Shingles (herpes zoster) is caused by infection with the varicella zoster virus. When the varicella viruses start to wreak havoc in your body for the first time, they cause chickenpox. This causes small red spots and pimple-like elevations that itch heavily all over the skin, sometimes even on the mucous membranes. After the chickenpox has subsided, the virus remains in the body for life. They nest in the nerve knots around the spinal cord (spinal ganglia) and stay there long after the chickenpox is over.
Usually they behave quietly there, for some people they don’t cause any problems for the rest of their lives. However, if the virus becomes active again due to a stimulus, shingles occurs. Experts assume that disturbances in the body’s defenses are related to the onset of the disease: if the immune system is weakened, it can no longer keep the viruses in check. Shingles develops.
Triggers are, for example, stress, UV rays or certain medications that suppress the immune system. Although shingles is more common in old age, younger people can also contract herpes zoster.
Shingles is a secondary infection. This means that the original infection was a long time ago, it took place when those affected were suffering from chickenpox. Although shingles and chickenpox have the same trigger, they express themselves differently: chickenpox in small “pimples” that are very itchy and spread all over the body, shingles in water-filled blisters that are limited to one area of the body. While chickenpox is a typical childhood disease, shingles mainly occurs in adults.
Whether shingles is contagious (for example for the partner) or not depends on the individual medical history: Although the disease itself is infectious, anyone who has ever had chickenpox is immune to shingles under normal circumstances.
However, transmission of the shingles virus to a person who has not yet had chickenpox does not trigger herpes zoster, but triggers chickenpox. A varicella-zoster infection, i.e. an illness with chickenpox or shingles, is notifiable, i.e. the doctor reports the disease to the health department.
Even if it itches, don’t scratch the shingles blisters! The fluid-filled blisters contain masses of viruses that can be transmitted to those around you via your hands. There is also a greater risk of shingles leaving scars. The same applies to the blisters in chickenpox.
Shingles in old age is more common than in younger adults. In addition, people with weakened immune systems and people over 50 years of age are more at risk. But even younger adults, children and adolescents are not immune to shingles.
The incubation period for shingles, i.e. the duration from infection to the point at which the disease becomes noticeable, cannot be determined for shingles because the initial infection with chickenpox was often a long time ago. In the case of chickenpox, it is an average of 14 to 16 days, but it can also be as little as eight or up to 28 days. Some people with shingles wonder how long it is contagious. This also cannot be poured into an exact time frame. In general, there is a risk of infection with shingles until the blisters have crusted over.
The highly contagious chickenpox viruses are transmitted by droplet infection, which means they get into the air through speaking, breathing or coughing, where other people breathe them in.
In the case of shingles, however, the infection with the virus usually occurs via smear infection, i.e. when the highly infectious blister fluid is passed on through physical contact.
You can prevent shingles by getting vaccinated. The Standing Committee on Vaccination (STIKO) recommends vaccination against shingles for all people over the age of 60. Anyone suffering from an underlying disease or immune deficiency should be vaccinated against shingles from the age of 50.
In Germany, two vaccines against shingles are approved for people over the age of 50: a live vaccine and an inactivated vaccine. However, the live herpes zoster vaccine has limited efficacy and is not recommended for the standard shingles vaccine. In addition, it is not suitable for people with a weakened immune system. The STIKO therefore recommends an inactivated vaccine for vaccination against shingles.
Two doses of the shingles vaccine are given at intervals of two to a maximum of six months. If a person has been vaccinated against chickenpox (varicella) with a live vaccine, shingles is possible despite vaccination. However, children who have received a chickenpox vaccination are three to twelve times less likely to develop shingles. In addition, the course is milder than without vaccination.
The inactivated vaccine against shingles is considered safe – according to the Robert Koch Institute, there were no indications of serious side effects or the occurrence of autoimmune diseases in the approval study of the vaccine.
However, the dead herpes zoster vaccine is considered to be very “reactogenic”: reactions such as redness, pain and swelling at the vaccination site are possible. It can also happen that vaccinated people feel tired for a day or two, have a fever, headache or muscle pain. About one in ten people experience these side effects after the shingles vaccine.
General malaise, burning pain in the chest, followed by red spots that spread like ribbons and gradually become small blisters – if you recognize these symptoms, you most likely have shingles.
This painful rash is caused by the same virus that causes chickenpox: varicella zoster. Since this belongs to the herpes viruses, shingles is also called herpes zoster or just zoster in technical jargon. The disease was given the name shingles because it often spreads like a belt around the body: first in the form of red spots, then usually small, fluid-filled blisters develop.
