Shingles is a viral disease. It is caused by the same pathogen as chickenpox. A painful skin rash is typical of shingles – but it can also be absent. It usually heals within a few weeks. However, early treatment is important to reduce the risk of complications. Read more about: How does shingles (herpes zoster) develop? What are the symptoms? Is shingles contagious? are shingles and herpes the same?
ICD codes for shingles disease: B02
Shingles: Quick Overview
- Path of infection: Anyone who has previously had chickenpox gets shingles (exception: vaccinated people). Chickenpox is highly contagious (droplet infection). Direct infection in people with shingles through contact with a rash or contaminated surfaces. Result: Chickenpox – after 14 to 16 days of incubation!
- Triggers: physical and psychological stress, other viral infections, cancer, immune system suppressing drugs, UV light.
- Symptoms: General malaise, headache and body aches, slight fever, tingling skin, shooting pains (burning, stinging), belt-shaped skin rash with fluid-filled blisters that later crust.
- Locations: Rash mostly on one side on the chest or abdomen, but also possible on the neck, face or scalp.
- Treatment: relieve the symptoms with painkillers (ibuprofen, paracetamol, gabapentin), ointments or tinctures. Causal therapy with antivirals.
Causes and risk factors of shingles
Shingles (herpes zoster) is caused by the varicella-zoster virus (VZV). The pathogen belongs to the herpes viruses and is very contagious. In addition to shingles, it triggers another disease: chickenpox (varicella). This childhood disease occurs as an initial infection. This means:
If someone is infected with the varicella-zoster virus for the first time, they will get chickenpox. After this childhood disease has healed, the viruses remain in the body. They retreat into the so-called spinal ganglia. These are collections of nerve cell bodies along the spinal cord. Here the viruses can “slumber” inactively for life.
However, they can also become active again, even years or decades after the chickenpox infection. The “awakened” viruses then spread along nerve tracts and cause inflammation of the affected nerve tissue on their way. As a reaction, the typical painful rash of shingles develops in the affected area of skin.
Risk of infection & route of infection
This means that only people who have previously had chickenpox can get shingles. This is important to know when it comes to the risk of shingles infection. Ultimately, the infectiousness of chickenpox is decisive, and it is extremely high: 90 out of 100 contagious people contract chickenpox if they have had contact with a sick person. You are contagious if you have not yet had the childhood disease and have not been vaccinated against it.
But what does “contact with a sick person” mean? In the case of chickenpox, it means that an infectious person is within several meters of a sick person. The varicella are passed on via a so-called droplet infection.
This means that the pathogens are transmitted via the airway. So you don’t even have to touch a sick person to get infected. It is enough to inhale the tiny virus-containing droplets that the patient spreads into the ambient air when breathing or coughing.
Shingles is contagious in another way : the varicella-zoster virus is transmitted through direct contact with the virus-containing content of the skin vesicles. This can happen, for example, when a healthy person touches a patient’s rash. Viruses can also be transmitted when touching objects that the patient previously had in his/her contaminated hand (indirect contact).
The person will then get chickenpox if they have not had it before and have not been vaccinated against it. Direct infection with shingles is not possible, since this can only break out when viruses that have settled in nerve cells are reactivated.
Many people don’t get chickenpox because they’ve been vaccinated against the childhood disease. However, they can also develop shingles if they have been immunized with a live vaccine.
The vaccine viruses can then nest in the nerve cells and become active later in life. But that happens less often than in people who have had chickenpox. In addition, the disease is then milder. Shingles usually shows up near the original vaccination site.
How long is shingles contagious?
Shingles patients are contagious from the time the skin blisters appear until they have completely crusted over. Generally this takes 5 to 7 days.
For comparison: Chickenpox patients are contagious one to two days before the rash appears. There is a risk of infection until the skin blisters have crusted over. Again, this usually lasts five to seven days after the first blisters appear.
What can cause shingles?
As explained above, only people who have previously had chickenpox can get shingles. The varicella-zoster viruses “sleeping” in them are normally kept in an inactive state by the immune system.
If the body’s defenses are weakened, the pathogens can “wake up” and trigger shingles. There are many reasons for an immune deficiency and thus the risk factors for shingles. The most important are:
- Max stress (also mental strain).
- UV radiation: In excessive doses, UV radiation can trigger shingles. So it is quite possible that the herpes zoster follows a severe sunburn.
- Other infections that precede herpes zoster: They can promote shingles. Sometimes a flu infection is enough.
