Shingles • Symptoms & Treatment of Herpes Zoster

Shingles or herpes zoster is a viral infection that is associated with a painful, blistering rash along various nerve pathways. Shingles can break out in people who have had chickenpox before.

Shingles, medically called herpes zoster, is an infectious disease that is caused by viruses. This causes painful blisters to form on the skin along various nerve tracts (dermatomes). The rash usually only appears on one side of the head or upper body, and occasionally one side of the buttocks and one leg are also affected. Because herpes zoster occurs particularly often in a semicircular shape around the stomach, the disease is known as shingles.

Serious complications can arise if shingles appear on the face. If the eyes are affected, this can lead to blindness.

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Shingles mostly affects the elderly

It is estimated that one in three people will develop herpes zoster once in a lifetime. If the immune system declines with age, the risk of developing shingles also increases. Two thirds of those affected are over 50 years old.

The viruses that cause shingles are varicella, which causes chickenpox. If an infection with chickenpox is over, the varicella dormant in the nerve cells for a lifetime.

In stressful situations and a poor immune system, the pathogens can become active again and cause shingles – the second face of chickenpox. By recognizing and treating this in good time, one can prevent a severe herpes zoster course with complications.

Symptoms of Shingles

The first symptoms of herpes zoster are similar to those of the flu. Symptoms such as fever and chills develop. Sometimes the early signs of shingles are just a general feeling of weakness and tiredness. Afterwards, a tingling sensation and itching (pruritus) become noticeable on the skin areas along the affected nerve tracts. Grouped vesicles will later form at these points.

Typical: nerve pain

Overall, the skin in the affected areas is reddened and extremely sensitive to pain. The pain with shingles is pressing, stabbing or burning, it sometimes shoots in like lightning. After about a week, the vesicles begin to crust until they heal after another one to three weeks.

Very often shingles in the painful area also leads to sensitivity disorders in the form of hypersensitivity to stimuli (hyperpathia). Sometimes the pain threshold is lowered so that every touch of the skin in the affected area is painful (allodynia). These consequences of shingles are difficult to treat.

In five to 30 percent of cases, the rash does not heal without complications, but post-zoster neuralgia develops. There there is more or less severe pain along the affected nerves. Among people over 60 years of age, this consequence occurs even in 20 to 60 percent.

Herpes zoster infection as a cause of shingles

Shingles occurs in a weakened immune system due to the reactivation of the pathogen causing chickenpox, the so-called varicella (varicella zoster). So only those who have already endured chickenpox can get sick. After such an infection, the viruses remain in the body as “sleepers” and settle along the nerve pathways in the nerve nodes of the spine and / or the cranial nerves. In this inactive state, they are invisible to the immune system, so they are not fought any further.

Deficiency in the immune system leads to shingles

There, in connection with a weakened immune system, they can become active again at any time and trigger shingles. However, the exact cause of why an outbreak occurs remains unclear in most cases. HIV-infected or leukemia sufferers in particular have a significantly increased risk of developing shingles due to their weakened immune system.

Thoughtful woman

Self test

Shingles self-test: am I at risk?

Shingles is an infectious disease that manifests itself through blistering changes in the skin and usually occurs in a belt-shaped manner on one side of the body. The infection is caused by the herpes zoster virus – the chickenpox virus. The pathogen is dormant in the body of anyone who has had itchy smallpox in their life – in a third of people the virus breaks out again in the course of their life and manifests itself as shingles.

Elderly people are particularly affected, as the immune system weakens with age, but other factors also play a role. Shingles usually heals on their own, in more severe cases it can lead to so-called postherpetic neuralgia, in which the virus permanently damages nerve cells – deep-seated pain is the result. This test provides you with an initial assessment of how high your current individual risk of developing shingles is.

This test is not a substitute for diagnosis or medical advice. Therefore, if in doubt, please do not hesitate to see an appropriate doctor!

Shingles: this is how the diagnosis works

In order to diagnose shingles, a medical questioning (anamnesis) takes place. An important note is usually the pain that occurs along the affected nerve tracts before the vesicles form, which is characteristically limited to only one half of the body. If the vesicles have already formed on the skin, the typical appearance of these skin changes reveals the disease.

However, shingles should not be confused with cold sores (herpes simplex), which can spread not only to the lips but to adjacent skin areas – similar to herpes zoster.