In contrast to the medical term “herpes zoster”, shingles is called “shingles” in English. If you become ill abroad, it may be useful to know the English term.
The first signs of shingles are usually quite unspecific. Initially, the early stages of shingles are without a rash. Many of those affected initially feel a bit exhausted and ill, feel a slight fever and aching limbs. It could just as well be a common cold. After one or two days, however, patients with shingles experience pain, which can sometimes be very pronounced. In this phase of the shingles, you will feel itching and possibly also a burning sensation in the affected skin areas.
This shingles-typical pain lasts between three and five days. During this time, the viruses penetrate the cells and cause the characteristic shingles rash there: First, red spots appear, which usually lie around the body like the girdle that gives the disease its name, and by means of which a doctor can already recognize shingles. After a day or two, they turn into small sacs filled with liquid. Both spots and blisters, unlike chickenpox, are localized and appear only in the area served by the affected nerve.
Shingles most commonly occurs under the chest or abdomen, and is almost always unilateral. That is, the rash does not exceed the middle of the body. The skin changes associated with shingles often begin on the back, more precisely: on the spine, from where it spreads.
In principle, however, the disease can occur almost anywhere on the body: some get shingles on their legs, especially on their thighs, while others get shingles on their arms. Shingles blisters can also form on the neck or scalp. Shingles on the head occurs when the viruses are in the cranial nerve.
Harder to spot is shingles without a rash, which can also occur. Experts call this form of shingles without blisters zoster sine herpete. There is virtually no such thing as shingles without pain. Exception: The doctor discovers and treats the shingles in the early stages, in which it has not yet completely broken through – it may then be possible to prevent a painful course.
Shingles in children is less common than in adults, but it does occur. Smaller children usually have fewer blisters. If the children are otherwise healthy, the disease usually goes well and the rash heals without scarring. Provided that the parents make sure that the offspring does not scratch themselves too much.
It is usually more difficult for adults with shingles, some complications can occur here and they do so more often than in children. For example, the affected area can become inflamed (superinfection), causing permanent discoloration or scarring of the skin.
In addition, complications such as paralysis can occur with shingles on the scalp or face. If shingles affects the trigeminal nerve in the face, the eye can be affected, in extreme cases there is a risk of going blind.
Another serious complication of shingles affects the ear (zoster oticus): Severe ear pain, dizziness and even loss of hearing are possible. A very unpleasant consequence of shingles, which occurs particularly frequently in patients over 50, is the so-called post-herpetic neuralgia. This means that the severe nerve pain continues for several weeks or months after shingles has been overcome.
In most cases, the doctor can already diagnose shingles based on the typical symptoms, so that specific diagnostics (e.g. in the laboratory) is only necessary in cases with atypical clinical pictures, in the case of pregnancy or if other diseases are (could) be present, such as diseases of the central nervous system or pneumonia.
If shingles treatment is started at an early stage, there is a good chance that it will heal within two to four weeks. The treatment itself lasts about a week. In general, however, the duration of treatment for shingles depends on how severe the symptoms are and whether there are concomitant diseases or complications.
Typically, two-thirds of shingles cases are completely cured. However, it is possible for shingles to occur more than once. The doctor has the following options for shingles therapy, several of which can be used at the same time:
Shingles patients and pregnant women should avoid each other to be on the safe side. If the pregnant woman has already had chickenpox in her life, she is usually protected. If this is not the case, she can become infected with the varicella zoster virus. Depending on the time of infection, chickenpox can have serious consequences for the unborn child, such as various malformations. Chickenpox infection around the time of birth is associated with a 30 percent mortality rate for the child.
Special laws apply when an expectant mother gets shingles. For example, pregnant women are not allowed to ingest certain substances that could be dangerous for the child, including antivirals and caution is also required with cortisone cream. The doctor will probably prescribe medication for the itching. In any case, talk to your doctor about options for treating shingles during pregnancy.
Shingles usually starts with flu-like symptoms before the typical rash appears with red spots, blisters and severe pain. In two-thirds of cases, shingles is mostly harmless and resolves itself after two to four weeks.
However, scars or areas of pigmented skin may remain. Possible complications include signs of paralysis and post-herpetic pain that persist beyond the shingles disease itself (long-term consequences). In general, if you have the slightest suspicion of shingles, go to the doctor. The earlier the therapy starts, the better it works.
This article was written by Carola Felchner, medical journalist
The original of this post “Painful rash: Two groups should be vaccinated against shingles” comes from FOCUS doctor search.
