Shingles

and Martina Feichter, medical editor and biologist

Marian Grosser studied human medicine in Munich. In addition, the doctor, who was interested in many things, dared to make some exciting detours: studying philosophy and art history, working on the radio and, finally, also for a Netdoctor.

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Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

Shingles is a viral disease. It is caused by the same pathogen as chickenpox. A painful rash is typical of shingles - but it can also be absent. It usually heals within a few weeks. However, early treatment is important to reduce the risk of complications. Read more on the topic: How does shingles develop (herpes zoster)? What are the symptoms? Is Shingles Contagious? How is it treated?

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. B02

Shingles: Quick Reference

Infection route: Shingles gets shingles who have previously suffered from chickenpox (exception: vaccinated people). Chickenpox is highly contagious (droplet infection). Direct infection in shingles sufferers through contact with skin rashes or contaminated surfaces. Consequence: Chickenpox - after 14 to 16 days of incubation!
Trigger: physical and psychological stress, other viral infections, cancer, drugs that suppress the immune system, UV light
Symptoms: general feeling of illness, headache and body aches, slight fever, tingling of the skin, shooting pains (burning, stinging), belt-shaped skin rash with fluid-filled blisters that later crust
Localizations: Rash mostly on one side of the chest or abdomen, but also on the neck, face or scalp possible
Treatment: relieving symptoms with painkillers (ibuprofen, paracetamol, gabapentin), ointments or tinctures. Causal antiviral therapy

Shingles: causes and risk factors

Shingles (herpes zoster) is caused by the varicella zoster virus (VZV). The pathogen belongs to the herpes viruses and is very contagious. In addition to shingles, it causes another disease: chickenpox (varicella). This childhood disease occurs as the first infection. This means:

If someone is infected with the varicella zoster virus for the first time, they will get chickenpox. After this childhood disease has healed, the viruses remain in the body. They withdraw into the so-called spinal ganglia. These are collections of nerve cell bodies along the spinal cord. Here the viruses can "dormant" for life.

But you can also become active again, even years or decades after the chickenpox disease. Then the "woken up" viruses spread along nerve tracts and cause inflammation of the affected nerve tissue on their way. The typical painful skin rash of shingles develops in the affected area of the skin.

Mechanism of shingles

Dormant viruses become active in shingles. They cause vesicles and can lead to nerve damage.

Risk of contagion & route of infection

This means that only those people who have had chickenpox before can get shingles. This is important to know when it comes to the risk of shingles infection. After all, the infectiousness of chickenpox is decisive, and it is extremely high: 90 out of 100 infectious people get chickenpox if they have had contact with an infected person. One is contagious if one has not yet had the childhood disease and is not vaccinated against it.

But what does "contact with a sick person" mean? In the case of chickenpox, it means that an infectious person is within several meters of a sick person. The varicella are passed on via a so-called droplet infection. This means that the pathogens are transmitted via the air. So you don't even have to touch a sick person to get infected. It is sufficient to inhale the tiny, virus-containing droplets that the patient spreads in the surrounding air, for example when breathing or coughing.

Shingles is contagious in another way: The varicella zoster viruses are transmitted through direct contact with the virus-containing contents of the skin vesicles. This can happen, for example, when a healthy person touches a patient's rash. Viruses can also be transmitted when touching objects that the patient previously held in their contaminated hand (indirect contact). The person concerned will then get the chickenpox if he has not had it and is not vaccinated against it. A direct infection with shingles is not possible, as this can only break out when viruses embedded in nerve cells are reactivated.

Many people do not get chickenpox because they have been vaccinated against the childhood disease. However, they can also develop shingles if they have been immunized with a live vaccine. The vaccine viruses can then implant themselves in the nerve cells and become active later in life. But this happens less often than in people who have had chickenpox. In addition, the disease is then milder. The shingles usually shows up near the original vaccination site.

How long is shingles contagious?

Shingles patients are contagious from the appearance of the skin vesicles to their complete crust. Generally this takes five to seven days.

For comparison: Chickenpox patients are contagious a day or two before the rash occurs. There is a risk of infection up to the crust of the skin vesicles. Again, this usually takes five to seven days after the first blisters appear.

What can cause shingles?

As explained above, in principle only those people can get shingles who have had chickenpox before. The varicella zoster viruses "dormant" in them are normally kept in an inactive state by the immune system. If the body's defenses are weakened, the pathogens can "wake up" and trigger shingles. There are many reasons for an immune deficiency and thus the risk factors for shingles. The most important are:

great stress (also emotional stress)
UV radiation: In excessively high doses, UV radiation can trigger shingles. So it does happen that the herpes zoster follows a strong sunburn.
other infections that precede herpes zoster: They can promote shingles. Sometimes a flu-like infection is enough.
AIDS: This syndrome caused by the HIV virus destroys certain cells of the immune system (T cells).
Cancers: These often weaken the immune system.
Chemotherapy: The drugs used to fight cancer also affect immune cells, among other things.
Medicines that dampen the body's defense system (so-called immunosuppressants): for example TNF blockers as part of rheumatism therapy.
Congenital immune deficiencies: Here certain components of the body's defenses are reduced or absent from birth.