Various blood tests, in which the pathogen or specific antibodies are detected, can confirm the diagnosis. The findings sometimes also provide indications of other diseases.

Treatment of shingles

Specific therapy for shingles is usually not necessary for people with a healthy immune system. Shingles heals on its own without special drug therapy. In these cases, drying and antiseptic treatment of the areas of skin covered with blisters and adequate pain treatment are usually sufficient.

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Antiviral therapy for severe shingles

A therapy that specifically fights the herpes zoster virus (antiviral therapy) can shorten or alleviate the disease and prevent a severe course. The active ingredients acyclovir, brivudine, famciclovir or valaciclovir are available for this purpose.

Antiviral treatment is urgently recommended for:

  • People over 50 years of age

  • Herpes zoster in the head and / or neck area

  • severe herpes zoster, for example if more than one segment is affected, the vesicle formation is unusually pronounced, or if the mucous membrane (in the mouth or on the eye) is affected

  • People with weakened immune systems

  • People with severe allergic skin lesions (dermatitis atopica)

  • Children and adolescents on long-term treatment with salicylates or corticosteroids

The therapy of shingles is therefore always based on the individual circumstances of the patient.

Shingles: course, stages and complications

Anyone who develops herpes zoster is usually healthy again after two to three weeks, provided the immune system is intact. However, complications such as meningitis (meningitis) or chronic courses with repeated attacks of nerve pain (post-therapeutic neuralgia, zoster neuralgia, post-zoster neuralgia) can occur.

Further complications that can occur in the acute stage are additional bacterial infections in the affected areas of the skin, symptoms of paralysis in the area of ​​the affected nerves, conjunctivitis and various complaints of internal organs.

If pregnant women develop shingles, there is little danger for the unborn child (unlike chickenpox infection). In the stage of blistering on the skin, expectant mothers should definitely stay away from other pregnant women, as they may not have their own immune status against varicella and could therefore develop chickenpox.

Shingles infection

In the vesicular stage, shingles is highly infectious by smear infection. In unprotected people who have neither been vaccinated against chickenpox nor have already had a varicella infection, the transmission of the herpes zoster virus is very likely to lead to a chickenpox infection. Recent studies even suggest that shingles, chickenpox, and herpes can still be contagious in their early stages and as they go away.

Preventing shingles with vaccinations?

Especially if the shingles does not heal after two to four weeks and a post-zoster neuralgia follows, those affected sometimes suffer greatly from the consequences. Treatment options are available, but these are often limited in their ability to alleviate the symptoms of shingles and prevent subsequent complications. Treatment should begin within 72 hours of the rash appearing. This does not always succeed, however, as the symptoms can initially be unspecific, which is why the disease is often noticed late. It is therefore all the more important to protect yourself against the virus before it breaks out.

Dead vaccine recommended as the standard vaccination for everyone over 60

A vaccine is available for people aged 50 and over. This can also be used in immunocompromised people to prevent shingles and post-zoster neuralgia, as it is a dead vaccine, which therefore does not contain any pathogens capable of multiplying. The vaccine contains parts of the surface structure of the virus and thus elicits a specific immune response in the body. In addition, an active enhancer helps to increase this immune response.

According to an international study called ZOE-70, published in the New England Journal of Medicine in 2016, vaccination lowers the risk of the herpes zoster virus outbreak again by 97.2 percent. The vaccination consists of two doses, with only two and a maximum of six months between the individual vaccinations.

Since December 2018, vaccination has been recommended by the Standing Vaccination Commission STIKO as the standard vaccination for all people aged 60 and over. In addition, as an indication vaccination for all persons over 50 years of age who have an increased risk of developing shingles. This is especially the case with existing underlying diseases and an acquired immune deficiency (immunodeficiency). Affected are people with HIV, rheumatoid arthritis, inflammatory bowel disease or bronchial asthma.

The statutory health insurance companies are obliged to assume the costs for people aged 60 and over. In the event of a particular risk, the amount will also be reimbursed to people aged 50 and over.

A healthy lifestyle supports the defense

Because it is known that shingles often occurs in stressful situations and with a weakened immune system, a healthy lifestyle can prevent it to a certain extent. A healthy diet rich in vitamins and sufficient physical exercise are good foundations for strengthening your own immune system.

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Source: Lifeline | Das Gesundheitsportal by

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