Herpes zoster, or shingles, is caused by the zoster/varicella virus. The first exposure to the herpes zoster virus results in chickenpox, an itchy rash characterized by small blisters with surrounding redness beginning on the torso before spreading over the rest of the body. After the chickenpox rash resolves, the virus travels to the dorsal root ganglions (collections of nerve tissue at the base of the spine), where it remains until reactivation. Chicken pox is disappearing in the younger population due to immunization early in life.
Later in life, typically when under stress, the virus may become reactivated. It travels along a specific nerve and appears as grouped blisters along a nerve root on one side of the body. It does not cross the midline. It can be preceded or accompanied by pain. The pain (resulting from injury to the nerve) can last months or longer, is often very severe, and is referred to as “post-herpetic neuralgia.” Post-herpetic neuralgia is more prevalent in older patients.
Zostavax immunization in adult life markedly decreases the incidence of zoster, though it is not 100%. However, if an immunized patient subsequently does get shingles, it is usually very mild.
Treatment of acute infections usually includes an anti-viral prescription medication with or without systemic (internal) cortisone. Topical medications help to dry the blisters faster. Pain treatment may be required for post-herpetic neuralgia. This occurs more often in elderly patients. Injections of low dose triamcinolone beneath the eruption speed healing and can diminish the severity of or resolve post-herpetic neuralgia.