Shingles, also known as herpes zoster, is a painful condition involving an outbreak of a rash or blisters on the skin that may be accompanied by fever, chills, or stomach upset. Shingles is caused by the varicella-zoster virus, which also causes chickenpox.
Only people who've had chickenpox and are harboring the virus in their nervous system can develop shingles. After the initial chickenpox infection, the varicella-zoster virus can remain latent for years, then travel down nerve cell fibers to cause a renewed infection. But with shingles, the nervous system is more deeply involved than it was during the bout with chickenpox, and the symptoms are often more severe. The face, eye, or torso may be affected.
There is no cure for shingles, but in most patients the lesions heal and the pain subsides within three to five weeks. Mild discoloration and scarring of the affected area usually persist. About 10 percent of normal adults can be expected to get shingles during their lifetimes, usually after age 50.
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The central nervous system, which is made up of the brain and spinal cord, harbors the varicella-zoster virus for life. Nerves connect the central nervous system to the rest of the body. Shingles occurs when the virus travels down nerve fibers to cause a new infection.
A dermatome is a region of skin that is served by the branches from one spinal nerve, a nerve that comes out from the spinal cord.
Shingles occurs when the varicella-zoster virus reactivates and travels down long nerve fibers to infect some part of the body. Scientists are not certain why the virus reactivates or why it reactivates only in some of the people who have had chickenpox. There is evidence to suggest that a weakened immune system may cause the virus to break out of its dormant state, multiply, and move along nerve fibers to the skin. Even among healthy individuals, temporary suppression of the immune system because of stress, a cold, or even sunburn may be associated with an attack of shingles.
Unlike highly contagious chickenpox, which can be spread through air as well as through contact with the rash, you can't catch shingles, and contact with someone who has chickenpox will not trigger shingles. An individual must already have had a case of chickenpox in order to develop shingles. But someone with shingles can transfer the varicella-zoster virus to a person who has never had chickenpox. The second person will develop chickenpox, not shingles.
Everyone who has had chickenpox is at risk for shingles. People are at particular risk for shingles if they have a weakened immune system, are over the age of 50, have been ill, are experiencing trauma, or are otherwise under stress.
The incidence increases with age so that shingles is 10 times as likely to occur in adults over 60 as it is in children under 10. Studies show that people over age 80 have five times as great a chance of having shingles as do adults between the ages of 20 and 40.
Most people who contract shingles develop immunity to the virus and will not get the disease again; however, shingles may recur in some individuals.
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Shingles is a serious threat to immunosuppressed individuals, such as those with HIV or those who are receiving certain treatments that destroy cancerous tissue but also have the potential to damage cells that normally fight invading organisms. Patients who receive organ transplants and take drugs to suppress the immune system to prevent the body from rejecting the foreign tissue of the transplant are also vulnerable to shingles.
Should any of these patients contract shingles, there is a possibility that the zoster virus will spread throughout the body, reaching vital organs like the lungs. If unchecked, such disseminated zoster can lead to death from viral pneumonia or a secondary bacterial infection.
Youngsters whose mothers had chickenpox late in pregnancy—five to 21 days before giving birth—are vulnerable to shingles. Sometimes these children are born with chickenpox or develop it within a few days. A third of the babies will develop shingles in the first five years of life.
The time lapse between the start of the mother's illness and the birth of the baby generally allows the mother's immune system to react and produce antibodies to fight the virus, and these antibodies can be transmitted to the unborn child and help fight the infection.
Last reviewed on 9/26/08
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