Shingles is distinctive because it affects only one side of the body. Shingles is derived from the Latin and French words for belt or girdle, reflecting distribution of the rash in a broad band. The chickenpox virus (varicella) remains in a dormant state in the body in the root of nerves that control sensation. The majority of people with shingles, however, are healthy. No special tests need to be done to see if your immune system is strong. It occurs only in people who have had chickenpox in the past and represents a reactivation of the dormant varicella virus.
What causes shingles?
Shingles occurs when the virus that causes chickenpox starts up again in your body. After you get better from chickenpox, the virus “sleeps” (is dormant) in your nerve roots. In some people, it stays dormant forever. In others, the virus “wakes up” when disease, stress, or aging weakens the immune system. It is not clear why this happens. But after the virus becomes active again, it can only cause shingles, not chickenpox.
The main symptom of shingles is often extreme sensitivity or pain in a broad band on one side of the body. The pain and general symptoms subside gradually as the eruption disappears. In uncomplicated cases recovery is complete in 2-3 weeks in children and young adults, and 3 to 4 weeks in older patients. The pain may be just in one spot or it may spread out. The patient usually feels quite unwell with fever and headache. The lymph nodes draining the affected area are often enlarged and tender.
Before a rash is visible, the patient may notice several days to a week of burning pain and sensitive skin. Before the rash is visible, it may be difficult to determine the cause of the often severe pain. Shingles start as small blisters on a red base, with new blisters continuing to form for three to five days. The blisters follow the path of individual nerves that comes out of the spinal cord (called a dermatomal pattern). The entire path of the nerve may be involved or there may be areas with blisters and areas without blisters.
Antiviral medications are also routinely prescribed in severe cases of shingles or when the eye is affected. Such treatment needs to begin within three days of getting the rash to be effective, so if you suspect you have shingles, see your doctor immediately. For reasons that are not completely understood, some PHN patients get no relief from pain medication, and what works in one case may not be effective in another.
The severity and duration of an attack of shingles can be significantly reduced by immediate treatment with antiviral drugs, which include acyclovir, valacyclovir, or famcyclovir. Antiviral drugs may also help stave off the painful aftereffects of shingles known as postherpetic neuralgia (see section entitled “What are the Complications of Shingles?). Doctors now recommend starting antiviral drugs within 72 hours of the first sign of the shingles rash. Early treatment is believed to reduce the risk of postherpetic neuralgia and may speed up the healing process.