Shingles

In this Article

• What is shingles? What causes shingles?
• What are symptoms of shingles? How long does shingles last?
• Is shingles contagious?
• What is the treatment for shingles? Should I visit my health-care professional?
• What are the complications of shingles?
• What is postherpetic neuralgia?
• Can shingles be prevented with a vaccine?
• Shingles At A Glance
• Pictures of Shingles - Slideshow
• Gallery of Skin Problems Pictures and Images Collection
• Pictures of Adult Skin Problems - Slideshow
• Patient Discussions: Shingles - Effective Treatments

What is postherpetic neuralgia?

The most common complication of shingles is postherpetic neuralgia. This occurs when the nerve pain associated with shingles persists beyond one month, even after the rash is gone. It is a result of irritation of the nerves of sensation by the virus. The pain can be severe and debilitating. Postherpetic neuralgia occurs primarily in people over the age of 50 and affects 10%-15% of people with shingles. There is evidence that treating shingles with antiviral agents can reduce the duration and occurrence of postherpetic neuralgia.

The pain of postherpetic neuralgia can be reduced by a number of medications. Tricyclic antidepressant medications (amitriptyline [Elavil] and others), as well as antiseizure medications (gabapentin [Neurontin], carbamazepine [Tegretol], pregabalin [Lyrica]), have been used to relieve the pain associated with postherpetic neuralgia. Capsaicin cream (Zostrix), a derivative of hot chili peppers, can be used topically on the area after all the blisters have healed, to reduce the pain. Lidocaine pain patches (Lidoderm) applied directly to the skin can also be helpful in relieving nerve pains by numbing the nerves with local lidocaine anesthetic. These options should be discussed with your health-care professional.

Can shingles be prevented with a vaccine?

In May 2006, the U.S. Food and Drug Administration (FDA) approved the first vaccine for adult shingles. The vaccine, known as Zostavax, is approved for use in adults ages 60 and over who have had chickenpox. The shingles vaccine contains a booster dose of the chickenpox vaccine usually given to children. Tests over an initial four-year period showed that the vaccine significantly reduced the incidence of shingles in these older adults. The single-dose vaccine was shown to be more than 60% effective in reducing shingles symptoms and it reduced the incidence of postherpetic neuralgia (PHN, see above) by at least two-thirds. Studies are ongoing to evaluate the effectiveness of the vaccine over a longer term.

People with weakened immune systems due to immune-suppressing medications, cancer treatment, HIV disease, or organ transplants should not receive the shingles vaccine because it contains live, weakened viral particles.

Since vaccination against VZV is now recommended for children, the incidence of chickenpox has been reduced. This is also expected to reduce the incidence of shingles in adults as these children age.

Shingles At A Glance

• Shingles is caused by the same virus that causes chickenpox and can be spread to people who have not had chickenpox.
• Shingles, also known as Herpes zoster, is not related to the sexually transmitted herpes virus disease called herpes genitalis.
• Shingles may cause pain that can continue after the rash disappears.
• Steroids and antiviral drugs can help prevent long-term pain after shingles if they are started within the first two days of the appearance of the rash.
• A vaccine is available for people over 60 years of age to reduce the incidence and severity of shingles.

Previous contributing author: Frederick Hecht, MD, FAAP, FACMG

Shingles - Effective Treatments

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