles. According to the NINDS, the vaccine reduces the risk of shingles by more than half in treated patients. Vaccinated people who do develop the disease have a significantly reduced risk of complications such as post-herpetic neuralgia.
References
- "Harrison's Principles of Internal Medicine, 23rd Edition;" A.S. Fauci et al.; 2008
- National Institute of Neurological Disorders and Stroke: Shingles
- National Shingles Foundation: Shingles & PHN: Your Questions Answered
- U.S. Centers for Disease Control and Prevention: Shingles: Disease FAQs for Providers
- MayoClinic.com: Shingles: Treatments and Drugs
