Herpes Zoster Has Various Treatment Options

Shingles is a type of viral infection caused by the varicella zoster virus that can affect any part of the body and typically causes painful rashes.

Most of the time, shingles appears around the sides of the torso as a single stripe with blisters.

The varicella zoster virus is the same virus that causes chickenpox. After an individual has an episode of chickenpox, usually at a young age, the virus lingers in the nerve tissues near the brain and spinal cord. This inactive virus can then reactivate and cause shingles.¹

Shingles has an extremely long recorded history. In the 18th century, investigator William Heberden, a physician, found a way to distinguish between shingles and smallpox. In 1831, scientist Richard Bright introduced the idea that the infection may arise from the dorsal root ganglion, and in 1861 this idea was confirmed by dermatologist Felix Von Barensprung. In 1953, investigators were finally able to isolate the shingles virus.² The name “shingles” was derived from the Latin and French words for belt or girdle and refers to the skin with eruptions on the trunk of the body.³

One of every 3 individuals in the United States will at some point in their lives develop shingles or herpes zoster.

Each year, about 1 million people contract shingles in the United States, according to the CDC.

Individuals of any age can be diagnosed with chickenpox and shingles, but the risk of getting shingles increases with age.⁴

The painful rash from shingles typically lasts between 7 to 10 days and fully clears within 2 to 4 weeks. Before the main rash appears, many patients complain of itching, pain, and tingling in the affected area. In some cases, the rash can also appear on the side of the face, which can then affect the eyes and even cause vision loss. Symptoms may include chills, fever, headache, and an upset stomach.⁴

Notably, direct contact with fluid from the rash blisters can spread the zoster virus, even to individuals who have never had chickenpox. Those who come into contact with the patient’s rash may first develop chickenpox, which then may cause shingles later in life. If the rash is covered, the disease can be contained. The virus does not spread before the blisters appear or after the blisters dry out.4

One of the major complications of shingles is postherpetic neuralgia (PHN), also known as long-term nerve pain. PHN can occur in the same areas where the shingles blisters emerged, even after the rash disappears. The pain caused by PHN can be debilitating and severe, to the point of interfering with daily activities and keeping patients bed bound. This pain can last for months or even years.4

PHN occurs in approximately 10% to 15% of individuals who contract shingles. As patients get older, the risk of PHN and more severe symptoms increase. Other complications from shingles can include encephalitis, eyesight problems, hearing problems, pneumonia, or even death.⁴

There are various antiviral medications for patients with shingles, including acyclovir, famciclovir, and valacyclovir. These medications are effective if taken as soon as the diagnosis is made, and they can shorten the duration of the infection while improving symptoms. Other treatments may include calamine lotion, colloidal oatmeal baths, OTC pain medications, and wet compresses. Using an oatmeal bath with lukewarm water may alleviate some itching in the affected area.⁴

Vaccination offers an important preventive option against shingles. The recombinant zoster vaccine (RZV, or Shingrix) is the recommended vaccine for patients aged 50 years and older. These patients should get 2 doses of the Shingrix vaccine, separated by 2 to 6 months. There is no maximum age to receive the Shingrix vaccine, and it is recommended even if the patient does not remember having chickenpox.

The rash and other symptoms of shingles can be very painful and can last a long time. Because of this, pharmacists and providers should always recommend the appropriate vaccine and should advise patients to avoid contact with anyone who has the infection. With aggressive treatment and rest, patients can hopefully suffer as little as possible and recover quickly from the painful virus.

References

1. Shingles. Mayo Clinic. October 6, 2020. Accessed June 23, 2021. https://www.mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054 

2. Richard Bright. Britannica. Updated May 3, 2021. Accessed June 23, 2021. https://www.britannica.com/biography/Richard-Bright

3. Shingles. American Osteopathic College of Dermatology. Accessed June 23, 2021. https://www.aocd.org/page/Shingles

4. Shingles (herpes zoster). CDC. Updated October 5, 2021. Accessed June 23, 2021. https://www.cdc.gov/shingles/index.html