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Shingles (herpes zoster) is a viral infection caused by the varicella-zoster virus (VZV), the same virus that causes chicken pox. After a person has had chickenpox, VZV remains in a dormant (inactive) state in the nerve roots for the rest of their life. VZV may reactivate years later in the form of a painful skin rash known as shingles. Shingles is a relatively common disease, with about 500,000 cases of Shingles reported annually, according to the National Institute of Allergy and Infectious Diseases.

Why VZV becomes active after a prolonged period of dormancy is unknown. Research suggests that several factors may play a role in the development of shingles (e.g., weakened immune system, stress, and fatigue). A physician can often diagnose a shingles rash by physical examination. However, a physician may perform tests for confirmation (e.g., Tzank smear). Most cases of shingles go away without treatment. A physician may recommend some treatments to alleviate symptoms.

Anyone with VZV can potentially have a shingles outbreak, making shingles impossible to prevent once the virus is in the body. People who have been vaccinated or who have never had chickenpox cannot develop shingles but may develop chickenpox following exposure to VZV. According to the American Academy of Dermatology (AAD), about 20 percent of people exposed to VZV develop shingles, with most of these outbreaks being relatively mild and without recurrence.

Repeated attacks of shingles are possible. However, most episodes are mild and occur once, unless the patient is immunosuppressed (e.g., HIV patient, organ transplant recipient, chemotherapy patient). Widespread or recurrent shingles may indicate an underlying problem with the immune system. Shingles most often affects adults of both genders aged 55 and older. This may be due to a breakdown in VZV immunity as people age. However, shingles may potentially affect anyone infected with VZV due to an earlier chickenpox infection.

Some people may experience post-herpetic neuralgia, a condition of shingles that causes the skin to remain painful for months or sometimes years after a shingles rash has gone away. Post-herpetic neuralgia pain can be slightly uncomfortable or severe and incapacitating, resulting in depression, anxiety and sleeping difficulties. The rate of incidence increases significantly with age, usually occurring in patients aged 60 and older. Rarely, other potentially serious complications may occur in association with shingles, including: Bacterial skin infection, Inflammation of the cornea (keratitis) or membranes of the eye (uveitis}, Nerve damage, Meningitis (inflammation of the membranes that protect the brain and spinal cord), Encephalitis (inflammation of the brain), Stroke, or Myelitis (inflammation of the spinal cord).

Shingles is only contagious from direct contact with open blisters. Individuals who have not had chickenpox or received the vaccine and are then exposed to shingles are not at risk of developing shingles, but may develop chickenpox. Covering open blisters may be an effective way of preventing the spread of VZV to others. Likewise, scratching of blisters may worsen symptoms or spread VZV to others and should be avoided. Medical attention should be sought immediately if a rash with blisters develops on the nose or near the eyes. When this occurs, VZV may spread to the eye and cause eye damage or visual loss. In addition, pregnant women and individuals with weakened immune systems have an increased risk for complications and should seek medical attention if shingles develops.

It may affect many different body parts depending on which dermatomes (the area of the body supplied by a spinal cord nerve) are involved. Shingles tends to be more painful and cause less itching than chickenpox.

In most cases, the dominant symptom is extreme sensitivity or pain along specific bands of nerves on one side of the body. It is sometimes accompanied by other vague symptoms, such as numbness, tingling and itching.

Two to five days following the initial sensation, a rash consisting of red blisters appears on the surface of the skin in the same location. The blisters then break, forming small ulcers that dry and crust over. The rash usually lasts about two or three weeks before it scabs and disappears, sometimes leaving pink or scarred skin.

Rash blisters or lesions most often appear along a single dermatome, and on only one side of the body, though two or three adjacent dermatomes may occasionally be involved. The thoracic (chest) and lumbar (lower back) dermatomes are most often affected by shingles. Some patients may develop a few scattered blisters on the body separate from the rash. This occurs when small amounts of VZV are released from the affected nerve areas into the bloodstream and spread to other locations.

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