Much is said about Herpes zoster, but do you really know what it is? There are approximately 1 million new estimated cases per year in countries such as the United States. According to research, it is estimated that by the age of 85, 50% of people will have had an episode of herpes zoster at some point in their lives. Although most people who develop herpes zoster have only a single episode, some may have recurrent cases of the disease.

What is Herpes Zoster?

Herpes zoster, commonly known as shingles, is a viral infection that causes a painful skin rash. Although it can appear anywhere on the body, the lesions usually appear as a single line of blisters wrapping around the left or right side of the torso.

Causes of Herpes Zoster

Herpes zoster is caused by the Varicella-Zoster Virus (VZV), the same virus that causes chickenpox (varicella). After a person has had it, the virus remains inactive in the nerve tissue near the spinal cord and brain. Years later, it can reactivate, causing herpes zoster. However, not everyone who has had chickenpox will develop shingles. The Varicella-Zoster Virus is part of a group of viruses called Human Herpes Viruses (HSV), which includes those that cause cold sores and genital herpes. The reason for shingles is not clear, but it may happen due to reduced immunity as a result of aging. It is more common in older adults and people who have a weakened immune system. Although it is not a fatal condition, shingles can be very painful. Vaccines help reduce the risk of infection, while early treatment helps shorten the duration of illness and lowers the chance of complications.

Symptoms of Herpes Zoster

The signs and symptoms of herpes zoster usually affect a small section of one side of the body. These signs and symptoms may include:

  • Pain, burning, numbness, or tingling
  • Sensitivity to touch
  • Red skin rash that appears a few days after the pain
  • Fluid-filled blisters that burst and crust over
  • Itching

Some people also experience:

  • Fever and chills
  • Headache
  • Sensitivity to light
  • Fatigue
  • Malaise
  • Nausea
  • Body aches
  • Swollen lymph glands

Pain is usually the first symptom of the disease. For some, it can be severe. Depending on the location of the pain, it can sometimes be mistaken for symptoms of heart, lung, or kidney problems. Some people experience the pain of shingles without developing the rash. Although shingles most often affects the torso, the rash can sometimes occur around the eye, on one side of the neck, or on the face.

Is Herpes Zoster Contagious?

A person with herpes zoster can transmit the virus to others through direct contact with the fluid from active lesions. Therefore, susceptible individuals should avoid contact with people who have the condition, especially pregnant women, those who have never had chickenpox, and individuals with compromised immune systems. It cannot be transmitted by coughing or sneezing, and it is not contagious before the blisters appear. Once the shingles rash has dried and developed scabs, it is no longer considered contagious. There are some important points to consider when discussing the varicella zoster virus and its transmission. If a person who has never had chickenpox or has not received the vaccine comes into direct contact with the fluid from a shingles rash, they may develop chickenpox, but will not immediately develop shingles. It is possible, however, for them to develop shingles later in life, just as it occurs in others who have already been exposed to the virus and developed chickenpox.

Risk Factors for Herpes Zoster

Anyone who has had chickenpox can develop herpes zoster. Most adults in Brazil contracted chickenpox as children, well before childhood vaccination — now available — that protects against the disease. However, some people may be more susceptible to developing shingles. These include:

  • Adults over age 50 – It is more common in people over 50 as age is a risk factor. Some experts estimate that half of people aged 85 or older will get shingles.
  • People with immunosuppressive diseases – Diseases that weaken the immune system, such as HIV/AIDS and cancer, can increase the risk of shingles.
  • Patients undergoing cancer treatments – Radiation or chemotherapy can lower resistance to diseases, making the patient vulnerable to illness.
  • People who use certain medications – Medications used by organ transplant recipients to prevent rejection can increase the risk of shingles, as can long-term use of steroids, such as prednisone.

When Should I See a Doctor?

It is important to seek medical help if you suspect shingles, but especially in the following situations:

  • If pain and rash occur near an eye. If not treated, this infection can cause permanent eye damage.
  • If you are 60 years old or more, because age significantly increases the risk of complications.
  • If you or someone in your family has a weakened immune system (due to cancer, medications, or chronic diseases).
  • If the rash is widespread and painful.

Treatment for Herpes Zoster

Treatment aims to minimize the effects of the virus as well as pain control. The sooner it is diagnosed, the sooner the doctor can start treatment with antiviral medications. If started immediately after the onset of symptoms (rashes), there may be a lower chance of complications. The most common treatments include:

  • Antiviral medications to reduce pain and the duration of lesions
  • Pain medications
  • Prevention of secondary infections of skin lesions
  • Cool or cold baths and wet compresses over the affected area may help relieve itching and pain.

What Are The Complications of Herpes Zoster?

Complications may include:

  • Postherpetic neuralgia – For some people, the pain continues long after the lesions have healed. This condition is known as postherpetic neuralgia, and occurs when damaged nerve fibers send confused and amplified pain messages from the skin to the brain.
  • Vision loss – Lesions inside or around an eye (ophthalmic herpes zoster) can cause painful eye infections that may result in loss of vision.
  • Neurological problems – Depending on which nerves are affected, herpes zoster can cause brain inflammation (encephalitis), facial paralysis, or hearing or balance problems.
  • Skin infections – If the lesions are not properly treated, bacterial skin infections may occur.

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