Herpes zoster (shingles): causes, symptoms, treatment and prevention
Herpes zoster, or shingles, is a reactivation of the varicella‑zoster virus causing a painful, blistering rash. Age, immune status, antivirals, and vaccination affect risk, severity and complications.
Herpes zoster, commonly called shingles or zona, is an illness caused by reactivation of the varicella‑zoster virus (VZV). The same virus produces chickenpox after primary infection in childhood; years later the latent virus can awaken and produce shingles (chickenpox link to primary infection).
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Symptoms
The illness typically presents with localized pain followed by a rash that develops into grouped fluid‑filled blisters in a band corresponding to a single sensory nerve distribution (dermatome). Common early features are:
- Pain, burning or tingling in one area of the skin
- Rash that evolves to blisters and then crusts
- Fever, headache and general malaise in some people
- Possible eye involvement (herpes zoster ophthalmicus) or facial nerve involvement (Ramsay Hunt syndrome)
Cause and course
After an initial episode of chickenpox, VZV remains dormant in sensory ganglia. Reactivation—often decades later—causes viral replication in the nerve and painful skin lesions along its sensory distribution. Risk of reactivation rises with advancing age and weakened immunity, and stressful events or certain medical treatments can contribute.
Diagnosis and differential
Diagnosis is usually clinical, based on the characteristic unilateral, dermatomal rash and pain. Laboratory confirmation, when needed, can use PCR testing of lesion swabs, direct antigen detection, or viral culture. Conditions that can mimic shingles include contact dermatitis, herpes simplex, and other vesicular eruptions.
Treatment and prevention
Antiviral therapy (for example acyclovir, valacyclovir or famciclovir) is most effective when begun early—typically within the first 72 hours of rash onset—and can shorten duration and reduce complications. Pain management ranges from simple analgesics to neuropathic agents and topical measures; severe cases may require specialist input. The shingles vaccine reduces the risk of developing shingles and of severe outcomes; see vaccine information for guidance (vaccine).
Complications and prognosis
Most episodes resolve over weeks, but complications can include persistent nerve pain (postherpetic neuralgia), eye damage if the eye is involved, secondary bacterial infection of lesions, and less commonly neurologic sequelae. Prompt recognition, early antiviral therapy, and vaccination in eligible persons reduce the burden of disease.
Etymology
The popular German term "Gürtelrose" (shingles) originated because the reddish rash in particularly pronounced manifestations starts from the spine and wraps itself around the body on one side or completely in the shape of a belt, where it causes erysipelas. At the same time erysipelas is an old-fashioned term for an acute, locally limited skin inflammation, which was often used undifferentiated for different clinical pictures of different causes.
The term herpes zoster (formerly herpes zoster) derives from ancient Greek ζωστήρ zoster ('girdle' in reference to the "girdle-like" course first found in Pliny the Elder). Compare also ancient Greek ἕρπειν herpein, German 'kriechen'.
In English, herpes zoster is called shingles, which in turn is borrowed from the Latin cingulum for 'girdle', in French zona and zoster.
Old names include fever lichen as well as "fire belt" (Latin zona ignea), in France and England also zone or zona, and the otherwise for ergotism ("Antonius fire") used term Ignis sacer ("sacred fire"). Herpes zoster was formerly also called belt rash and belt lichen as well as zona serpiginosa.
The abbreviated technical terms zoster (for herpes zoster, triggered by the varicella-zoster virus (VZV)) and herpes (for herpes simplex, a disease caused by herpes simplex viruses) are often confused, although they are two different diseases that differ significantly in the pathogen and especially in the secondary diseases.
Pathophysiologically, herpes zoster has also been contrasted as poliomyelitis acuta posterior to poliomyelitis acuta anterior (polio).
Epidemiology
In Germany, about 350,000 to 400,000 people contract herpes zoster every year, about 2/3 of them are over the age of 50. The most recent study for Germany showed that more than 306,000 people over the age of 50 contract herpes zoster every year. This results in an incidence of 9.6 per 1000 people per year.
Since around 98% of the population had contact with the varicella-zoster virus by the age of 40, usually either clinically manifest in the form of chickenpox or in the form of a silent infection, almost all adults are at risk. This is due to the fact that the varicella-zoster viruses remain inactive in the body for life. Around 25 to 30% of the population will experience zoster in their lifetime. Among 85-year-olds, 50% have already experienced a disease. The changes brought about by the introduction of vaccination in the first year of life, which has been recommended since 2004, are not yet known.
The likelihood of herpes zoster infection increases with age, and women are more likely to contract the disease. Other risk factors are diseases that are associated with a weakening of the immune system:
- Diseases of the immune system significantly increase the risk, such as lymphoma (odds ratio OR = 3.9), myeloma (OR = 2.2), HIV infection (OR = 5.1), stem cell transplantation (OR = 13.5).
- Immunosuppressive drugs: oral corticosteroids (OR = 1.5), Janus kinase inhibitors (relative risk 2.0 - 3.2), other immunosuppressants (OR = 1.8).
- Diseases with indirect weakening of the immune system: rheumatoid arthritis (OR = 1.5), inflammatory bowel diseases (OR = 1.4), chronic obstructive pulmonary disease (COPD, OR = 1.3), asthma, chronic renal insufficiency, type I diabetes
- Further risk factors are a family history (OR = 1.7), previous herpes zoster disease (OR = 1.8), but also sleep disorders (OR = 2.5), depression (OR = 3.8) and stress (OR = 2.8).
Questions and answers
Q: What is herpes zoster?
A: Herpes zoster is a disease in humans that is also known as shingles or zona.
Q: What causes herpes zoster?
A: The same virus that causes chickenpox also causes shingles.
Q: What are the symptoms of herpes zoster?
A: The symptoms of herpes zoster include pain and a rash with blisters.
Q: How can you reduce the risk of shingles?
A: The shingles vaccine can reduce the risk of shingles.
Q: Can antivirus medicine help with herpes zoster?
A: Yes, antivirus medicine can reduce the seriousness and duration of shingles if started within 3 days of the rash.
Q: Is herpes zoster contagious?
A: Yes, people who have not had chickenpox can catch the virus from someone with shingles, although they will develop chickenpox instead of shingles.
Q: How is herpes zoster treated?
A: Treatment for herpes zoster involves easing the symptoms, such as using pain relief medication, and taking antivirus medicine if started within 3 days of the rash.
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Author
AlegsaOnline.com Herpes zoster (shingles): causes, symptoms, treatment and prevention Leandro Alegsa
URL: https://en.alegsaonline.com/art/43876
Sources
- cdc.gov : "CDC - Centers for Disease Control and Prevention - Shingles (Herpes Zoster) - Signs & Symptoms"