Shingles Disease and Symptoms: The Complete Overview of Signs and Prevention

Did you know that approximately 1 in 3 people¹ will develop shingles in their lifetime? Shingles, a painful and often debilitating condition caused by the reactivation of the varicella-zoster virus (the same virus that causes chickenpox²), poses significant health risks, especially to older adults and those with weakened immunity and chronic conditions³. Despite its prevalence, many people remain unaware of the risks associated with shingles and the measures they can take to prevent it.

In this comprehensive overview, we’ll discuss shingles by exploring its causes, symptoms to watch out for, potential complications, and, ways to protect yourself.

Whether you've had shingles disease, know someone who has, or simply want to be informed, this overview will equip you with the needed knowledge.

Remember to also consult your doctor to understand the disease, risks, symptoms and complications.

Overview on Shingles

Shingles, also medically known as herpes zoster, is a viral infection caused by the reactivation of the virus, varicella-zoster². This virus, the same one responsible for chickenpox, lies dormant or inactive within the nervous system after a primary infection. Years later, it can be reactivated, leading to a characteristically painful rash².

The shingles rash can appear anywhere on the body but most commonly occurs as a single stripe of blisters, typically around the left or right side of the torso, neck, or face. While not life-threatening, herpes zoster can be quite uncomfortable. Most cases resolve within 2-4 weeks⁴.

In some cases, shingles can lead to postherpetic neuralgia (PHN) - a chronic condition characterised by persistent pain even after the shingles rash clears⁵.

What is the Shingles Virus?

The varicella-zoster virus (VZV) is responsible for causing chickenpox (varicella) and shingles. Chickenpox shows up as an itchy rash that starts with small bumps and blisters and eventually develops into dried crusts (scabs) within 7 to 10 days⁴. After chickenpox resolves, varicella-zoster virus remains dormant in the nerves. If reactivated, it leads to a shingles rash. This rash is can also lead to postherpetic neuralgia - persistent nerve pain. Postherpetic neuralgia can affect up to 1 in 4 people with Shingles⁵.

While shingles is referred to as herpes zoster, it's important to understand that the varicella-zoster virus differs from the viruses that cause cold sores or genital herpes.

In simple terms, shingles disease is not a sexually transmitted infection⁶.

What are the Symptoms of Shingles Disease?

The initial shingles symptoms are unbearable pain and burning⁴.

When the Shingles rash appears, it typically forms a band of blisters that encircles one side of the torso, left or right. In other cases, the rash might occur around one eye or on a single side of the neck or face⁴.

Other shingles disease symptoms may include the following⁶:

1. Itching
2. Tingling or burning in a specific area of the skin
3. A rash that appears a few days after the shingles pain
4. Fluid-filled blisters that break open and form scabs in 7-10 days.
5. Fatigue
6. Headache
7. Sensitivity to light or touch
8. Fever
9. Upset stomach
10. Chills
11. Muscle weakness

What is the Reason for Shingles?
Shingles disease is triggered by the varicella-zoster virus (the culprit behind chickenpox). After a person has had chickenpox, the virus remains dormant in the nervous system for years².

The exact reason for shingles’ virus reactivation is not fully understood, but it often occurs when the immune system weakens, which can happen naturally with age or due to illnesses and medications⁹. When the immune system is compromised, the varicella-zoster virus can become active again, travelling along nerve pathways and resulting in a painful rash on the skin. While having had chickenpox increases the risk of shingles, it does not guarantee it.

If you have shingles, you can pass the virus to someone who is not immune to chickenpox. Transmission typically happens through direct contact with the open sores of the shingles rash. However, if the virus is transmitted, the person will develop chickenpox, not shingles⁷.

How Common is it to Get Shingles Disease?

Shingles disease is a common issue in India, with cases most common in those over 50¹. Anyone who has had chickenpox carries the risk of shingles later in life².

Who is at Risk of Getting Shingles?

Here are some of the factors that increase your risks of getting shingles disease:

1. Having had chickenpox²
2. Having a family history of shingles³.
3. Shingles becomes more likely as you get older, especially after 50¹.
4. Certain medical conditions like cancer³, diabetes⁽¹⁰⁾ and autoimmune diseases³ can weaken your body's defence (immune system), making you more prone to shingles.
5. Long-term use of steroids can increase your chances of developing herpes zoster⁹.
6. Chronic stress can weaken your immune system and can be the reason for shingles^3.

What are Some Complications of Shingles?

Some people experience persistent shingles pain, called postherpetic neuralgia, long after the rash disappears. This happens when damaged nerves send mixed signals to the brain, causing intense and long-lasting pain. Postherpetic neuralgia can last for months or even years, significantly impacting quality of life⁵.

Around 1 out of 4 people over the age of 50 who have had shingles will develop postherpetic neuralgia⁵. The reason why some develop it, and others don't is still unclear. It may be due to increased nerve sensitivity or the virus potentially damaging the central nervous system¹⁰.

Other complications of herpes zoster include:

1. Herpes zoster ophthalmicus (HZO) occurs in approximately 1 in 4 shingles patients. Up to half of those with HZO may develop ophthalmic complications like painful eye infections and permanent vision damage¹⁰.
2. About 1% of individuals infected with shingles can experience brain inflammation (encephalitis), characterized by symptoms such as headache, fever, confusion, and seizures11.
3. Shingles can also affect facial nerves, leading to weakness or paralysis of the face (Ramsay Hunt syndrome)¹².
4. Shingles can impact nerves controlling hearing and balance, resulting in hearing loss, tinnitus (ringing in the ears), vertigo, and dizziness. Balance problems may develop in up to 1% of people with shingles¹².

