If you think having chickenpox as a child is the end of the line for the varicella zoster virus in your body, think again. The virus that causes chickenpox settles in and bides its time, hid-ing in nerve cells, until something—its not clear what—causes it to rage back decades after the initial infection. Only this time, you’ve got shingles.
The medical term for shingles is ‘herpes zoster,’ the manifestation of the varicella zoster virus after its initial infection causes chickenpox, also known as ‘varicella.’ “Many episodes of shingles develop spontaneously, without an obvious inciting cause,” explains Dr. Erin Gardner, a physician with Dermatology Specialists of St. Louis and on staff at Missouri Baptist Medical Center. “However, any form of immunosuppression does increase the risk that shingles will develop.”
Whereas chickenpox is known for the itchy red spots that appear all over the body, shingles is a different story. And it can be a very painful one because the nerves themselves are inflamed when shingles occurs, says Dr. Divya Chauhan, a family physician at Creve Coeur Family Medicine and on staff at St. Luke’s Hospital. “And another thing: In anybody who has chickenpox, you will see these blisters all over the body, but in shingles that’s not how it is. It may show up on one side of the forehead, in one arm, etc. It’s not an even distribution.”
As Chauhan describes, shingles often first manifests as red blistering patches that are grouped at a particular region of the body. Gardner adds pain at the site may be a prominent symptom. “A new rash that is painful and blistering, and that develops quickly should prompt physician evaluation.”
Primary treatment for shingles is a week-long course of antiviral tablets. “Those with extensive eruptions or who are older should restrict normal physical activities for a few days. A heating pad may improve symptoms,” Gardner says.
And for many people that’s the extent of it. However, some individuals develop ‘postherpetic neuralgia,’ ongoing pain that may last for weeks or months after the initial shingles out-break. Postherpetic neuralgia can affect quality of life, although it usually subsides within three months. Other potential complications include partial paralysis of the face (Bell’s palsy); ear pain and hearing loss (Ramsay Hunt syndrome); loss of vision (imminent acute retinal necrosis syndrome); and Guillain-Barre syndrome, in which the arms and/or legs become weak, painful and sometimes paralyzed. These complications are rare, but prompt treatment helps prevent them.
Of course, the best strategy is prevention, and all adults aged 60 and older should be vaccinated with Zostavax, a stronger version of Varivax, the chickenpox vaccine recommended for children. The website of the U.S. Centers for Disease Control and Prevention (cdc.gov) has more information about the vaccine and the disease, in general.