Shingles

For other uses, see Shingle (disambiguation).
"Zoster" redirects here. For other uses, see Zoster (disambiguation).

Shingles
Other namesHerpes zoster
Herpes zoster blisters on the neck and shoulder
SpecialtyDermatology
SymptomsPainful rash
ComplicationsMeningitis, facial nerve palsy, keratitis, postherpetic neuralgia[1]
Duration2–4 weeks[2]
CausesVaricella zoster virus (VZV)[1]
Risk factorsOld age, poor immune function, having had chickenpox before 18 months of age[1]
Diagnostic methodBased on symptoms[3]
Differential diagnosisHerpes simplex, chest pain, insect bites, cutaneous leishmaniasis[4]
PreventionShingles vaccine[1]
MedicationAciclovir (if given early), pain medication[3]
Frequency33% (at some point)[1]
Deaths6,400 (with chickenpox)[5]

Shingles, also known as herpes zoster or zona,[6] is a viral disease characterized by a painful skin rash with blisters in a localized area.[2][7] 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][8] Other common symptoms are fever, headache, and tiredness.[1][9] The rash usually heals within two to four weeks,[2] but 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][10]

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)[11] for years or decades, after which it may reactivate and travel along nerve bodies to nerve endings in the skin, producing blisters.[1][8] 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.[12] How the virus remains dormant in the body or subsequently re-activates is not well understood.[1][13]

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.[14]

Shingles vaccines reduce the risk of shingles by 50 to 90%, depending on the vaccine used.[1][15] 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.[16][17] 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.[14] 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.[9][18] 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][19] Although symptoms can be severe, risk of death is very low: 0.28 to 0.69 deaths per million.[11]

  1. ^ a b c d e f g h i j k l m n o p q r s Lopez A, Harrington T, Marin M (2015). "Chapter 22: Varicella". In Hamborsky J, Kroger A, Wolfe S (eds.). Epidemiology and Prevention of Vaccine-Preventable Diseases (13th ed.). Washington D.C.: U.S. Centers for Disease Control and Prevention (CDC). ISBN 978-0990449119. Archived from the original on 30 December 2016. Retrieved 9 January 2020.Public Domain This article incorporates text from this source, which is in the public domain.
  2. ^ a b c d "Shingles (Herpes Zoster) Signs & Symptoms". Centers for Disease Control and Prevention (CDC). 1 May 2014. Archived from the original on 26 May 2015. Retrieved 26 May 2015.Public Domain This article incorporates text from this source, which is in the public domain.
  3. ^ a b c d e Cohen JI (July 2013). "Clinical practice: Herpes zoster". The New England Journal of Medicine. 369 (3): 255–263. doi:10.1056/NEJMcp1302674. PMC 4789101. PMID 23863052.
  4. ^ "Herpes Zoster Diagnosis, Testing, Lab Methods". Centers for Disease Control and Prevention (CDC). April 2022. Archived from the original on 3 June 2022. Retrieved 10 June 2022. Public Domain This article incorporates text from this source, which is in the public domain.
  5. ^ GBD 2015 Mortality and Causes of Death Collaborators (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  6. ^ "Herpes zoster | Shingles, Varicella-Zoster, Pain Relief | Britannica". www.britannica.com. 18 September 2024. Retrieved 26 October 2024.
  7. ^ Sivapathasundharam B, Gururaj N, Ranganathan K (2014). "Viral Infections of the Oral Cavity". In Rajendran A, Sivapathasundharam B (eds.). Shafer's textbook of oral pathology (Seventh ed.). Elsevier Health Sciences ]. p. 351. ISBN 978-8131238004. Archived from the original on 17 December 2019. Retrieved 11 September 2017.
  8. ^ a b de Oliveira Gomes, Juliana; Gagliardi, Anna Mz; Andriolo, Brenda Ng; Torloni, Maria Regina; Andriolo, Regis B.; Puga, Maria Eduarda Dos Santos; Canteiro Cruz, Eduardo (2 October 2023). "Vaccines for preventing herpes zoster in older adults". The Cochrane Database of Systematic Reviews. 2023 (10): CD008858. doi:10.1002/14651858.CD008858.pub5. ISSN 1469-493X. PMC 10542961. PMID 37781954.
  9. ^ a b Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, et al. (2007). "Recommendations for the management of herpes zoster". Clin. Infect. Dis. 44 (Suppl 1): S1–26. doi:10.1086/510206. PMID 17143845.
  10. ^ Johnson RW, Alvarez-Pasquin MJ, Bijl M, Franco E, Gaillat J, Clara JG, et al. (July 2015). "Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective". Therapeutic Advances in Vaccines. 3 (4): 109–120. doi:10.1177/2051013615599151. PMC 4591524. PMID 26478818.
  11. ^ a b Pan CX, Lee MS, Nambudiri VE (2022). "Global herpes zoster incidence, burden of disease, and vaccine availability: a narrative review". Therapeutic Advances in Vaccines and Immunotherapy. 10. doi:10.1177/25151355221084535. PMC 8941701. PMID 35340552.
  12. ^ "Shingles (Herpes Zoster) Transmission". Centers for Disease Control and Prevention (CDC). 17 September 2014. Archived from the original on 6 May 2015. Retrieved 26 May 2015.Public Domain This article incorporates text from this source, which is in the public domain.
  13. ^ "Researchers discover how chickenpox and shingles virus remains dormant". UCLH Biomedical Research Centre. 20 April 2018. Retrieved 25 April 2023.
  14. ^ a b "Overview". Centers for Disease Control and Prevention (CDC). 17 September 2014. Archived from the original on 16 May 2015. Retrieved 26 May 2015.Public Domain This article incorporates text from this source, which is in the public domain.
  15. ^ Cunningham AL (2016). "The herpes zoster subunit vaccine". Expert Opinion on Biological Therapy. 16 (2): 265–271. doi:10.1517/14712598.2016.1134481. PMID 26865048. S2CID 46480440.
  16. ^ Chen N, Li Q, Yang J, Zhou M, Zhou D, He L (February 2014). "Antiviral treatment for preventing postherpetic neuralgia". The Cochrane Database of Systematic Reviews. 2014 (2): CD006866. doi:10.1002/14651858.CD006866.pub3. PMC 10583132. PMID 24500927.
  17. ^ Jiang X, Li Y, Chen N, Zhou M, He L (December 2023). "Corticosteroids for preventing postherpetic neuralgia". The Cochrane Database of Systematic Reviews. 2023 (12): CD005582. doi:10.1002/14651858.CD005582.pub5. PMC 10696631. PMID 38050854.
  18. ^ Nair PA, Patel BC (2 November 2021). "Herpes zoster". StatPearls. PMID 28722854. Archived from the original on 10 June 2022. Retrieved 10 June 2022 – via NCBI Bookshelf.
  19. ^ Schmader KE, Dworkin RH (2011). "Herpes Zoster and Postherpetic Neuralgia". In Benzon HT (ed.). Essentials of Pain Medicine (3rd ed.). London: Elsevier Health Sciences. p. 358. ISBN 978-1437735932. Archived from the original on 17 December 2019. Retrieved 11 September 2017.