Herpes zoster

Herpes zoster or shingles is an infectious disease that affects the nerves and skin. It is caused by the human herpes virus type 3, which is also responsible for chickenpox.
This condition causes propagating pain and a rash along the strip of skin that reaches the affected nerve. Symptoms usually pass in 2-4 weeks. Sometimes the pain remains even after the rash has passed, most often in people over 50 years of age.

Further complications are rare.
The doctor may prescribe an antiviral drug to limit the severity of the disease.

Herpes zoster is an infection of a nerve and the area of skin innervated by it.
It is caused by a virus called varicella zoster because it is the same virus that causes chickenpox.
Anyone who has had chickenpox in the past can also get herpes zoster.
Herpes zoster is something completely different from genital herpes (genital herpes), which is caused by another virus and is called herpes simplex.
About one in five people will suffer from herpes zoster in their lifetime.
It can occur in any year of life, but is most common in people over the age of 50.
One can also get herpes zoster at least twice, but a recurrence occurs in a case of fifty.
The most affected areas include the face, chest (intercostal nerve), buttocks and legs.


Causes of herpes zoster

Most people have had chickenpox in their lives (usually as a child).
The virus is not completely excreted from the body after chickenpox appears.
Some virus particles remain inactive in the nerve roots near the spinal cord.
These do not cause any damage or symptoms.
For reasons that are still unclear, the virus may begin to multiply again (reactivation).

This process often takes place many years later.
The reactivated virus travels along the nerves to the skin and causes herpes zoster.
In most cases, an episode of herpes zoster occurs for no apparent reason.
Sometimes it seems to be a period of stress or an illness that can cause reactivation.
This disorder is most common in the elderly.

The immune system keeps the virus inactive and prevents it from multiplying.
A slight weakness of the immune system in the elderly may explain the reactivation and multiplication of the virus that causes herpes zoster.
This condition is also more common in immunosuppressed people.
For example, herpes zoster often affects younger people who suffer from HIV/AIDS or whose immune systems are suppressed by treatments such as chemotherapy or steroids.

Symptoms of herpes zoster

The virus usually affects a single nerve on one side of the body. The symptoms occur in the area of skin where the end of this nerve leaks.
In the initial phase, the symptoms consist of pain and rash.
Occasionally, two or three nerves are affected next to each other.
The most commonly affected nerves are those that arrive in the skin of the chest or abdomen.
The upper part of the face (including one eye) is a commonly affected area.

The pain is circumscribed and follows the course of the nerve.
It can occur anywhere on the body, depending on the nerve affected.
The intensity of the symptoms can vary from moderate to high.
The pain can be constant and dull, launching or, at worst, intermittent burning.
The affected skin is usually numb.

Usually, the rash appears 2-3 days after the onset of pain.
The red spots appear quickly and turn into blisters that cause itching on the skin. The rashes are similar to chickenpox, but they are only located in the area of skin that is innervated by the affected nerve.
New blisters may appear up to a week after the onset of pain.
The soft tissues under and around the rash may be slightly swollen due to the inflammation caused by the virus.
Later on, the bubbles burst, form a grind and gradually disappear again.
Where the blisters were located, slight scars can form.

A herpes zoster episode usually lasts 3-4 weeks.
In some cases, a rash appears without the patient feeling pain. Rarely, skin rashes do not appear, while pain is felt.
You may also have a fever and feel nausea for a few days.

Diagnosis of herpes zoster

The doctor can diagnose this condition by examining the painful areas and having the patient describe the symptoms.
Blood analyses or other instrumental examinations are not necessary.

Is herpes zoster contagious?

Yes, anyone who has not yet had chickenpox can become infected with herpes zoster in someone.
The incubation period of chickenpox is 15 days.
You can not get infected with herpes zoster in someone who has this disease.
The herpes zoster rash is contagious until all blisters have crusted or dried up.
Most adults or children over the age of 10 have already had chickenpox and are therefore immune.
In addition, if the blisters (vesicles) are covered with a bandage, it is unlikely that the virus will be transmitted to others.
The infection occurs only with direct contact with the blisters. This virus does not transmit through the airways from a person who has contracted herpes zoster, unlike chickenpox. So you can return to work when the blisters have dried up or earlier when you keep the rash covered and feel sufficiently well.

However, it is generally true that women in pregnancy who have not yet had chickenpox should avoid people with herpes zoster.
In addition, someone who has a weakened immune system should avoid the proximity of people with this condition.
These are the general safety rules, since only direct contact with the rash can cause transmission of the virus.
In addition, to make sure that the virus is not transmitted to people who have not yet had chickenpox, you should not use shared towels, go swimming or practice contact sports such as rugby while you have rashes from herpes zoster.


Most people have no complications.
Possible complications are listed below.

Postherpetic neuralgia
This is the most common complication. It occurs when the nerve pain (neuralgia) of herpes zoster persists, even after the rash has passed.
These complaints are rather rare in people under 50 years of age.
However, up to 1/4 of people with herpes zoster over the age of 60 still feel pain for more than a month.
The older you are, the more likely these complaints are.
Usually, the pain passes gradually.
However, it lasts for a few months or years in some people. The likelihood of the pain persisting decreases with treatment.

