What Is Shingles?Shingles, also known as herpes zoster, is a viral infection of the nerve roots. It's an infection that is most commonly seen in people older than 50, however, it is very common in people with weakened immune systems -- specifically, people living with HIV. Anyone who has had chickenpox can get shingles. After having a bout of chickenpox, the virus becomes inactive ("dormant"). Later in life, the virus "awakens" and causes shingles symptoms. Why the virus becomes active is not entirely understood. Keep in mind that once a person has had chickenpox, the virus that causes shingles remains in the nerve roots for life and there is no cure.
What Are Shingles Symptoms?An outbreak of shingles actually occurs in two stages: the prodromal stage and the eruptive stage. The symptoms vary depending on the stage.
Prodromal Stage - symptoms occur about 2 to 7 days before any rash or blisters appear and include numbness, tingling, burning, itching, or shooting pain of one side of the face or body at the site where the outbreak is about to occur.
Some retrospective surveys also suggest that some people experience other systemic complaints preceding the outbreak, which may include:
- flu-like symptoms
Eruptive Stage Redness and swelling will appear at the same site of the prodromal stage.
- Soon after the pain starts, blisters filled with clear fluid will erupt in clusters or in linear patterns.
- The pain and itching associated with the blisters range from very mild to severe.
- Within 2 weeks or so, the vesicles, or blisters, become fluid filled and crust over.
- From start to finish, the shingles rash will last 3 to 5 weeks.
The pain from shingles can last for weeks, months, or even years after an outbreak. This post outbreak pain is known as post-herpetic pain.
Where Do Shingles Erupt?Technically, shingles blisters can erupt anywhere. Since shingles is caused by a virus that infects nerve endings, anywhere you find nerves you can find shingles. However, there are places on the body where shingles eruptions are most likely to occur. These include:
- on the sides of your torso, often spreading around to the back;
- your waistline or belt line but not crossing the midline;
- one side of your face;
- one side of the buttocks;
- the arms, legs, or near the axilla ("armpit"), again not crossing the midline
How Do I Know if I Have Shingles?Keep in mind that a shingles outbreak can often be mistaken for chickenpox or a poison ivy rash. Obviously, the best way to find out if your symptoms are shingles is to see your medical provider HIV specialist. However, there are three key ways you can tell if what you are experiencing could be shingles:
- You had internal symptoms before visual symptoms. The first stage of shingles, the prodromal stage, typically has symptoms that you feel but don't see. Headaches, pain, itching, and even flu-like symptoms are all symptoms you may feel in the initial stages of shingles.
- Typically, only one side of the body is affected. The rash and blisters that develop with shingles are typically limited to one side of the body. They will appear in clusters or linear bands but do not cross the mid-line of the body.
- You have already had chickenpox, are over the age of 50, or have a suppressed immune system as is the case in HIV or diabetes. In order to have shingles, the person must have had chickenpox sometime in their lifetime. People over the age of 50 or have a weakened immune system as is the case with HIV-positive people are at an increased risk of having a shingles outbreak.
While shingles can be very uncomfortable, painful and inconvenient, they are seldom life-threatening. However, you should seek treatment as soon as you suspect you may be having a shingles outbreak. Oral antiviral medications are typically the treatment of choice. Hospitalization and intravenous treatment may be required for outbreaks on the face or near the eyes/ears, outbreaks that affect multiple areas of the body (known as disseminated) or if the virus is is resistant to conventional treatments. If you think you are having a shingles outbreak, contact your HIV specialist or medical provider right away.
Gottesman, D.; "Could it Be Shingles?"; Health Monitor Network; September 2009.
Novartis Pharmaceuticals Corp.; "The Facts About Shingles"; 2009.