Shingles: Understanding and Avoiding this Painful Virus
"If you're experiencing symptoms, get to the doctor right away, so you can get an antiviral medication that can help reduce the severity and duration of the infection."
We’re talking about shingles today! Sadly, not the ones on the roof. Dr. Keller Wortham, MD, is going to discuss the painful rash known as shingles that can occur on the torso or one side of the body. We’ll talk about what this condition is, how it happens, and how to prevent it, so stay tuned.
- 00:31: What the Term “Shingles” Means
- 02:01: Understanding Shingles
- 05:19: Symptoms of Shingles
- 06:43: Treating Shingles
- 07:15: Shingles Vaccine
- 07:59: Important Notes About Shingles
What the Term “Shingles” Means
The term "shingle" comes from the Latin term "singulus" which means girdle. The medical name for shingles is herpes zoster — the Greek word "zoster" also refers to a girdle or a belt. So, why do all the terms referring to this blistery burning rash contain references to a belt? Well, it has to do with the fact that shingles has a very peculiar distribution as a rash. It manifests in a belt-like pattern, known in the medical field as a dermatomal pattern.
This belt-like rash typically streaks across just a band of the body, usually on the torso. Shingles usually appear on one half of the body — it’s rare for them to occur on both sides at the same time. It’s extremely painful, so it’s best to prevent it if at all possible.
Shingles is an infectious disease caused by a particular virus known as the herpes zoster virus, or the varicella zoster virus. It’s not quite as simple as just contracting the virus and getting the rash — it’s a little more complicated than that. You get shingles by getting the varicella zoster virus years before the shingles appear, in the form of chickenpox. In fact, the name varicella zoster virus alludes to both the diseases this causes: varicella, which is a medical name for chickenpox, and zoster, which is the medical name for shingles.
So, how does this happen exactly? Well, when you are young and contract chickenpox (which most of us do), you get blisters on your skin, along with other symptoms like fever and malaise. Depending on your age, these might be mild symptoms, or they could be more extreme if you are older. Then chickenpox runs its course, but the virus is really pesky. The virus is in the vesicles on the skin, and it starts to travel from the skin down the nerves that bring sensation to the skin all the way back to the base of the spinal cord.
This is where the nerve roots are — what we call the dorsal nerve roots of the spinal cord — and these little nerve roots run up and down your whole spine, providing sensation to specific distributions along your body. In other words the nerves on the left provide sensation to the left side of the body, and vice versa. They fan out in an almost rib-like pattern across the body, and these little sensation bands that correspond to each nerve root are called dermatomes.
So, the virus sneaks down the dermatome and it just stays dorman there for years. Many years later, typically when you're into your 50s or 60s, something happens that wakes the virus up. As it wakes up, it starts to travel back up the nerve and goes all the way until it reaches the skin of that particular nerve distribution, erupting into a fiery vesicular pattern.
Symptoms of Shingles
As the virus travels back up the nerve when it's woken up, you can get something called a prodrome which is a tingling feeling you get as it's traveling. So you might feel that along the nerve distribution before you ever see the actual rash. In fact, sometimes people can get that prodrome, and the prickly sensation and the pain, without the rash ever erupting. But most of the time, you feel the prodrome, you feel the prickling tingling area where the rash is going to come on, and then the rash erupts. At this point, you’re definitely contagious.
The virus is there on the surface of the skin in little vesicles, and it becomes quite painful. The virus itself is very contagious, but it's not going to give shingles to anyone. It might, however, give chickenpox to someone who has never had chickenpox before. So, if they've had chickenpox before, you're not contagious to them. And if they have never had shingles, you don’t have to worry about that — if they get shingles, it will be as a result of their own chickenpox. You’re only contagious to people who never contracted chickenpox as children.
There are a couple things it’s important to be aware of though. If people are immunocompromised — if they have low immune system functionality — there could be some risk to them. Also, you should certainly avoid pregnant women if you have shingles; if they've never had chickenpox, they are at a very severe risk.
If you feel a prodrome coming on or you get the shingles eruption, get to your doctor as soon as possible, because there are some things your doctor can do to help tackle the infection if you catch it early. If you become aware of it especially within the first two to three days, your doctor can prescribe something called an antiviral that can block the herpes virus from expanding. It won’t get rid of it completely, but it can certainly speed up the healing process and reduce the severity of it.
As we said, this is an infection you had back as a child. However, later in life you can get a shingles vaccine to prevent the virus from resurfacing in this painful way. If you're in your 50s or 60s and have not had shingles, but you did have chickenpox as a child, you should consider the shingles vaccine. There are two kinds: Zostavax and Shingrix.
The Shingrix is two doses spread out over a few months, but it provides better immunity and reduces the risk of shingles by up to 90%.
Important Notes About Shingles
An increase in childhood chickenpox vaccinations means we're being less exposed to that herpes zoster virus as adults. So, actually, our immune system has never retriggered again. So, as more children get vaccinated for chickenpox, it's actually going to potentially increase the risk of shingles outbreaks in adults. In fact, we're already seeing that. On the up side, those children who get vaccinated for chickenpox will also not have to deal with the ravages of shingles in the future.
Additionally, there is one long-lasting complication of shingles called postherpetic neuralgia. That’s a fancy word that basically means pain that lingers after a shingles outbreak, and it can be very painful. The rash may be healing but the pain is not going away — that's because a nerve became irritated when the virus traveled up it. And that irritated nerve can continue to send pain signals for months to come.
So, if you want to reduce your risk of getting that long-term painful sensation even after the rash heals, consider getting vaccinated to prevent shingles. If you're experiencing symptoms, get to the doctor right away, so you can get an antiviral medication that can help reduce the severity and duration of the infection, and reduce your risk of long-term complications.