Skin infection
Sometimes the rash becomes infected by bacteria (germs).
The surrounding skin becomes red and numb.
In this case, a cycle of antibiotics may be required to clear the infection.

Eye problems
Herpes zoster can cause inflammation at the front of the eye.
In the most severe cases, it can lead to complete inflammation and loss of vision.

Sometimes the affected nerve is a motor nerve (which contracts the muscle) and not a sensory nerve (of sensitivity). This can cause weakness (paralysis) of the innervated muscles.

Other rare complications
For example, an infection of the brain by varicella zoster or the spread of the virus throughout the body.
These complications are very serious, but rarely occur.
People with a weakened immune system and herpes zoster, have an increased risk of developing rare or serious complications.
This applies, for example, to people with HIV/AIDS who are receiving a chemotherapy cycle, etc.

Treatment of herpes zoster

The two main goals of therapy of herpes zoster are:

  • relieve pain and discomfort during the reactivation of the varicella-zoster virus;
  • if possible, prevent the development of postherpetic neuralgia.

General measures
Wide cotton clothing is the best way to reduce irritation of the affected skin areas.
The pain can be relieved by placing ice (wrapped in a plastic bag) on the affected areas, damp bandages with cold water or a cool bath.
A non-sticky bandage that covers the rash if there are no dried blisters will help reduce the pain caused by contact with clothing.
Some simple creams (emollients) can help if the rashes itch.

Simple acetaminophen, acetaminophen in combination with codeine, or anti-inflammatory drugs such as ibuprofen, for example, can bring relief.
Stronger painkillers such as oxycodone and tramadol may be necessary in certain cases.

Antiviral drugs
Antivirals include acyclovir, valaciclovir and famciclovir.
An antiviral does not kill the virus, but prevents it from multiplying.
In this way, the severity of symptoms in the herpes zoster episode is limited.
Previously, it was hoped that antiviral drugs could reduce the risk of chronic pain caused by postherpetic neuralgia.
So far, however, research has shown that antivirals taken during an episode of herpes zoster do not have much effect on preventing this complication.
In this context, further research is needed to clarify whether certain patient groups have a benefit and whether newer antivirals can prevent postherpetic neuralgia.

An antiviral drug is more effective if taken in the early stages of herpes zoster within 72 hours of the rash.
Nevertheless, the doctor may also prescribe an antiviral medication if the rashes are older, especially in older people with severe herpes zoster for more than 72 hours or if the herpes zoster affects one eye.

Antivirals are not recommended for every herpes zoster.
For example, adolescents and children in whom herpes zoster develops in the abdominal area very often have mild symptoms and a low risk of developing postherpetic neuralgia.
Therefore, in this situation, an antiviral is not necessary.
The doctor should prescribe these drugs to his patients only if he believes that they are indicated.
As a general rule, the following groups of people should be prescribed an antiviral drug when developing herpes zoster:

If they are older than 50 years. Older people have a higher risk of developing severe herpes zoster or complications and are more likely to experience relief from treatment.

Regardless of age and in the following situations:

  • affects the head area, herpes zoster affects the eye or ear;
  • weakened immune system;
  • Herpes zoster affects all parts of the body except the trunk (i.e. arms, legs, neck and genital area);
  • moderate or severe pain;
  • moderate or severe rash.

If prescribed, therapy with antivirals usually lasts seven days.

Antidepressants and anticonvulsants
If the pain in a herpes-zoster episode is very severe or postherpetic neuralgia develops, the doctor may recommend taking the following drugs:
An antidepressant of the tricyclic group. An antidepressant is not only used to treat depression.
Tricyclic antidepressants such as amitriptyline, imipramine and nortriptyline provide relief from neuralgia (nerve pain) and this effect is different from their effect on depression.
An anticonvulsant such as gabapentin. This relieves nerve pain regardless of the effect on a seizure.

If the doctor prescribes an antidepressant or an anticonvulsant, it should be taken regularly and as recommended.
The medication may take two or more weeks to effectively help against the pain.
In addition to relieving the discomfort of a herpes zoster episode, they can also help prevent postherpetic neuralgia.

steroid medication or cortisone
Corticosteroids help reduce inflammation. A short cycle of cortisone tablets (prednisolone) can be used in addition to the antiviral drug.
This medication helps relieve pain and speed up the healing of the rash. However, the use of cortisone in herpes zoster is controversial, one should follow the doctor’s instructions. Steroids cannot prevent postherpetic neuralgia.

Natural remedies

Nutrition is fundamental to fight any infection and inflammation, recommended are natural anti-inflammatories.
You can apply some oil from the tea tree to the painful areas, as this substance is an excellent antiviral agent.

Physiotherapy can be helpful for faster recovery by means of laser therapy, which is without side effects, as long as the patient has no contraindication against it.

Some people have the painful areas “drawn”. This is a method in which a person says a few sentences out loud and makes movements with his hands without touching the affected area. This therapy is not scientifically proven.

How long does the disease last? Prognosis

From the appearance of symptoms to complete cure, about a month passes, recovery times can be shorter with appropriate therapy.

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