Steven Doerr, MD
Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and ended his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.
John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha’s educational background includes a BS in Biology from Rutgers, the State University of Fresh Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He ended residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, Fresh Jersey.
Shingles (herpes zoster) facts
- Shingles, also called herpes zoster, is a painful skin rash.
- Shingles is caused by reactivation of the varicella zoster virus, the same virus that causes chickenpox.
- Older adults and individuals with a weakened immune system are at greatest risk for developing shingles.
- Shingles symptoms and signs include
- one-sided stabbing agony,
- tingling, itching, searing, or stinging sensation that precedes the appearance of the rash by a few days,
- fever and chills,
- assets aches, and
- fluid-filled sweeping crimson rash, typically on the chest or face.
Zoster Shingles Vaccine Side Effects
The most common adverse effects are:
Some individuals may practice shingles or chickenpox-like rashes within 42 days after receiving zoster vaccine. Transmission of VZV virus from vaccinated individuals to other individuals occurs infrequently.
What is shingles? What does shingles look like?
Shingles is a disease characterized by a painful, impetuous skin rash that affects one side of the assets, typically the face or pecs. This condition may also be referred to as herpes zoster, zoster, or zona. There are approximately 1 million estimated fresh cases per year in the U.S., with almost one out of every three people developing shingles at some point in their lifetime. However most people who develop shingles will only have a single gig, there are some who develop recurrent cases of shingles. Shingles is more common in older individuals and in those with weakened immune systems.
The characteristic rash of shingles typically emerges after an initial period of searing, tingling, itching, or stinging in the affected area. After a few days, the rash then shows up in a stripe or band-like pattern along a nerve path (called a dermatome), affecting only one side of the assets without crossing the midline. The rash pours out as clusters of puny crimson patches that develop into blisters, which may show up similar to chickenpox. The blisters then break open and leisurely begin to dry and eventually crust over.
What causes shingles?
Shingles is caused when the varicella zoster virus (VZV) reactivates, the same virus that causes chickenpox (varicella). The varicella zoster virus belongs to the Herpesviridae family. Only those who have previously had chickenpox and those who have received the varicella vaccine can develop shingles later in life. Initial exposure to the varicella zoster virus, which typically occurs in children or adolescents, leads to the development of varicella. After the gig of chickenpox has resolved, varicella-zoster remains in a dormant state in the jumpy system in certain nerve cells of the figure located in the spine. While in this inactive state, you will not practice any symptoms from the varicella zoster virus. However, in certain individuals and for reasons that are not downright clear, the varicella zoster virus may reactivate years later and travel along nerve paths to cause shingles. The location and pattern of the ensuing rash reflects the region of the affected nerves.
However similar in name, herpes zoster is not the same disease as herpes simplex (which is caused by the herpes simplex virus causing cold sores, fever blisters, or genital herpes).
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Pictures of Shingles
What are risk factors for shingles?
Shingles can only occur in individuals who have previously been exposed to the varicella zoster virus. Risk factors for the development of shingles include the following:
- Enhancing age: However shingles can infrequently occur in children, it is much more common in older adults, with the incidence enhancing with age. This is thought to be in large part due to waning immunity as people age. Approximately 50% of all cases of shingles occur in adults 60 years of age or older.
- Weakened immune system: Individuals with impaired immune systems have a higher probability of developing shingles. This can be seen in diseases such as cancer and HIV/AIDS, or in individuals taking certain medications. Patients taking steroids or other immunosuppressive medications, such as people who have undergone organ transplants, and individuals with certain autoimmune diseases (such as rheumatoid arthritis, systemic lupus erythematosus, Crohn’s disease, and ulcerative colitis) are at enlargened risk for developing shingles. Psychological and emotional stressors are also thought to possibly contribute to the development of shingles, perhaps from the detrimental effects of stress on the immune system and the person’s health.
What is the contagious period for shingles?
