Shingles - Cause & Symptoms

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Shingles (herpes zoster)

Shingles is an infectious disease caused by the varicella zoster virus (VZV) from the herpes virus family. Ten to 20 percent of varicella sufferers later suffer from herpes zoster. Overall, around two to five in 1,000 people develop shingles each year. The first infection with the herpes virus usually takes place in childhood and causes chickenpox. After healing, the viruses do not completely disappear from the body, but some remain in nerve nodes as it were “asleep” for life. They can be reactivated after years.

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• What are the causes of shingles?
• Shingles and pregnancy
• What are the prevention options?
• What are the symptoms of shingles?
• What complications can occur?
• How is the diagnosis made?
• How is shingles treated?
• Whom can I ask?
• How are the costs going to be covered?

What are the causes of shingles?

Varicella Zoster © rob3000

The main risk factor is a weakened immune system, either as a natural aging process or in connection with factors such as:

• chronic diseases,
• Tumors,
• HIV infection,
• Organ transplant,
• certain drugs,
• severe stress and emotional strain,
• Exposure to the sun,
• family inclination.

Almost half of those affected are over 65 years of age. Occasionally, shingles can occur in children, adolescents and younger adults and despite a functional immune system. Often, however, there is also no apparent reason for the virus to multiply again.

Low risk of infection

Anyone who has already had chickenpox does not have to fear infection, even in close contact with people with shingles. Conversely, people who currently have shingles do not usually need any special rules of conduct to prevent infection of their fellow human beings, since herpes zoster is not very contagious - with one exception: when dealing with pregnant women.

Shingles and pregnancy

If a woman who is not vaccinated or who has not had chickenpox infection comes into contact with VZV during pregnancy, she will develop chickenpox and, in rare cases, may infect her child through the placenta. Infection between the fifth and 24th week of pregnancy is particularly dangerous. For a newborn baby, chickenpox infection in the mother poses a health risk, especially shortly before or after birth.

Note People with herpes zoster should avoid close contact with pregnant women. As soon as the blisters become encrusted, there is no longer any risk of infection from the shingles.

What are the prevention options?

In Austria a vaccine against herpes zoster is available for people, which is usually well tolerated. However, vaccination does not offer 100% protection. If people are vaccinated from the age of 60, their risk of shingles is reduced by about half. If herpes zoster occurs despite vaccination, the disease is usually much more harmless, ie shorter and milder than in unvaccinated people. The risk of complications is also significantly reduced.

According to the Austrian vaccination plan, vaccination against herpes zoster is recommended for all people over the age of 50 who have already had a varicella infection. People who have had shingles in the past can also be vaccinated.

What are the symptoms of shingles?

The term shingles is derived from the typical characteristics of the disease: A skin rash in the form of pin-head-sized blisters forms on reddened, swollen skin. This rash usually spreads from the spine in a belt-like manner along the infected nerve path around the body. In principle, herpes zoster disease can affect any nerve root - in rare cases several at the same time. A distinction is made between acute symptoms and post-zoster neuralgia (PZN), which only occurs with a significant delay.

Acute shingles

Uncomplicated shingles usually takes the following course:

• Uncharacteristic beginning with complaints such as: tiredness, exhaustion, photophobia, headache, fever, swollen lymph nodes.
• Burning and severe pain then occur in the area of skin that is supplied by the affected nerve cord: especially the chest, and more rarely the face, neck, arms, back or legs (both on one side).
• Two to three days later, a typical rash (exanthema) appears: small raised redness and blisters filled with clear fluid. These break open after another three to five days, dry off within a week and form brown crusts.
• After two to four weeks, the skin changes heal completely.

What complications can occur?

Herpes zoster is associated with complications in around a third of all patients. In the over 60 age group, around every fourth person suffers from at least one of the following herpes zoster complications:

• Eyes: Inflammation of the conjunctiva, cornea and optic nerve with visual disturbances.
• Ear canal: dizziness, hearing problems, facial paralysis.
• Meninges and brain: Inflammation with symptoms of meningitis or encephalitis, such as paralysis and sensory disorders.
• Skin: scarring.
• Bacterial superinfections.

Post-zoster neuralgia (PZN)

One in ten patients experience pain again weeks or months later in the previously affected body regions. In these cases there is presumably persistent nerve damage. There are three types of PZN pain:

• burning, boring pain;
• short, shooting attacks of pain;
• Severe pain to the touch: often spreads to neighboring skin regions that were not affected by the shingles.

The pain is often severe and difficult to treat. They can become chronic and, in the worst case, persist for life. Often those affected also suffer from severe itching. The risk of PZN increases with age.

How is the diagnosis made?

A diagnosis can usually be made based on the shape of the rash. In unclear cases, a blood sample or a vesicle smear is taken and a pathogen detection carried out. If post-zoster neuralgia is suspected, the extent of nerve damage, the nature of the pain and the intensity of the pain are determined.

How is shingles treated?

Shingles regresses in two thirds of those affected after two to four weeks, usually without treatment. However, therapy should be started as early as possible in order to reduce the risk of complications - ideally within 72 hours of the appearance of the skin changes or as long as there are still fresh blisters. The aim of this treatment is to stop the virus as early as possible and to prevent further damage to the nerves - post-zoster neuralgia (PZN). In any case, it is important to ensure sufficient rest and protection.

Acute treatment

Therapy aims to relieve symptoms and shorten the duration of the illness. The following measures are mainly used:

• Antiviral drugs (e.g. brivudine, acyclovir, famciclovir or valaciclovir): They are supposed to contain virus replication quickly and thereby prevent complications.
• Pain therapy (e.g. with NSAIDs): An early start in the first few days can prevent PZN.
• Disinfectant powders and skin care solutions: They can prevent infection of the blisters and relieve itching.

Treatment of post-zoster neuralgia (PZN)

Drug and non-drug therapy options are used, including:

• Painkiller;
• low-dose antidepressants;
• Anti-epileptic drugs;
• local pain relief such as capsaicin patches or lidocaine cream;
• Transcutaneous Electrical Nerve Stimulation (TENS);
• Psychotherapy.

Whom can I ask?

A general practitioner should be seen at the first signs of shingles. Even if the pain persists after you have suffered shingles, you should immediately seek medical help in order to prevent nerve pain from becoming chronic. To do this, you can contact your family doctor or a specialist in neurology.

How are the costs going to be covered?

All necessary and appropriate diagnostic and therapeutic measures are taken over by the health insurance carriers. Your doctor or the outpatient clinic will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS, BVAEB).

However, you can also use a doctor of your choice (ie doctor without a health insurance contract) or a private outpatient clinic. For more information, see Costs and Deductibles.