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Shingles (herpes zoster): causes, symptoms, who should you see?

Shingles (herpes zoster) is caused by reactivation of the varicella-zoster virus, which lies dormant in the nervous system. Indeed, after having had chickenpox, the virus remains latent (dormant) in the body. Shingles generally affects adults and older people. The first symptoms include skin pain, then, 2 to 3 days after the virus reactivates, blisters appear as part of a skin rash. Although these symptoms are painful, shingles does not normally pose a risk to health, even though in rare cases chronic pain can develop (post-herpetic neuralgia). Prevention relies on vaccination.

What are the signs of shingles?

2 to 3 days before the rash appears, the first symptoms of shingles appear. They include:
   • Fever;
   • itching over a band of skin (dermatome) or a tingling sensation;
   • Pain localised on the band of skin affected by shingles.
Then, around 3 to 5 days after these first signs, a red area appears on a band of skin, with small fluid-filled blisters at its centre. You may also see papules (spots), erythema (skin redness) and, more rarely, oedema (swelling). The rash can thus spread over a further 3 to 5 days. There are also several forms of shingles, with different symptoms on the body:
   • Ear shingles (Ramsay Hunt syndrome): pain, hearing loss, partial facial paralysis, dizziness, vertigo, tinnitus…
   • Oral shingles: it can affect the mouth and shows up as blisters or erosions on the lining of the upper and lower jaw (gums and palate);
   • Ophthalmic shingles: the lesions can affect the eye socket, the skin of the forehead and the upper eyelid. Possible complications include: chronic eye inflammation, chronic pain or loss of vision.
Whatever its form, shingles involves the central nervous system, since the virus settles in the sensory ganglia at its root. The varicella-zoster virus can therefore affect several areas of the brain and cause various other symptoms:
   • Loss of bladder control (neurogenic bladder);
   • Facial paralysis;
   • Muscle weakness;
   • Myelitis (inflammation of the spinal cord);
   • Guillain-Barré syndrome;
   • Diaphragm paralysis;
In the most serious cases, patients may develop brain inflammation (encephalitis).

How is shingles transmitted?

Just like chickenpox, shingles is caused by the same virus, which shares its name with both diseases: the varicella-zoster virus. Infection happens in two stages:
   • The first infection, responsible for chickenpox;
   • Then, reactivation of the dormant chickenpox virus causes shingles, generally after several years lying dormant;
Because of its nature (a type 3 herpesvirus), the infection is sometimes called herpes zoster. Shingles is also thought to be linked to a weakened immune system, which can be brought on by a medication or an illness. Doctors in fact believe that shingles results from the immune system's failure to control replication of the virus. During chickenpox, nerve cells (nerve ganglia) located at the level of the spinal cord or cranial nerves become infected with the virus. The virus indeed circulates through the bloodstream. For a time, the virus remains inactive (dormant or latent); it may in fact never wake up again, or it may reactivate after several years. When it reactivates, the shingles virus travels back along the nerve fibres up to the epidermis. As with chickenpox, painful spots appear. The pain is also caused by inflammation of the nerves affected by the virus. Finally, shingles infection generally only occurs once, unlike other herpes infections. In fewer than 4% of cases, a person experiences further episodes of shingles.

Treatments for shingles (herpes zoster)

Treatments for shingles include:
   • Treating the symptoms;
   • Antiviral medication.
To relieve symptoms, damp compresses can be applied to the lesions. Despite a sedative effect, the use of painkillers is often necessary. Some forms of shingles also require care from a specialist, as with ophthalmic shingles, where it is compulsory to see an ear, nose and throat specialist. Oral antiviral medications reduce the duration of symptoms during the acute phase of the rash and their severity. They also reduce the frequency of complications, particularly in elderly and immunocompromised patients. Antiviral treatment also helps relieve severe pain and the facial rash around the eye. More broadly, it is recommended to start treatment for shingles as quickly as possible, even before the rash stage. Diagnosis is therefore essential. For example, when given after the blisters have appeared, antivirals may be ineffective. Antiviral treatment generally lasts between 7 and 10 days, until the lesions have all crusted over. Particular care must be taken in the treatment and management of pregnant women. Although the data are reassuring regarding the use of an antiviral such as aciclovir during pregnancy, there is still debate within the medical community about the use of antivirals during pregnancy.

Treat shingles symptoms quickly with an online dermatologist

As mentioned above, shingles requires prompt care and treatment to be started as soon as possible; certain signs can suggest shingles, and antiviral treatment (even before the rash appears) gives good results. Shingles blisters are often painful, and diagnosis by a dermatologist is generally preferred over that of a general practitioner. Lastly, don't forget that vaccination exists against the varicella-zoster virus. Ask an online dermatologist for more information about the vaccine during an online consultation.