The virus that causes shingles, the varicella zoster virus, can be transmitted from person to person by direct contact with the fluid from the active sweeping rash. Therefore, susceptible individuals should avoid contact with people who have active shingles, especially pregnant women who have never had chickenpox and immunocompromised individuals. It cannot be transmitted by coughing or sneezing, and it is not contagious before the blisters emerge. Once the shingles rash has dried and developed crusting, it is not considered to be contagious.
There are a few significant points to consider when discussing the varicella zoster virus and transmissibility. If an individual who has never had chickenpox or the chickenpox vaccine comes in direct contact with the fluid from the shingles rash, they may go on to develop chickenpox, but they will not instantaneously develop shingles. It is possible, however, for them to develop shingles later in life, just as it is with others who have previously been exposed to the virus and developed chickenpox. Also, if you have previously been exposed to the varicella zoster virus and you have had chickenpox, you will not contract the virus from others with shingles.
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What are shingles symptoms and signs?
Shingles usually starts with searing, tingling, itching, or stinging in the region where the rash will ultimately develop. Sometimes, this anguish can be severe and individuals may complain of utterly sensitive skin. This discomfort typically occurs a few days before the visible rash develops. In uncommon instances, the characteristic shingles rash will not emerge (a condition called zoster sine herpete).
Often, individuals may also practice other associated symptoms such as
A few days after the skin discomfort commences (or uncommonly, several weeks afterward), the characteristic rash of shingles will show up. It typically starts as clusters of petite crimson patches that eventually develop into petite blisters. These fluid-filled blisters eventually break open, and the puny sores begin to leisurely dry and scab over. The crusts usually fall off after several weeks, and the shingles rash typically clears up after approximately two to four weeks. However uncommon, in cases of a severe rash, skin discoloration or scarring of the skin is possible.
The location of the shingles rash can vary. However shingles can show up almost anywhere on the figure, it most commonly affects the chest and the face (including the eyes, ears, and mouth). It is often present in the area of the ribcage or the midbody. This characteristic rash is in a stripe or band-like pattern that affects only one side of the assets (the right or the left), and it usually does not cross over the midline. In some cases, the rash can affect adjacent dermatomes (an area of skin that is supplied by a single spinal nerve), and uncommonly it can affect three or more dermatomes (a condition termed disseminated zoster). Disseminated zoster generally occurs only in individuals with a compromised immune system.
How do health care professionals diagnose shingles?
Shingles can often be diagnosed by your doctor based upon the distinctive appearance and distribution of the characteristic shingles rash. A painful, sweeping rash that is localized to defined dermatomes is a sign very suggestive of shingles. Blood work or other testing is usually not necessary. Diagnosing shingles before the appearance of the rash or in cases of zoster sine herpete (zoster without rash) can be challenging. In cases where the diagnosis is unclear, laboratory tests are available to help confirm the diagnosis. Depending on the clinical situation, testing can be done using either blood work (to detect antibodies to the varicella zoster virus) or by specialized testing of skin lesion samples.
What types of health care professionals treat shingles?
Shingles is most commonly diagnosed and treated by a primary-care physician (family practitioner, pediatrician, and internist) or an emergency-room physician. For certain individuals who develop complications of shingles, a specialist in ophthalmology, neurology, or infectious disease may also be involved. Select patients with postherpetic neuralgia may require the care of a agony specialist.
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What are medical treatments for shingles?
The treatment for shingles is aimed at diminishing the effects of the virus, as well as anguish management. There are several medications that can be used, and your doctor will discuss the best treatment options for your particular situation. The vast majority of cases of shingles can be managed at home. In some cases, people with an impaired immune system or individuals with severe symptoms and/or complications may require hospital admission.
Antiviral drugs (medications used to combat viral infections) are used against the varicella zoster virus. These medications help shorten the course of the illness, decrease the severity of the illness, and hasten the healing of the skin lesions. They may also help prevent the potential complications sometimes encountered with shingles. Antiviral medications are most effective when commenced within 72 hours of the very first appearance of the rash, however, in select cases of shingles (for example, in an immunocompromised person), it can be embarked after 72 hours. There are several antiviral medications that can be used, including acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). In certain situations, intravenous (IV) antiviral medication may need to be administered.
