SHINGLES

Shingles develops in stages:

Prodromal stage (before the rash appears)

• Pain, burning, tickling, tingling, and/or numbness occurs in the area around the affected nerves several days or weeks before a rash appears. The discomfort usually occurs on the chest or back, but it may occur on the belly, head, face, neck, or one arm or leg.
• Flu-like symptoms (usually without a fever), such as chills, stomachache, or diarrhea, may develop just before or along with the start of the rash.
• Swelling and tenderness of the lymph nodes may occur.

Active stage (rash and blisters appear)

• A band, strip, or small area of rash appears. It can appear anywhere on the body but will be on only one side of the body, the left or right. Blisters will form. Fluid inside the blisters is clear at first but may become cloudy after 3 to 4 days. A few people won’t get a rash, or the rash will be mild.
• A rash may occur on the forehead, cheek, nose, and around one eye (herpes zoster ophthalmicus), which may threaten your sight unless you get prompt treatment.
• Pain, described as “piercing needles in the skin,” may occur along with the skin rash.
• Blisters may break open, ooze, and crust over in about 5 days. The rash heals in about 2 to 4 weeks, although some scars may remain.

Postherpetic neuralgia (chronic pain stage)

• Postherpetic neuralgia (PHN) is the most common complication of shingles. It lasts for at least 30 days and may continue for months or years. Symptoms are:
• Aching, burning, stabbing pain in the area of the earlier shingles rash.
• Persistent pain that may linger for years.
• Extreme sensitivity to touch.
• The pain associated with PHN most commonly affects the forehead or chest. This pain may make it difficult for the person to eat, sleep, and do daily activities. It may also lead to depression.

Shingles may be confused with other conditions that cause similar symptoms. The rash from shingles may be mistaken for an infection from herpes simplex virus (HSV), poison oak or ivy, impetigo, or scabies. The pain from PHN may feel like appendicitis, a heart attack, ulcers, or migraine headaches.

DIAGNOSIS

Doctors can usually identify shingles when they see an area of rash around the left or right side of your body. Your doctor may order herpes tests on cells taken from a blister if a diagnosis of shingles is not clear.

RECOMMENDED MEDICATIONS

If there is reason to think that shingles is present, your doctor may not wait to do tests before treating you with antiviral medicines. Medicines can help limit the pain and discomfort caused by shingles, shorten the time you have symptoms, and prevent the spread of the disease. Medicines also may reduce your chances of developing shingles complications, such as postherpetic neuralgia (PHN) or disseminated zoster.

Medicine choices

Medicines to treat shingles when the rash is present (active stage) may include:

• Over-the-counter pain medicines, to help reduce pain.
• Antiviral medicines, to reduce the pain and duration of shingles.
• Topical antibiotics, to stop infection of the blisters.

Medicines to treat postherpetic neuralgia pain may include:

• Tricyclic antidepressants, such as amitriptyline.
• Medicines put on the skin (topical medicines), such as creams or skin patches containing capsaicin or lidocaine.
• Anticonvulsants, such as gabapentin or pregabalin.
• Nerve block injections.
• Tramadol and other opioids, such as codeine, oxycodone, and morphine.

If prescription medicines don’t help control your pain, you may need to see a pain specialist about other ways to treat PHN.