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Shingles


Description

Shingles (otherwise known as Herpes Zoster) is a painful, blistering rash caused by the chickenpox (varicella) virus.

The typical rash consists of red patches of skin with small blisters (vesicles) that look very similar to early chickenpox. The rash often increases over 3 to 5 days when the blisters break to form small ulcers that begin to dry and form crusts. The crusts fall off in 2 to 3 weeks, leaving behind pink healing skin.

The rash typically appears along a single dermatome (an area of the body served by a single spinal nerve), and is only on one side of the body (unilateral). The trunk is most often affected, showing a rectangular belt of rash from the spine around one side of the chest to the sternum (breastbone).

Lesions may affect the trigeminal nerve, which has three branches that go to the forehead, the mid-face, and the lower face. Eye lesions may lead to permanent blindness if not treated with emergency medical care.

Shingles may be complicated by post-herpetic neuralgia, which is persistence of pain that may last from months to years following the initial episode. The pain can be severe enough to be incapacitating. The elderly are at higher risk.



Causes

Shingles (Herpes Zoster) is caused by the virus Herpes zoster, which causes chickenpox. After having chickenpox, the virus lies dormant in the nerves. Shingles occurs when it is activated in one particular nerve to the skin, thus explaining the way it affects a clearly demarcated band of skin only. The cause of the activation is usually unknown, but seems to be linked to aging, stress, or an impaired immune system.

Widespread or recurrent shingles may indicate an underlying problem with the immune system such as leukemia, Hodgkin's disease and other cancers, atopic dermatitis, HIV infection, or AIDS. People with suppressed immune systems due to organ transplant or treatment for cancer are also at risk.

Conventional Labs

Tests are rarely necessary, but may include:

Viral culture of skin lesion

Tzanck test of skin lesion

Complete blood count (CBC) may show elevated white blood cells, a nonspecific sign of infection

Specific antibody (immunoglobulin) measurement demonstrates elevation of varicella antibodies

 

 

 

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