In the case of shingles, or herpes zoster in technical terms, the skin reddens in places and often forms blisters that are very painful. The disease is a late consequence or secondary disease as a result of chickenpox, which often dates back decades. Shingles is characterized by pain, discomfort, and reddening of the skin with blistering, often limited to a belt-like strip of skin. The majority of herpes zoster infections occur in the chest and in the elderly.
Causes and risk factors
As mentioned, the varicella-zoster virus is the cause of chickenpox and shingles. Shingles usually follows as a secondary disease years after chickenpox or, more rarely, after a vaccination.
The varicella-zoster virus belongs to the herpes virus family. It is also called Human Herpes Virus-3 (HHV-3). After surviving chickenpox, the virus "hides" at the roots of certain nerves. When it is reactivated, it multiplies and the infection travels down the appropriate nerve. It is responsible for a specific skin area, in the classic case for a strip that runs from the spine on one side over the back to the middle of the chest. The area of skin lesions that appear there resembles a ribbon or belt. Hence the name shingles. The affected nerve also transmits the disturbed sensations such as tingling or pain to the brain. Herpes zoster rarely spreads to other nerves because the immune system responds quickly and strongly to the outbreak and contains it. Therefore, the risk of a recurrence of the disease is low at around 5%.
Triggers and risk factors of reactivation
How exactly the known factors reactivate inactive varicella-zoster viruses is unclear. The decisive factor seems to be that the immune system is generally or locally weakened. The following circumstances can favor shingles:
- Existing, acquired and temporary immune deficiency with medical causes (e.g. HIV infection, suppression of the immune system with medication, for example after transplantations, tumor diseases, chemotherapy, infections, surgical interventions, certain rheumatism medication, congenital immune deficiency)
- Stress
- Strong sun/UV radiation
- Heavy physical exertion
- Chemical irritants (e.g. toxins)
- Nerve injuries
Symptoms
Do you suddenly have a spot or area of your skin that is sensitive?
Does this area tingle, burn, sting, or otherwise feel odd?
Do you see redness there that is slightly increased, or have blisters already formed on the reddened areas?
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| Shingles or herpes zoster |
Then it could well be shingles. At the first signs that could indicate this, you should seek professional advice immediately! A slight fever, tiredness and exhaustion often appear before the visible symptoms. They are often associated with unpleasant sensations in a defined area, usually on only one side of the body. This area can be so painful, for example, that a herniated disc or appendicitis is suspected. Herpes zoster sometimes brings with it extreme pain. The skin on the affected area can also itch, burn or sting. These sensations can spread over a larger area. Two to three days later, reddened areas of skin appear there, which can be felt as elevations. In most cases, the skin changes are on the chest and cover one half of the body like a band up to the middle of the chest. Within a day, blisters form on the reddened skin. They grow over the next few days, can merge with others and are very painful. The blisters are bulging with an initially clear, later cloudy, highly infectious liquid. They often stand together in groups. After a few days, the blisters break open and begin to dry out. This results in yellow to brown crusts. It usually takes no longer than three weeks for the scabs to fall off and for the shingles to heal.
The chest is most commonly affected on one side, less often the back is affected as well or alone. Blisters also often appear on the arms, legs or face, and almost always only on one side. Other parts of the body are rarely affected. Dangerous is an equally rare infestation of the entire nervous system.
Shingles can leave scars, especially after complications such as additional infections of the affected skin areas by bacteria or bleeding into the blisters with tissue breakdown. The pain also sometimes lasts for a long time after the blisters have healed, which is one of the most common complications. Therapy that starts as early as possible reduces the risk of complications and severe courses.
Shingles and chickenpox
The causative agent, the varicella zoster virus (VZV), belongs to the herpes virus family. It can cause two diseases: chickenpox (varicella) and shingles (herpes zoster). The first illness to appear is the "childhood disease" chickenpox. Most people go through it at a young age or are vaccinated against it. You are then safe from chickenpox, but still carry the pathogen – according to studies, more than nine out of ten people over the age of 14. Certain circumstances can awaken the “dormant” viruses. This leads to the secondary disease, shingles. It is far less infectious than chickenpox, and there is no droplet infection. People can only become infected through direct contact with the blister fluid (smear infection) and anyway only those who have never had chickenpox and have not received any vaccination against it. However, you do not contract this disease through infection from people with shingles, but chickenpox. When the blisters have crusted over, the contagious phase is over.
Shingles and pregnancy
Shingles during pregnancy does not pose a risk to the unborn child - in contrast to chickenpox. Pregnant women who have never had chickenpox and are not vaccinated should avoid close contact with people with herpes zoster during the contagious phase. Conversely, to be on the safe side, people with shingles should keep their distance from pregnant women.
Treatment
In most cases, experts only need to look at the affected areas of skin to clearly identify herpes zoster. Several factors play a role in the treatment: the extent of the disease, the location of the affected parts of the body, the stage of the skin changes, concomitant diseases, especially those affecting the immune system, and the age of the patient. In young people, shingles on the trunk, arms or legs usually heal without any problems. Older patients are more likely to experience severe and persistent pain. Here – in addition to the symptomatic therapy of the skin changes and the pain as in younger people – there is usually also a causal treatment against the viruses. It also often occurs when skin areas are affected over a very large area or critical areas such as around the eyes. Treatment should always be done in consultation with professionals.
Symptomatic treatment: Those affected take painkillers to relieve the pain. If the usual active ingredients such as paracetamol, ibuprofen and the like are not sufficient, opioids (e.g. codeine, tramadol) can help. In some patients, however, all painkillers fail. If no blisters have appeared on the skin, moist compresses can help. Drying mixtures or lotions work against fresh blisters. Solutions containing the substance clioquinol are intended to prevent bacterial infections. Once the blisters have dissolved, suitable ointments can soften and loosen the scabs.
Antiviral treatment: In mild cases, tablets with antivirals (most commonly with the active ingredient aciclovir) are usually sufficient. In severe cases, antivirals are used as an infusion for one to two weeks. The treatment then takes place in the hospital. If there is also a bacterial infection, if there is a suspicion of this in the case of severe courses, or if patients are at high risk of infection, they often receive antibiotics.
Prevention
Immunocompromised people who have never been exposed to varicella-zoster virus should stay away from children with chickenpox and, if possible, get vaccinated, as should their close contacts.
In studies, people who were vaccinated against chickenpox were less likely to develop herpes zoster than those who went through a natural chickenpox infection.
A special zoster vaccine has been on the market for a few years. It is intended to refresh the vaccine protection, especially in older people, and protect them from shingles. The vaccine is considered safe and effective. In studies, outbreaks decreased by about half. Post-herpetic neuralgia was also less common. Duration and pain, on the other hand, did not decrease. The vaccine is quite expensive and it is unclear how long its protective effects will last.