- AIDS: In this syndrome caused by the HI virus, certain cells of the immune system (T cells) are destroyed.
- Cancers: These often weaken the immune system.
- Chemotherapy: The drugs used to fight cancer also affect the immune cells, among other things.
- Medicines that dampen the body’s defense system (so-called immunosuppressants): for example TNF blockers as part of rheumatism therapy.
- Congenital immunodeficiencies: Here, certain components of the body’s defenses are reduced or absent from birth.
The fact that shingles usually only occurs after the age of 40 is also related to the immune system: the body’s defenses become less efficient with age. Shingles in children or young adults is rare.
Incubation period of shingles
The incubation period is the period of time between being infected with a pathogen and the appearance of the first symptoms. In the case of shingles, however, there is no contagion: the pathogen has been lodged in the body since the chickenpox infection. So one can only speak of an incubation period for chickenpox. It is usually 14 to 16 days here.
Symptoms of shingles
The symptoms of shingles are not uniform. They can vary from case to case, especially in terms of their severity. Most of the time, the shingles symptoms follow a certain pattern:
In the early phase of the disease, there are no specific symptoms. The patients only report general symptoms such as exhaustion, headaches and body aches or a slight fever. Discomfort such as tingling can occur on the affected skin area. They turn into pain after two to three days, and the typical shingles rash types.
The pain can occur before, during and in unfavorable cases also after the rash. Since the viruses attack the nerves in shingles, it is called neuropathic pain. These are expressed by a burning or stinging sensation, are sometimes dull and shoot up suddenly again and again.
Shingles pain can be felt to be very strong. Especially the nerve pain after the rash has subsided (post-herpetic neuralgia) often causes major problems.
The typical feature of shingles is the characteristic skin rash, which is also known as zoster. It usually begins with a non-specific reddening of the affected area with small skin nodules. Within hours, these nodules develop into small skin blisters, which can also itch. They are filled with an initially clear liquid that gradually becomes cloudy.
The skin blister phase lasts up to five days. After bursting, the blisters dry up within two to ten days. Yellowish crusts often form, and the rash eventually disappears when they fall off. Overall, it generally takes two to four weeks for the lesions from shingles to disappear.
It’s also possible for shingles to appear without a rash (just with pain). Doctors then speak of a “zoster sine herpete“.
Are shingles and herpes the same?
Herpes zoster, also known as shingles, is caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes varicella (chickenpox).
Which body region is affected?
What is striking about shingles is the pattern of spread of the rash. The viruses migrate along certain nerve tracts on the skin’s surface (technical term: dermatomes). This is why the rash often develops in stripes.
Shingles most commonly develops on the back or chest. In principle, however, herpes zoster can affect all parts of the body. The head and neck are often affected. In other people, shingles develops on the leg or arm. The painful rash is usually limited to one side of the body.
Sometimes several skin areas are affected at the same time. If the immune system is severely weakened, the shingles rash can also spread over the entire surface of the body. This generalized herpes zoster is then difficult to distinguish from chickenpox.
Shingles on the face
Occasionally, shingles also develops on the face. This can be problematic: sometimes the cornea of the eye is affected. Then an inflammation of the cornea (keratitis) can develop.
The auditory and taste buds can also be affected. Some patients even develop a one-sided facial nerve paralysis (facial paralysis).
Herpes zoster: pregnancy and newborns
According to the current state of knowledge, if a pregnant woman gets shingles, this is not a problem for the unborn child: it is not affected by the disease. Even if shingles occurs around the due date, there is generally no danger: infection with the varicella-zoster virus at this stage is unlikely.
Chickenpox is more dangerous
However, an initial infection with the varicella-zoster virus during pregnancy, i.e. a chickenpox infection, can be dangerous: an illness in the first half of pregnancy can cause birth defects and damage to the unborn child. Doctors speak of congenital varicella syndrome (CVS).
Although it is rare, it is serious: the affected children have, for example, underdeveloped limbs, eye defects, convulsions, scarring and skin ulcers. Some of the little patients die as a result.
It can also be life-threatening for the child if a pregnant woman falls ill with chickenpox shortly before or after birth. The child can be infected by the mother and then get chickenpox itself. These newborn varicella can be severe and even fatal. There are two reasons:
On the one hand, the child’s immune system is not yet mature, so it cannot fight the pathogen effectively. On the other hand, because of the “fresh” infection, the mother does not yet have any antibodies that she could pass on to the child (via the umbilical cord or breast milk).
