Herpes zoster, or shingles, is a common skin disease characterized by a painful, one-sided band like blistering eruption. It may occur at any age.
The disease represents activation of the chicken pock virus which remains in the body after that infection. It is estimated that by age 85 at least half of the population will have had one attack of Herpes zoster. Second attacks, although uncommon, may occur.
Patients with shingles are infectious to people who have not had chicken pox. One may contract chicken pox from a person with shingles. Patients with advanced cancer may also be at risk and should be isolated from patients with Herpes zoster.
The first symptom of Herpes zoster is pain or an abnormal sensation in the area which will later develop the rash. This may last for two to three days before the rash occurs, and may be mistaken for a number of medical or surgical problems: such as, pleurisy, heart attack, ulcer disease, appendicitis, disc problems, and others. The rash, when it occurs, is distinctive. It is band-like and does not cross the mid-line of the body, being entirely on the right or left side. It is made up of blisters which vary in size from patient to patient, some being quite small and clear, others being large and occasionally blood-filled. The rash spreads for 1-4 days, dries, and crusts for 7-10 days, and heals over 2-3 weeks. It tends to be more severe in older patients.
The uncomplicated case requires no special treatment. Pain medications (aspirin, acetaminophen, or codeine) are sometimes necessary. Cool compresses and calamine lotion may speed up drying of the blister, and the application of olive oil to the crusts may loosen them. Recently, it had been shown that acyclovir and related antiviral agents may shorten the duration of zoster. This is particularly true is the drug is started within three days of the onset of the rash. It is important to keep in mind that acyclovir does not prevent post herpetic neuralgia and that for thousands of years people have recovered from herpes zoster without any therapy.
- Pain may last for months to years after an attack. This is rare in patients less than age 50, but more common in patients over 60.
- Dissemination: 2 to 10% of patients with H. zoster may have many blisters outside of the original band covering wide-spread areas of the body. This is usually not serious.
- Secondary infection may occasionally occur in zoster lesions. This is by no means the rule, but one must look for it.
- When shingles occur on the forehead and especially the nose, the possibility of eye involvement exists. Your doctor will know when to refer you to an eye specialist, as involvement of the eye with H. zoster requires prompt treatment.
- There are a number of other rare complications which may occur. Most of these are related to the muscles and nerves. Consult your doctor if anything unusual occurs with or shortly after your zoster.
- Zoster may be more severe in HIV positive patients. Special attention should be given to zoster patients at risk for HIV infection.