Shingles is an infection caused by the same virus that produces chickenpox. After childhood, the chickenpox virus remains in nerves in a dormant state. If immunity to the virus wanes, the infection may become reactivated, producing a painful skin eruption commonly called shingles. This relapse has its peak occurrence between the ages of 50 and 70 years.
Although there may be many systemic symptoms, such as fever, chills, and malaise, pain is the commonest feature. The skin rash, which starts as a raised, reddened area, may not appear for days after the onset of the pain. The rash quickly evolves into blister-like vesicles, permitting a diagnosis and explanation for the pain.
An attack of herpes zoster may be followed by prolonged pain in the affected area. Involvement of the eye may occur in some patients. There is a risk of blindness.
Important Points in Treatment
If consultation with your physician is early enough, treatment with an antiviral drug can shorten the course of the infection. This therapy is less effective if started 3 or more days after the onset of symptoms. Clean, wet compresses help keep the rash clean and free of secondary infection.
Secondary infection may require treatment with antibiotics. Except when the area of the rash is being treated with a compress, it should be kept clean and dry. The skin lesions contain the virus and can transmit chickenpox to people not previously exposed. Aspirin or acetaminophen (Tylenol) relieves much of the discomfort associated with the rash. Your physician should be consulted if severe pain persists.
The nerves of the face and of the eye can be involved. Report pain in the eye or the presence of lesions on the face, particularly the nose, to your physician immediately. Infection in these areas may require referral to an ophthalmologist or an anesthesiologist for specialized care.
In most patients, the infection remains confined to the distribution of one or two nerves. In a few patients, particularly those with a disturbed immune system, the infection can spread and become diffuse. In selected patients who are highly susceptible, such as those receiving some kinds of cancer treatment or transplant recipients, treatment should begin at the onset to prevent the spread of the infection. Your physician will counsel you if this becomes necessary.
A few patients experience continued pain after the infection has healed. Report continued pain to your physician to allow proper therapy for its control.
Notify Our Office If ...
- You have blisters on your face or eye pain.
- Your blisters seem to spread.
- Pain persists after the rash has healed.
- The rash suddenly seems to become inflamed or infected, with symptoms such as fever.