Shingles

Shingles
Other names	Herpes zoster
Herpes zoster blisters on the neck and shoulder
Specialty	Dermatology
Symptoms	Painful rash
Complications	Meningitis, facial nerve palsy, keratitis, postherpetic neuralgia[1]
Duration	2–4 weeks[2]
Causes	Varicella zoster virus (VZV)[1]
Risk factors	Old age, poor immune function, having had chickenpox before 18 months of age[1]
Diagnostic method	Based on symptoms[3]
Differential diagnosis	Herpes simplex, chest pain, insect bites, cutaneous leishmaniasis[4]
Prevention	Shingles vaccine[1]
Medication	Aciclovir (if given early), pain medication[3]
Frequency	33% (at some point)[1]
Deaths	6,400 (with chickenpox)[5]

Shingles, also known as herpes zoster, is a viral disease characterized by a painful skin rash with blisters in a localized area.^[2][6] Typically the rash occurs in a single, wide mark either on the left or right side of the body or face.^[1] Two to four days before the rash occurs there may be tingling or local pain in the area.^[1][7] Other common symptoms are fever, headache, and tiredness.^[1][8] The rash usually heals within two to four weeks;^[2] however, some people develop ongoing nerve pain which can last for months or years, a condition called postherpetic neuralgia (PHN).^[1] In those with poor immune function the rash may occur widely.^[1] If the rash involves the eye, vision loss may occur.^[2][9]

Shingles is caused by the varicella zoster virus (VZV) that also causes chickenpox. In the case of chickenpox, also called varicella, the initial infection with the virus typically occurs during childhood or adolescence.^[1] Once the chickenpox has resolved, the virus can remain dormant (inactive) in human nerve cells (dorsal root ganglia or cranial nerves)^[10] for years or decades, after which it may reactivate and travel along nerve bodies to nerve endings in the skin, producing blisters.^[1][7] During an outbreak of shingles, exposure to the varicella virus found in shingles blisters can cause chickenpox in someone who has not yet had chickenpox, although that person will not suffer from shingles, at least on the first infection.^[11] How the virus remains dormant in the body or subsequently re-activates is not well understood.^[1][12]

The disease has been recognized since ancient times.^[1] Risk factors for reactivation of the dormant virus include old age, poor immune function, and having contracted chickenpox before 18 months of age.^[1] Diagnosis is typically based on the signs and symptoms presented.^[3] Varicella zoster virus is not the same as herpes simplex virus, although they belong to the same family of herpesviruses.^[13]

Shingles vaccines reduce the risk of shingles by 50 to 90%, depending on the vaccine used.^[1][14] Vaccination also decreases rates of postherpetic neuralgia, and, if shingles occurs, its severity.^[1] If shingles develops, antiviral medications such as aciclovir can reduce the severity and duration of disease if started within 72 hours of the appearance of the rash.^[3] Evidence does not show a significant effect of antivirals or steroids on rates of postherpetic neuralgia.^[15][16] Paracetamol, NSAIDs, or opioids may be used to help with acute pain.^[3]

It is estimated that about a third of people develop shingles at some point in their lives.^[1] While shingles is more common among older people, children may also get the disease.^[13] According to the US National Institutes of Health, the number of new cases per year ranges from 1.2 to 3.4 per 1,000 person-years among healthy individuals to 3.9 to 11.8 per 1,000 person-years among those older than 65 years of age.^[8][17] About half of those living to age 85 will have at least one attack, and fewer than 5% will have more than one attack.^[1][18] Although symptoms can be severe, risk of death is very low: 0.28 to 0.69 deaths per million.^[10]