Anguish medication can be used to help relieve the discomfort caused by the rash, which can sometimes be severe. For some individuals with mild shingles anguish, over-the-counter analgesics such as acetaminophen (Tylenol) or the anti-inflammatory drug ibuprofen (Motrin or Advil) may be all that is needed. Individuals with more severe agony may require stronger opioid anguish medication.
Over-the-counter antihistamine medication such as diphenhydramine (Benadryl) may help alleviate the localized itching.
The use of a corticosteroid medication, such as prednisone, is used in select cases of complicated shingles, such as those with eye or ear involvement, and it should be used with concurrent antiviral therapy. Prednisone is not generally recommended in cases of uncomplicated shingles.
Are there any home remedies for shingles?
Care of the skin rash can be provided at home, and this can suggest some symptom ease. Topical calamine lotion can be applied to the rash in order to decrease itching. Cool raw compresses against the rash can sometimes be soothing, and for some individuals, a compress with aluminum acetate solution (Burow’s solution or Domeboro) may also be helpful. For some, colloidal oatmeal baths may also provide ease from the itching. It is significant to maintain good individual hygiene, avoid scraping the rash, and to attempt to keep the affected area clean in order to prevent a secondary bacterial infection of the skin. The rash should be covered to decrease the risk of transmissibility should you come into contact with susceptible individuals.
What is the duration of a shingles outbreak?
The duration of an acute shingles outbreak may vary, but typically it will last anywhere inbetween two to four weeks. In some individuals, it may last longer.
What are complications of shingles?
However shingles often resolves without any major problems, there are several potential complications that can arise from shingles.
- Postherpetic neuralgia: This is the most common complication of shingles. This condition is characterized by persistent agony and discomfort in the area affected by shingles. The anguish can last for months to several years after the rash has cleared up. This complication is thought to occur because of harm to the affected nerves. The ache can sometimes be severe and difficult to control, and the likelihood of developing postherpetic neuralgia increases with age. This chronic post-herpetic anguish can sometimes lead to depression and disability. In people 60 years of age and older with shingles, postherpetic neuralgia will develop in approximately 15%-25% of cases. It infrequently occurs in people under 40 years of age. Timely treatment with antiviral medication during a shingles outbreak may reduce the incidence of developing postherpetic neuralgia. If postherpetic neuralgia develops, there are various treatment options available including topical creams such as tiger balm (Zostrix), topical anesthetic lidocaine patches (Lidoderm), antiseizure medications such as gabapentin (Neurontin), pregabalin (Lyrica), tricyclic antidepressant medications, and opioid agony medications. Intrathecal glucocorticoid injections may be useful for select patients with postherpetic neuralgia who do not react to conventional medications and treatment measures.
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What are complications of shingles? (Part Two)
- Ramsay Hunt syndrome: If shingles affects the nerves of the face, this uncommon complication can lead to facial muscle paralysis, and the characteristic rash can affect the ear and the ear cave, and uncommonly the mouth. Symptoms may include ear ache, ringing in the ears, hearing loss, and dizziness. Tho’ most people recover fully with treatment, some individuals may have permanent facial weakness and/or hearing loss.
- Bacterial skin infection: A secondary bacterial infection of the skin blisters can sometimes develop, leading to cellulitis. This skin infection may be characterized by enhancing redness, tenderness, and warmth in and around the area of the rash. Most of these bacterial skin infections are caused by either Staphylococcus aureus or group A Streptococcus bacteria. These bacterial infections can be treated with antibiotics.
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What are complications of shingles? (Part Trio)
- Eye involvement: Shingles can sometimes affect the eye, a condition termed herpes zoster ophthalmicus. In certain cases, it can lead to blindness. Individuals with a rash involving the eye, forehead, or nose should have a careful eye evaluation performed by a doctor, as prompt medical treatment may be necessary.
