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Immune system
Shingles (also known as herpes zoster) is a painful blistering skin rash caused by a virus, called the varicella zoster virus. It is the same virus that causes chickenpox. Only people who have had chickenpox in the past will develop shingles. After the symptoms of chickenpox have gone, the virus lies inactive for years in the nerves, but later becomes activated to cause shingles.

In some people, the virus may damage the nerve, causing severe pain called neuralgia. This pain may persist after the original symptoms of shingles have gone. In such cases this is called post-herpetic neuralgia and the pain can last months, sometimes years.

Shingles most commonly occurs in those over the age of 50, but it can strike at any age in those who have a poor immune system. About 250,000 people in the UK get shingles every year, and about 100,000 of these will develop post-herpetic neuralgia.
Varicella zoster virus is spread in tiny droplets of saliva or nasal secretions when a person with chickenpox coughs or sneezes. It takes between two to three weeks to develop chickenpox after being in contact with an infected person. The person who catches the disease will develop a red blistery rash and is himself or herself infectious for about 1 week, starting about 2 days before a rash develops and remaining infectious for a further 5 to 6 days until the last blister crusts over. (see separate article on Chickenpox)

Although the person recovers from chickenpox, the virus remains in the body, hiding in the nerves protected from the body’s immune system, in an inactive or dormant state. Many years later, usually when the person is over 50 years of age, the virus can start to become active again causing the symptoms of shingles. It is not known exactly why the virus should become active again, but it is probably caused by stress that affects the person’s immune system.

Shingles is not infectious but it is contagious (spread by touch). If an adult or child has direct contact with the shingles rash and has not had chickenpox as a child or has not been vaccinated against chickenpox, they can develop chickenpox, not shingles. Although they may develop shingles later in life just like any other person who has had chickenpox.
Symptoms of shingles include pain and rash. The first symptom is usually a pain, tingling or burning sensation on one side of the body. The pain is usually concentrated around whichever nerve is affected by the virus. The most commonly affected nerves are in the skin of the abdomen and chest and the symptoms occur in a band around the trunk. Sometimes nerves in the face, eyes, mouth and ears can be involved. A rash usually appears a few days after the pain starts, appearing first as red patches on the skin. The red patches develop into small blisters that burst, dry and subsequently crust over. An attack of shingles may last 2 to 4 weeks.

In some people, the virus may damage the nerve causing severe pain called post-herpetic neuralgia that may persist for months, sometimes years after the original symptoms of shingles have gone.
There is no cure for shingles but the pain may be treated with simple analgesics such as paracetamol and the rash may be treated with calamine lotion or antihistamines. If the pain is very severe, stronger analgesics such as the non-steroid ant-inflammatory drugs ibuprofen or diclofenac may be tried.

Antiviral agents such as aciclovir, famciclovir and valaciclovir may help reduce the intensity of a shingles attack and reduce the risk of post-herpetic neuralgia. To be effective, these antivirals must be taken as soon as possible and within 48 hours of the start of the rash. If post-herpetic neuralgia does occur, creams containing capsaicin may be applied directly to the area to relieve pain, or drugs such as amitriptyline, imipramine, gabapentin, pregabalin and carbamazepine may be used.
When to see your pharmacist
Visit your pharmacist if you think that you may have shingles. Your pharmacist will be able to confirm your illness.

If the rash is painful, your pharmacist will be able to recommend medicines to ease pain. If the rash is causing a lot of discomfort the pharmacist will recommend calamine lotion to be applied directly to the rash or will recommend an antihistamine to take.

If your pain is particularly severe, or if you have suffered from post-herpetic neuralgia in the past, the pharmacist will advise you to visit your doctor who will be able to prescribe stronger pain killers or antiviral medicines.

Always tell your pharmacist if you are pregnant, taking any other medicines, including supplements bought from health shops, or if you have any other illness.
When to see your doctor
If you are pregnant and think you might have been in contact with someone who has chickenpox or shingles, and you are not sure if you have had chickenpox before you should see your doctor immediately. If you have had chickenpox before, then both you and the baby are protected. Your baby is protected even if you develop shingles during your pregnancy.

If you have not had chickenpox before, there is a risk of the baby developing an abnormality if you catch chickenpox between the 13th and 20th week of your pregnancy. If you have not had chickenpox before or are not sure if you have had chickenpox, see your doctor immediately. Your doctor will test your blood for antibodies against the disease and give you an injection of varicella zoster immunoglobulin (antibodies) if you are not immune.

Shingles can be very severe for people with a lowered immune system. Anyone currently or recently receiving corticosteroids or chemotherapy, or with diseases of the immune system, such as leukaemia, HIV and AIDS, should seek medical advice if they think they might have been in contact with someone with chickenpox or shingles.

If you have suffered from shingles in the past, or if shingles is affecting the eye or ear, you should see your doctor as soon as symptoms first appear as your doctor may want to prescribe antiviral medication at a time when it is most effective.

If you think the shingles rash has become infected you should see your doctor.

If your pain is particularly severe and continues after the rash has gone and you think that you may have post-herpetic neuralgia see your doctor.
Living with shingle and post-herpetic neuralgia
If you develop shingles it is important not to scratch the rash as this will risk breaking the skin and causing a skin infection. Keep the skin clean, but avoid vigorous cleansing and the use of scented soaps as this may aggravate the rash.

A cold compress such as a damp flannel applied to the area will help take the heat out of the rash and reduce irritation. If the rash is particularly severe, take a cool bath, dab the area dry with a towel and apply calamine lotion.

During the day, wear light loose fitting clothes made of cotton rather than synthetic fibres.

If you suffer from post-herpetic neuralgia, talk to your pharmacist or doctor about the use of a TENS (transcutaneous electrical nerve stimulation) machine, a device that gives small electric pulses that block the nerves carrying pain signals to the brain.

If you have suffered from shingles or post-herpetic neuralgia in the past there is a risk of your having another attack. Be aware of your symptoms and learn to recognise the tingling sensation that indicates that shingles is starting. As soon as you notice these symptoms, go to see your doctor and ask to be prescribed antiviral medicines.
Further information
The Shingles Support Society provides information and advice about shingles and post-herpetic neuralgia.

Shingles Support Society
41 North Road
N7 9DP
Tel: 0845 123 2305

Reviewed on 6 June 2011