Diagnosis of shingles
Most patients with suspected shingles go to their family doctor or dermatologist. If the eye or ear area is affected, an ophthalmologist or ear, nose and throat doctor should be consulted.
The typical clinical picture usually leads the doctor quickly to the diagnosis of shingles: the course and type of symptoms are characteristic of the secondary disease caused by the varicella-zoster virus.
However, in the early stages of shingles, it can sometimes be difficult to diagnose. The general signs of illness and an initial rash can have many causes. Then certain tests help to reliably identify herpes zoster and rule out other diseases with similar symptoms (such as herpes simplex). There are essentially two ways to do this:
- Direct detection: The virus can be detected directly from a wound swab, for example with the help of the so-called PCR (polymerase chain reaction) or a cell culture.
- Indirect detection: The patient’s blood is examined for specific antibodies against the varicella zoster virus. If the brain is affected, a sample of the cerebrospinal fluid can also be analyzed.
Treatment for shingles
The unpleasant symptoms of shingles can be alleviated with medication: Light painkillers such as ibuprofen or paracetamol , for example, help against the pain . These also have an antipyretic effect. If necessary, the doctor can also prescribe stronger painkillers.
Depending on the stage, the rash is treated with skin care products : antipruritic products in the form of ointments or tinctures are available, for example. Some preparations also promote the drying out of the blisters or the detachment of the crusts.
In addition to these purely symptomatic measures, you can also start a causal treatment for shingles: The patients are given antiviral drugs (antivirals) that fight the varicella-zoster virus.
Shingles: disease course and prognosis
The prognosis for shingles is usually good. It heals within a few weeks in most people with a healthy immune system. After the blisters burst, they crust over and after a few days the scab falls off. In contrast to chickenpox, patients here usually do not feel embarrassed to scratch because the pain prevents them from doing so.
Complications of shingles
Sometimes shingles has complications. These include, among others:
- Bacterial secondary infection: The skin areas damaged by zoster are also infected with bacteria.
- Pigment disorders, bleeding and melting of the skin as well as scarring
- Signs of paralysis and sensory disturbances (paraesthesia) in the affected body region
- Meningitis and encephalitis when zoster affects the central nervous system
- Disseminated (generalized) herpes zoster: The whole body is attacked by the zoster virus. Internal organs are also affected.
In addition, zoster can cause damage, especially to the eyes and ears, which can lead to blindness or deafness. These specific shingles symptoms are described in more detail in the post “ Shingles on the Face”.
People with an immune deficiency are particularly susceptible to such shingles complications. These include AIDS or cancer patients. Disseminated herpes zoster and the attack on the central nervous system are particularly feared here. In addition, the herpes zoster symptoms in immunodeficiency are often atypical.
In some patients, neuropathic zoster pain persists or flares up repeatedly after the rash has cleared. Doctors then speak of “postherpetic neuralgia” or “postherpetic neuralgia” (PHN).
In the worst case, the symptoms remain for life. This complication is particularly feared in elderly patients with shingles. How exactly the pain arises is not yet clear. In any case, the affected nerves are permanently damaged by the zoster.
These neuralgias can cause extremely severe pain. It is therefore very important to intervene as early as possible with special medication. This gives you a chance to prevent persistent shingles symptoms.
Prevention of shingles
People with chickenpox or shingles should avoid scratching their often itchy rash. This reduces the risk of infecting other people. Because by scratching the blisters, the highly infectious content gets on your fingers.
From there it can be distributed to the environment, such as doorknobs or cutlery. If healthy people touch these objects and then unconsciously grab their mouth or nose, the viruses can be transmitted.
Vaccine against chickenpox
People who have not yet contracted the varicella-zoster virus can get vaccinated. This protects against the childhood disease and thus also against a possible subsequent shingles.
CDC recommends two doses of chickenpox vaccine for children, adolescents, and adults. Children should receive two doses of the vaccine—the first dose at 12 through 15 months old and a second dose at 4 through 6 years old.
Vaccine against shingles
There has been a vaccine against shingles since May 2018, which the Robert Koch Institute recommends for people over the age of 60. It lowers the risk of contracting herpes zoster.
Unlike the previously used live vaccine (which has been around since 2013 and is no longer recommended for standard vaccination), it consists of killed pathogens and also contains a new active enhancer.
Two doses of the active substance are required for the vaccination, spaced two to six months apart and administered intramuscularly (into the upper arm muscle).
Vaccination is generally standard for people over the age of 60, for people with chronic diseases such as diabetes, HIV, kidney failure, etc. or an immune deficiency from the age of 50.