How is Shingles Disease Diagnosed?

Doctors typically diagnose shingles through a two-pronged approach: examining the shingles virus symptoms, such as the rash and blisters, and discussing your medical history. This is because shingles often occurs with a very distinct rash pattern.

In some cases, additional testing might be needed. This involves a quick and painless procedure where a doctor uses a sterile swab to collect a small sample of tissue or fluid from a blister. The sample is then sent to a lab for analysis to confirm the presence of the varicella-zoster virus¹³.

How to Prevent Shingles?

Shingles can be unbearably painful^15# and the shingles disease symptoms can be severe, but vaccination can help prevent Shingles¹⁴.It boosts your body’s immune system so it can fight off the Shingles virus and keep it from reactivating¹⁴.

Adults aged 50 years and older should consult the doctor to understand the disease and discuss prevention through vaccination to protect yourself from severe symptoms and complications associated with shingles.

Conclusion

Shingles or herpes zoster is a painful viral infection that can arise from a previous case of chickenpox¹. While not life-threatening, shingles can cause significant discomfort and potentially lead to long-term complications. If you've had chickenpox, you carry the risk of shingles virus reactivation later in life. Fortunately, shingles is preventable with vaccination².

Talk to your doctor to understand Shingles, its risks and how you can protect yourself from shingles.

Frequently Asked Questions (FAQs)

1. Can the Shingles Rash Cause the Transmission of the Disease?

The shingles rash itself does not transmit shingles directly, but the varicella-zoster virus in the rash fluid can spread chickenpox to those who haven't had it or been vaccinated⁷

2. Is it Possible to Get Shingles Disease if You Have Not Had Chickenpox?

If you've never had chickenpox and come into direct contact with the oozing, blister-like rash of someone with shingles, you could be infected by the varicella-zoster virus and develop chickenpox. Once you have had chickenpox, the virus remains dormant in your nerve tissue and can be reactivate later in life as shingles⁷.

3. Can Shingles Appear on Any Part of the Skin?

Yes, shingles can appear on any part of the skin. However, it typically follows a specific nerve pathway, often appearing as a band or patch on one side of the torso or face⁹

4. Is Shingles Painful?

Yes, shingles is unbearably painful for most people^15#. It typically causes a band of pain in the affected area, which can feel like nails piercing, electric shocks or unbearable burning^6#. The intensity of the shingles pain can range from mild to severe and the skin in the affected area is usually tender to the touch.

Shingles pain typically affects nerves in the⁴:

Face
Chest
Neck
Lower back
Abdomen

It is important to discuss and consult your doctor on the shingles pain and to avoid any complications that may arise.

5. Can Shingles be Dangerous?

Yes, the complications of shingles can be dangerous due to its long-terms effects like the below.

The most common complication is Postherpetic neuralgia (PHN) where a persistent pain nerve pain is experienced with shingles that stays beyond one month, even after the rash is gone. ⁶

If shingles occurs on the face, it may have a chance of spreading to the eye causing blindness. This is called herpes zoster ophthalmicus⁶

Other rare complications include hearing problems, weakening of muscles on the side of the face, meningitis, pneumonia or even triggering an autoimmune reaction.⁶.

References:

1. Harpaz R et al. MMWR Recomm Rep. 2008 Jun 6;57(RR-5):1-30.
2. Weaver BA. J Am Osteopath Assoc. 2009;109(6 Suppl 2):S2
3. Marra F et al. Open Forum Infect Dis. 2020;7:1-8.
4. CDC. (2024, May 14). Shingles symptoms and complications. Shingles (Herpes Zoster). https://www.cdc.gov/shingles/signs-symptoms/index.html Accessed July 2024
5. Zoster vaccines for Australian adults. NCIRS.2022;1-17.
6. eMedicineHealth; 2021; 1-69; Shingles Treatment, Causes, Pictures & Symptoms Shingles Treatment, Pictures, Symptoms, Vaccine (emedicinehealth.com) Accessed July 2024
7. CDC. (2024, May 14). Causes and Spread (Herpes Zoster). About Shingles (Herpes Zoster) | Shingles (Herpes Zoster) | CDC Accessed July 2024
8. Huang CT, et al. J Clin Endocrinol Metab. 2022 Jan 18;107(2):586-597.
9. CDC About Shingles (Herpes Zoster) https://www.cdc.gov/shingles/about/index.html Accessed July 2024
10. Kedar S et al. Journal of Neuro-Opthalmology;2019;39;220-231.
11. Espiritu R et al. Infectious Disease in Clinical Practice;2007;15;284-288.
12. Crouch AE. NCBI Bookshelf;2022;1-12- Intro (p.1)
13. CDC Shingles | Specimen Collection for Varicella-Zoster Virus (VZV) Testing https://www.cdc.gov/chickenpox/php/laboratories/collecting-vzv-specimens.html
14. CDC Shingles (Herpes Zoster) Vaccination. Available from https://www.cdc.gov/shingles/vaccination.html. Accessed July 2024.
15. CDC Shingles (Herpes Zoster) Complications. Available at: https://www.cdc.gov/shingles/about/complications.html. Accessed July 2024.
16. AAD https://www.aad.org/public/diseases/a-z/shingles-symptoms Accessed July 2024
17. American Academy of Dermatology Association | Shingles: Diagnosis and treatment https://www.aad.org/public/diseases/a-z/shingles-treatment. Accessed August 2024

# Individual patient symptoms of Shingles may vary. These statements are based on some patient’s description of their shingles pain and do not represent every patient’s experience.