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Shingles is a painful condition caused by the virus (varicella-zoster virus, or VZV) that also causes chickenpox. It affects about 1 million individuals per year in the United States alone. Shingles, also known as herpes zoster, occurs in persons who have already had chickenpox. Shingles usually occurs only once in a person's lifetime. Most individuals who develop shingles are older than 50 years, have other medical problems (such as cancer), or are immune-suppressed from medications they take (such as steroid medications). The virus (VZV) causing shingles and chickenpox is a type of herpes virus. It is a different herpes virus from the ones responsible for cold sores or for genital herpes. VZV remains in nerve tissue after a person recovers from chickenpox. The virus remains dormant (inactive) until reactivated to cause shingles. The cause of this reactivation is not completely understood. The July 1, 2009, issue of JAMA includes an article about shingles.
Signs and symptoms
Rash on one side of the body or the face
Blisters that develop in the rash site and then crust over
Fever, headache, fatigue, and chills may occur.
Pain, often a tingling-type pain, can occur before the rash appears.
Antiviral medications, if taken soon after symptoms begin, can shorten the length of time a shingles episode lasts. The severity of the episode may also be less if antiviral medications are taken.
Supportive care, including rest and plenty of liquids, is useful in the treatment of shingles (like any other viral infection).
Acetaminophen may help relieve pain and reduce fever, if it is present.
Cover blisters until they are crusted over. Do not scratch blisters, since they can then become infected.
Wash hands frequently.
In rare cases, shingles can be severe and cause critical illness, including pneumonia or encephalitis (inflammation of the brain). Severe episodes of shingles may require hospitalization for more intensive treatment.
Vaccines are available for chickenpox and for shingles. Varicella vaccine (for chickenpox) is recommended for young children and for older children who have not already had chickenpox. Shingles vaccine is recommended for adults who are more than 60 years old. Certain individuals should not have these vaccines: pregnant women, persons with immune system disease, and infants younger than 12 months.
Persons who have shingles can pass on VZV to others who have not had chickenpox. Once the blisters have healed, the contagious phase is finished.
Some individuals develop a long-lasting pain condition called postherpetic neuralgia after having an episode of shingles. Postherpetic neuralgia is more common in older persons. Early treatment of shingles with an antiviral medication may help prevent postherpetic neuralgia.
For more information
Centers for Disease Control and Prevention http://www.cdc.gov
World Health Organization http://www.who.int
American Academy of Dermatology http://www.aad.org
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish. A Patient Page on chickenpox was published in the August 17, 2005, issue.
Sources: Centers for Disease Control and Prevention, World Health Organization, American Academy of Dermatology, National Institute of Neurological Disorders and Stroke, National Institute of Allergy and Infectious Diseases
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
TOPIC: INFECTIOUS DISEASES
Torpy JM, Burke AE, Glass RM. Shingles. JAMA. 2009;302(1):108. doi:10.1001/jama.302.1.108
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