Have you heard of herpes zoster? And of shingles? Get to know this viral infection
Shingles, also known as herpes zoster, is a viral infection that can appear at any time of life, but is most common in adults over the age of 50. It is a reactivation of the chickenpox virus, which remains dormant in the body after a person has had the illness. When the immune system weakens, the virus can wake up again, causing rather uncomfortable symptoms.
If you have heard of this condition and want to know how to recognise it, what the risks are and how to treat it, read on.
What is shingles?
Shingles is caused by the same virus that causes chickenpox, the varicella-zoster virus. After a person has had chickenpox, the virus does not disappear completely – it stays “hidden” in the nerve cells. It may never cause problems again but, in some people, it reactivates years later, appearing in the form of shingles.
Unlike chickenpox, which affects several parts of the body, shingles usually appears in a specific area of the skin (typically following the path of a nerve).
Symptoms of shingles
In the first few days, the symptoms can be mistaken for other conditions, as they include:
- Localised pain (usually on one side of the body)
- A burning or tingling sensation
- Fever and chills
- Headache
- Tiredness and a general feeling of being unwell.
After this initial phase, the characteristic rash appears. It begins with red patches that quickly develop into small fluid-filled blisters. These blisters can be very painful and, in some cases, even the simple touch of clothing on the skin can be uncomfortable.
Over time, the blisters dry out and form scabs, which eventually fall off after two to four weeks.
See here how shingles lesions can appear on the skin, from the first signs to the formation of scabs. Warning: some people may find the images distressing.
Where do the lesions appear?
Shingles can appear anywhere on the body, but it is most common on the torso, the face and around the eyes. It usually affects only one side of the body, following the path of a nerve.
If the infection reaches the area around the eyes (ophthalmic shingles), it can affect vision and, in severe cases, lead to blindness.
Is shingles contagious?
Yes and no. Someone who has already had chickenpox cannot “catch” shingles from another person. However, someone who has never had chickenpox can catch it if they come into contact with the blisters of an infected person. For this reason, anyone with shingles should avoid direct contact with pregnant women, babies and people with a weakened immune system.
What can cause the virus to reactivate?
The virus can remain dormant in the body for decades, but certain conditions can increase the risk of reactivation:
- Older age: shingles is more common after the age of 50
- A weakened immune system: people with conditions such as AIDS or cancer, or who are having treatments such as chemotherapy, are more vulnerable
- Stress and fatigue: chronic stress can affect the immune system and make it easier for the virus to reactivate
- Surgery or trauma: some medical procedures can contribute to the infection reappearing.
Treatment of shingles
There is no definitive cure, but there are treatments that help to relieve the symptoms and speed up recovery. Treatment should begin as early as possible, ideally within the first three days after the lesions appear.
It is essential to see a doctor as soon as the first signs of the illness appear, because treatment is most effective when started within the first 72 hours after the lesions appear.
How is it diagnosed?
Shingles is diagnosed mainly on the basis of the symptoms and by examining the lesions on the skin. In uncertain cases, laboratory tests can be carried out to detect the presence of the active virus in the body.
Medicines used
- Antivirals (aciclovir, valaciclovir): help to reduce the duration of the illness and the intensity of the symptoms
- Painkillers and anti-inflammatories: relieve pain and discomfort
- Anaesthetic creams or gels (lidocaine): can be applied to the skin to reduce pain
- Cortisone (in some cases): used to reduce inflammation and the risk of post-herpetic neuralgia
- Medicines for post-herpetic neuralgia (amitriptyline, gabapentin): used when the pain persists after the lesions have healed
Besides medical treatment, a few measures can help to relieve the symptoms:
- Wearing loose clothing to avoid rubbing against the skin
- Avoiding touching or scratching the blisters to prevent infection
- Keeping the skin clean and dry.
How long does shingles take to clear up?
In most cases, this viral condition lasts between two and four weeks. The cycle begins with pain and tingling on the skin, followed by the appearance of the rash and fluid-filled blisters. These eventually dry out and form scabs, which gradually fall off.
Some people may continue to feel persistent pain in the affected area, a condition called post-herpetic neuralgia, which can last for months or even years. The recovery time can vary depending on age, the state of the immune system and how quickly treatment was started.
How to prevent shingles?
The best way to prevent shingles is through vaccination. The shingles vaccine does not guarantee complete protection, but it significantly reduces the risk of developing the illness and the severity of the symptoms. It is recommended for people over 50 and for at-risk groups.
At present, the vaccine is still not subsidised by the SNS (the Portuguese National Health Service), which means the cost falls to the patient. The price is around 180 euros per dose, and two doses are needed for effective protection. For many people, this can be a barrier to accessing prevention.
Given this situation, doctors and patient associations have been calling for the vaccine to be included in the National Vaccination Programme (Programa Nacional de Vacinação), especially for those at greater risk of complications. If you have any questions about the vaccine, talk to your GP (family doctor) and consider whether it makes sense for you.
Strategies to prevent the virus from reactivating
- A balanced diet and physical exercise to strengthen the immune system.
- Managing stress through meditation, yoga or relaxing activities.
- Getting enough rest to avoid extreme fatigue and keep the body's defences strong.
- Managing chronic conditions such as diabetes or autoimmune problems.
- Avoiding contact with active lesions to prevent the virus from spreading.
How to prevent shingles?
You should see a doctor as soon as the first signs of shingles appear, especially if there is intense pain, fever or a general feeling of being unwell. Early treatment with antivirals can reduce the severity of the illness and prevent complications.
It is essential to seek immediate medical help if:
- The lesions affect the eyes or vision
- The pain is very intense and hard to control
- There are signs of infection in the blisters, such as pus or excessive redness
- The symptoms persist for more than four weeks.
If you suspect that you may have shingles, do not put off seeing a doctor. An early diagnosis and starting treatment promptly can make all the difference to how the illness develops.
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