Herpes Zoster

What is herpes zoster?

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Herpes zoster is the virus that causes shingles and chickenpox. The condition triggers a rash, which can be red, itchy, and painful. Shingles and chickenpox typically appear on the neck, face, and/or torso. While infections often clear up in a handful of weeks, the herpes zoster virus can remain dormant in the nervous system for years. If the virus remains in the body, children who have had chickenpox can experience shingles as an adult.

Herpes zoster can cause severe symptoms, which can be dangerous and uncomfortable. If you suspect you have shingles or chickenpox, contact your doctor as soon as possible. Visiting a primary care physician or a dermatologist is important. This step can help patients receive treatment to alleviate symptoms and reduce the risk of complications.

What causes herpes zoster?

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Herpes zoster is a contagious virus. People infected with the herpes zoster virus often develop itchy, painful, and red rashes. In people with no known prior infection, this is called chickenpox. In those who have had chickenpox, this is called shingles.

Keep in mind that not all herpes zoster infections lead to symptoms. The virus may remain dormant in an individual for many years. Similar to other types of herpes viruses, people may experience flare-ups, triggers, and recurring rashes. However, shingles reinfection is extremely rare.

While the rash itself is not contagious, herpes zoster can be spread between people. The virus spreads when a person comes into contact with an open blister. Like with other herpes viruses, herpes zoster is not contagious if blisters are scabbed over or covered. If you have not experienced prior infection, you cannot get shingles from somebody with the rash, but you can get chickenpox.

What is the difference between chickenpox and shingles?

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The herpes zoster virus causes both chickenpox and shingles. Chickenpox usually incurs upon initial infection with the herpes zoster virus. It is typically found in children, and it is often a mild – though uncomfortable – illness. By contrast, shingles is the reactivation of the herpes zoster virus in people who had chickenpox earlier in life. The herpes zoster virus remains in the body even after recovering from chickenpox. Shingles occurs when that virus reactivates.

What are common symptoms of herpes zoster?

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Herpes zoster symptoms vary by person and infection. However, when the virus is active, it will often cause a distinctive rash. In both chickenpox and shingles, this rash may include the following symptoms:

  • Red, pink, brown, or purple bumps
  • Pain, itching, and/or burning at rash site
  • Rash formation on the abdomen, chest, back and/or face
  • Fluid-filled blisters

Both chickenpox and shingles are also associated with non-visible symptoms. This includes:

  • Fatigue
  • Muscle soreness and weakness
  • Chills
  • Fever
  • Headache
  • Loss of appetite

In many cases, herpes zoster rashes in adults affect just one side of the body. However, rashes in children are known to occur all over the body. This can be a helpful observation during the diagnostic process.

Herpes zoster can sometimes appear on the eyelids and around the eyes. When this happens, an individual may experience blurred vision, increase swelling, and tearing. Eyelid infection is a serious side effect of the herpes zoster virus. It can lead to nerve damage, which can cause chronic pain and long-term vision loss.

There are several risk factors associated with herpes zoster. Increased emotional stress can weaken the immune system. Aging, having a compromised immune system, and undergoing certain cancer treatments can also put a person at risk of catching herpes zoster. Pregnant people, children under 12 months old, and people with existing illness are also at a higher risk. According to the CDC, it is not possible to get shingles or chickenpox from the varicella-zoster vaccine.

What is the difference between herpes simplex and herpes zoster?

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Herpes simplex and herpes zoster are different viruses. They can cause similar rashes. These rashes are often characterized by blisters, itchiness, and pain. Additionally, both herpes simplex and herpes zoster can remain dormant in the body without causing symptoms. But, though they may look alike and behave similarly, these viruses are not the same.

What are possible herpes zoster complications?

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Both shingles and chickenpox can lead to complications. Shingles can lead to a condition called postherpetic neuralgia. This type of chronic pain can linger for months or years after the rash resolves. People with herpes zoster can also develop pneumonia, bacterial skin infections, and corneal damage. In severe cases, the virus can cause spinal cord and/or brain inflammation. This can lead to meningitis or encephalitis, both of which may be life-threatening.