- Encephalitis: Infrequently, individuals with shingles may develop inflammation of the brain (encephalitis). This condition can be life-threatening if severe, especially in people with an impaired immune system.
- Disseminated herpes zoster: This serious and potentially life-threatening condition occurs most commonly in people with an impaired immune system. It is infrequent in individuals who are otherwise healthy. With disseminated herpes zoster, the varicella zoster virus becomes more widespread. In addition to causing a more widespread rash, the virus can also spread to other organs of the figure, including the brain, lung, and liver.
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What can be done for recurrent shingles?
However most people will practice only one gig of shingles during their lifetime, recurrence can occur in certain individuals. In order to help prevent recurrent gigs of shingles, individuals with no contraindications can receive the zoster vaccine (Zostavax), which has been shown to be effective in decreasing recurrent gigs of shingles. Otherwise, people who do practice a recurrent case of shingles should see their doctor as soon as the rash emerges to promptly receive antiviral medication.
What is the prognosis of shingles?
Generally speaking, shingles typically resolves within two to four weeks in most individuals. The prognosis is excellent for junior and healthy individuals who develop shingles, with very few experiencing any complications. However, in older individuals and in those with compromised immune systems, the prognosis is more guarded, as complications and more severe outbreaks of shingles occur more commonly in these groups.
Approximately 1%-4% of people who develop shingles require hospitalization for complications, and about 30% of those hospitalized have impaired immune systems. In the U.S., it is estimated that there are approximately 96 deaths per year directly related to the varicella zoster virus, the vast majority of which occur in the elderly and in those who are immunocompromised.
Is it possible to prevent shingles with a vaccine?
In 2006, the United States Food and Drug Administration (FDA) approved a shingles vaccine (Zostavax). Presently, the FDA has approved its use for individuals age 50 years and older, and the Centers for Disease Control and Prevention (CDC) has recommended its use for individuals age 60 years and older. It is a live attenuated vaccine that boosts the immune system and only needs to be administered one time. Ongoing studies are under way to determine how long the shingles vaccine confers protection. It has been shown to significantly reduce the risk of developing shingles by about 50%-60%, as well as reducing the incidence of postherpetic neuralgia by approximately 66%.
The shingles vaccine is not recommended during pregnancy or for those with weakened immune systems from disease or immunosuppressive medications, as it is a live vaccine. It is also not recommended for cases of active shingles or for those who have already developed postherpetic neuralgia. However, even if you have had shingles in the past, the shingles vaccine can still be administered to help prevent future recurrent shingles.
The vaccination can be administered at a pharmacy or at your doctor’s office. If you are vaccinated with the shingles vaccine, it is safe to be around children, pregnant women, and immunocompromised individuals, as there are no documented cases of people getting chickenpox from a recently vaccinated person.
Research funded and conducted by the National Institute of Neurological Disorders and Stroke (NINDS) on shingles and the varicella zoster virus is ongoing to better understand the behavior of this virus. Several other organizations are also involved in research to understand, treat, and prevent varicella zoster virus reactivation.
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Bell’s palsy is one type of facial nerve paralysis. The 7th cranial nerve controls the muscles of the face, and albeit scientists do not know the exact cause of Bell’s palsy, they think it may be due to nerve harm from an infection, for example, the flu, common cold viruses, and more serious infections like meningitis. The symptoms of Bell’s palsy vary from person to person, but can include:
- Mild weakness to total paralysis
- Dry eye
- Dry mouth
- Eyelid drooping
- Mouth drooping
- Dry mouth
- Switches in taste
- Excessive tearing in one eye
People with Bell’s palsy usually don’t need medical treatment, however, drugs like steroids, for example, prednisone seem to be effective in reducing full salute and inflammation are used when medical is necessary. Most people with Bell’s palsy begin to recover within two weeks after the initial onset of symptoms. Total recovery may take three to six months.
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