shingles herpes zoster

Could It Be Shingles? A Quick Guide To Herpes Zoster

Hey there Guys. Today I had an interesting patient with a painful blistering rash that went in a band from his back across his belly. For doctors this is one of those “spot diagnoses”: Shingles, also knows as Herpes Zoster.

What Is Shingles / Herpes Zoster?

Shingles is caused by the same virus as chicken pox: Herpes Zoster. You can only get shingles if you have been infected with chicken pox in the past.

After chicken pox heals, the virus can lay dormant in the nerves in the spine. Later in life it can “reactivate” leading a band shaped rash and pain.  We do not know exactly what leads to the reactivation of the virus but it has been shown that periods of stress and immune system compromise can lead to reactivation of Herpes Zoster.

Is Shingles Contagious?

Yes, and no. If you have been infected with chicken pox in the past or if you have had the chicken pox vaccine it’s not likely you will be infected.

If you have never been infected with Herpes Zoster, the chicken pox virus, there is a risk of infection. In this case you will not get shingles, you’ll get sick with chicken pox.

If you have shingles and are around people with reduced immune function there is a risk of passing the virus on. It is best to keep the rash covered and to avoid people who may be unwell. There are rare cases of people becoming infected just being the the same space as someone with shingles.

Can Shingles Be Dangerous?

In some cases shingles can be very serious. Shingles around the face in particular near the eyes can lead to blindness. Urgent treatment is essential to protect the eyes.

Some cases of shingles can lead to pain even after the rash has healed. This is called post herpetic neuralgia with the pain lasting for months or even years.

Is There Treatment For Shingles?

If caught within 3 days of the rash starting antiviral treatment is available. This is normally a course of tablets for one week. The medications can reduce the impact and length of the infection. If the infection involves the eye it’s important to see an eye doctor for review urgently. They may add drops to help protect the eye.

Currently there is a vaccine available for prevention of shingles. The vaccine can help prevent reactivation of the Herpes Zoster virus as well as reduce the impact of shingles if you are mid infection. You can still receive the vaccine even if you have had chicken pox in the past.

Currently the vaccine is recommended for all people over the age of 60. If you are living with HIV, the shingles vaccine is considered generally safe if your CD4 count is above 200 and your viral load is undetectable and stable. If you are considering getting the vaccine be sure to talk with your family doctor or specialist.

So the basic take home points about shingles are:

  • If you notice the rash see your doctor asap as treatment is available if it’s less then 72 hours since the rash started.
  • Shingles that involves the eye or is around the eye can damage vision so see a doctor immediately
  • Vaccines are available and recommended to all adults aged 60 or older.
  • Shingles can be contagious. Avoid people with reduce immune systems or who have never had chicken pox or the shingles vaccine

Your in good health.

Dr George


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