Commonly known as shingles, herpes zoster is a rash caused by the Varicella-Zoster-Virus (VZV), a member of the herpes virus family: as the name suggests, it is the same virus that causes chickenpox in children

The virus is able to remain dormant in nerve tissue (e.g. cranial nerves or spinal cord) and can reactivate years later, triggering shingles, commonly referred to as shingles.

It is estimated that about 90% of the Italian population has contracted chickenpox at least once in their lifetime (usually in childhood), of which 10% decades later will have a recurrence with a reactivation of the virus in the form of shingles.

The main manifestation of herpes zoster (or shingles) is a painful rash

It resembles an elongated plaque covered with vesicles, usually appearing on one side of the body, most frequently the chest or abdomen, but can occur anywhere, including the face and eyes.

While it is not a life-threatening condition, it can be particularly painful and last for 2-4 weeks.

Is shingles contagious? Here are the causes and how it is transmitted

As already mentioned, shingles is caused by the varicella-Zoster virus from the herpes virus family.

The first time it comes into contact with the body, often in childhood, this virus triggers chickenpox.

Although the immune system usually manages to cope with the first illness, the virus remains in the body in a ‘dormant’ state within clusters of nerve cells located along the course of nerves and known as nerve ganglia.

It may remain in this state for life or, usually after several years, the viral agent may reactivate and, moving along the nerves, reach the skin surface where it causes shingles to appear.

Having contracted chickenpox in childhood does not necessarily lead to the development of shingles in adulthood.

In fact, reactivation of the virus is not the rule; when it does occur, however, there is usually only one episode of herpes zoster or at most two; it is rare for it to occur more than once.

At the origin of a reactivation of the virus in the form of shingles is believed to be a sudden lowering of the immune defences, which may in turn be due to

• severe psychophysical stress;
• certain pharmacological treatments;
• diseases affecting the immune system;
• excessive exposure to sunlight;
• old age.

Those who have developed herpes zoster are contagious, and can therefore transmit the virus to those who have never contracted the varicella-zoster virus in their lives, i.e. people who have never had chickenpox or who have been vaccinated against it: transmission occurs through direct contact with the open vesicles, which contain the virus.

Those who come into contact with the virus, since this is their first encounter, will not develop shingles, but chickenpox

For this reason, those who develop an episode of shingles are urged, until they are no longer contagious (i.e. until the last vesicle has dried), to avoid sharing towels, bathrobes and clothing with other people, to stay at home and not to frequent public places or engage in activities that may favour the transmission of the virus, such as going to the swimming pool or playing contact sports.

What are the symptoms of shingles?

These are characteristic symptoms of herpes zoster:

• Presence of an elongated, band-like, erythematous skin area covered with itchy, fluid-filled blisters, like those of chickenpox.
• Severe, burning, stabbing pain
• Headache
• Fever
• Chills
• Stomach pains
• Lassitude

Shingles: How is it diagnosed?

In most cases for the diagnosis of herpes zoster, a medical examination is sufficient, with a visual examination of the rash, which usually has features that the doctor can clearly distinguish.

The doctor also usually asks the patient a few questions, e.g. inquiring about a possible past episode of chickenpox and whether there were any particular symptoms before the blisters appeared.

In some rare cases, if the symptoms are not clear (e.g. no rash is present or it is much more extensive than expected), the doctor may rely on some laboratory tests.

The most common is a blood test that looks for IgM antibodies (those that the body immediately produces to fight the viral agent) linked to the presence of the Varicella Zoster virus.

It should be noted, however, that in individuals with a weakened immune system, antibody production may be limited and therefore antibody tests may be negative even in the presence of virus reactivation.

However, one can also look for the virus directly in a fluid sample taken from the vesicles.

Varicella-Zoster-Virus affects those who were not vaccinated in childhood

When as adults or the elderly the virus has reactivated as Herpes Zoster, recovery occurs spontaneously.

Shingles can be very painful and itchy and therefore pharmacological treatment can help to calm the pain.

They can be prescribed

• antiviral drugs, which help to block the proliferation of the virus and thus shorten the course of the disease;
• painkillers and anti-inflammatory drugs, which, however, have a rather mild effect on the neuritis pain caused by Herpes Zoster;
• anti-inflammatory therapies, usually applied as a cream or gel on the erythematous lesions to relieve itching.

To relieve itching and calm pain, it may also be useful to wear loose clothing and apply cool compresses to the blisters (or take a cool water bath,) taking care, however, to keep the rash clean and dry at all times to limit the risk of bacterial over-infection.

Shingles: what complications?

Herpes Zoster is generally not a dangerous disease, but if you suspect that you have it, you should seek medical attention to prevent any potentially serious complications.

Usually the typical shingles rash resolves in 2-4 weeks, but more rarely there can be a serious and disabling complication of the disease: post-herpetic neuralgia. In this case, pain may continue to occur even months later and in the absence of skin lesions.

Shingles generally involves the trunk, but when it affects the face or periocular area (ophthalmic herpes zoster) due to inflammation of the trigeminal nerve, early intervention is necessary to avoid the risk of very severe damage to vision.

Preventing shingles with vaccination

Those who fall ill with shingles may face further reactivation of the virus and new episodes of the disease during their lifetime.

Those who contracted chickenpox in childhood or are prone to recurrences of shingles can, however, evaluate with their doctor the possibility of receiving the specific vaccine against shingles.

The vaccine contains the attenuated form of the live virus and its administration strengthens the immune response to the virus and thus inhibits its reactivation.

The vaccine is able to reduce cases of post-herpetic neuralgia by about 65% and clinical cases of shingles by about 50%.

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Source:

Humanitas