Anyone experiencing herpes zoster symptoms should contact a doctor as soon as possible. Starting a prescription medication within a couple of days can help reduce symptoms, decrease the rash’s duration, and lower the risk for complications. This is true for both chickenpox and shingles symptoms.

When to see a doctor for herpes zoster?

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It is important to visit your primary care physician or dermatologist as soon as symptoms appear. The American Academy of Dermatology recommends that patients visit a doctor within three days of developing symptoms. This can significantly reduce the likelihood of long-term complications. If you have had a prior herpes zoster infection, communicate this information to your doctor for future reference.

How is herpes zoster diagnosed?

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Herpes zoster diagnoses require an in-office visit with a physician. The doctor will ask for a medical history and visually examine the blisters. Usually, diagnosis is possible with only an observational examination. However, if the doctor needs to rule out other potential infections, they may take a sample of the skin or fluid from the rash. They will then examine the sample to confirm the presence of the virus. But, in most cases, doctors are able to provide same-day diagnoses and immediately start treatment.

How is herpes zoster treated?

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There is no cure for herpes zoster. However, many treatments are available to help alleviate symptoms and reduce the likelihood of long-term complications. Doctors may prescribe a combination of medications, including:

  • Ibuprofen: Ibuprofen and other anti-inflammatory medications can reduce swelling and pain.
  • Antiviral medications: Drugs like valacyclovir, acyclovir, and famciclovir can speed recovery and alleviate pain.
  • Benadryl: Antihistamines can help reduce itching.
  • Narcotics: These medications may be used to reduce severe pain.
  • Lidocaine: Numbing creams, patches, and gels can help reduce topical pain.
  • Zostrix: Capsaicin can help reduce the risk of developing nerve pain after experiencing a herpes zoster rash.
  • Anticonvulsants: For patients with prolonged pain following infection, a doctor may recommend tricyclic antidepressants and/or anticonvulsants.

Additionally, there are a number of at-home remedies designed to alleviate herpes zoster symptoms. Some may find relief from calamine lotion, taking cold showers or baths, applying cold compresses, and supplementing with vitamin B12, vitamin C, vitamin A, and/or vitamin E. Remember to speak with your doctor before starting a vitamin supplement.

Are there ways to prevent herpes zoster?

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To prevent herpes zoster, avoid contact with open shingles and/or chickenpox blisters. This virus is not spread via airborne and droplet transmission. If you currently have open herpes zoster sores, be sure to keep them clean and covered. This can help reduce the risk of spreading the virus to friends and family.

Getting vaccinated against herpes zoster can prevent severe infections and complications. The National Institute on Aging recommends that all children receive two doses of the varicella immunization. Adults who were not vaccinated as children and who did not have chickenpox should also receive the varicella immunization. While this vaccine will not always prevent the development of chickenpox, it has a 90% chance of preventing infection.

Adults who have had chickenpox should receive the varicella-zoster immunization, also known as the shingles vaccine. Shingles can cause severe and long-term symptoms. This vaccine can prevent infection and any complications associated with the virus. The National Institute on Aging and the Centers for Disease Control recommend that adults over 50 years old receive this vaccine.

What is the outlook for people with herpes zoster?

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With quick and effective treatment, people experiencing herpes zoster symptoms can expect to lead normal, healthy lives. However, keep in mind that the body does not clear the virus after the rash resolves. For this reason, adults who had chickenpox as children should receive the shingles vaccine.

If a person has had both chickenpox and shingles, they are unlikely to experience shingles again. The recurrence rate of shingles is only around 5%. However, certain risk factors can heighten the chance for reinfection. These risk factors include:

  • Having shingles for more than three months
  • Being between 51 and 70 years old
  • Having an autoimmune disease
  • Having high blood pressure
  • Having a blood cancer, like lymphoma or leukemia
  • Having high “bad” cholesterol or low “good” cholesterol

While people with the herpes zoster virus can experience healthy lives, it is important to visit a doctor at the onset of symptoms. If you notice a rash that resembles chickenpox or shingles, schedule an appointment as soon as possible. Receiving prompt treatment from a primary care physician or dermatologist can reduce complications and relieve uncomfortable symptoms.