The fact that shingles usually only occurs after the age of 40 is also related to the immune system: the body's defenses become less efficient with age. Shingles in children or young adults is rare.

Shingles: incubation period?

The incubation period is the time between infection with a pathogen and the appearance of the first symptoms. In the case of shingles, however, there is no infection: the pathogen has been embedded in the body since the chickenpox infection. One can only speak of an incubation period for chickenpox. Here it is usually 14 to 16 days.

Shingles: symptoms

The symptoms of shingles are not uniform. They can vary from case to case, especially in terms of their severity. Most of the time, however, the symptoms of shingles follow a certain pattern:

No specific symptoms appear in the early stages of the disease. Patients only report general symptoms such as fatigue, headache and body aches, or a slight fever. Parasitic sensations such as tingling may occur in the affected skin area. You will go into pain after two to three days and the typical shingles rash will develop.

"Keep away from young children with shingles"

Three questions for

Dr. med. Hans-Ulrich Voigt,
Specialist in dermatology, phlebology, allergology
1
How do I know if I have shingles?

Dr. med. Hans-Ulrich Voigt
Shingles is an infection with the varicella zoster virus, which also causes chickenpox. The viruses spread from the spinal cord along the nerve tracts and migrate to the surface of the skin. Since the nerves in the trunk area run in a belt shape, the skin changes, which consist of grouped vesicles, erosions (small weeping little holes) and crusts, are also arranged in this way, hence the name "shingles".
2
Is shingles dangerous, i.e. what are the long-term effects?

Dr. med. Hans-Ulrich Voigt
Shingles can be dangerous in certain parts of the body as it can permanently damage organs. For example, corneal scars or inner ear disorders can develop. Furthermore, shingles can be very difficult in people with a weakened immune system - for example organ transplants, elderly patients, HIV patients - with organ involvement and nerve disorders.
3
How contagious is shingles?

Dr. med. Hans-Ulrich Voigt
Shingles is contagious to people who have never had chickenpox and they get chickenpox. Small children in particular are at risk. Sick people should stay away from these for a week. The best protection is a healthy immune system, which is promoted by a healthy lifestyle. But there is also a highly effective and well-tolerated vaccination, especially for people at risk.
Dr. med. Hans-Ulrich Voigt,
Specialist in dermatology, phlebology, allergology
Founder and owner of the Skin and Laser Center Dermatology am Dom in Munich, one of the first laser therapists in Munich.

pains

The pain can occur before, during and, in unfavorable cases, after the rash. Since the viruses attack the nerves in shingles, it is known as neuropathic pain. These are expressed by burning or stinging, are sometimes dull and always shoot in suddenly. Shingles pain can be felt as very strong. The nerve pain after the rash has subsided (post-therapeutic neuralgia) in particular often causes major problems.

skin rash

The typical feature of shingles is the characteristic rash, which is also known as zoster. It usually begins with a non-specific reddening of the affected area with small skin nodules. These nodules develop into small skin vesicles within hours that can also be itchy. They are filled with an initially clear liquid that becomes cloudy over time.

The vesicle phase lasts for up to five days. After bursting, the blisters dry out within two to ten days. Yellowish crusts often form, and when they fall off, the rash eventually disappears. Overall, it generally takes two to four weeks for the skin changes from shingles to go away.

It is also possible for shingles to occur without a rash (just painful). Doctors then speak of a "zoster sine herpete".

Which part of the body is affected?

What is noticeable about shingles is the spread of the rash. The viruses migrate along certain nerve tracts on the surface of the skin (technical term: dermatomes). Therefore, the rash often develops in stripes.

Most often, shingles develops on the back or chest area. Here the rash often looks belt-shaped. This is where the German name of the disease comes from.

In principle, however, herpes zoster can affect all parts of the body. Often the head or neck are affected. In other people, shingles develops on the leg or arm. The painful rash is usually limited to one side of the body. Sometimes several skin areas are affected next to each other. If the immune system is severely weakened, the shingles rash can spread over the entire surface of the body. This generalized herpes zoster is then difficult to distinguish from chickenpox.

Shingles on the face

Occasionally, shingles also develops on the face. This can be problematic: Sometimes the cornea of the eye is affected. Then inflammation of the cornea (keratitis) can develop.

The auditory and taste nerves can also be affected. Some patients even develop hemiplegic facial nerve paralysis (facial paralysis).

Read everything you need to know about herpes zoster on the face and the possible complications in the article Shingles on the face.

Shingles: pregnancy and newborns

According to the current state of knowledge, if a pregnant woman develops shingles, this is not a problem for the unborn child: it is not affected by the disease.Even if the shingles occurs around the due date, there is generally no risk: infection with the varicella zoster virus is unlikely during this phase.

Chickenpox is more dangerous

However, an initial infection with the varicella zoster virus during pregnancy, i.e. a chickenpox infection, can be dangerous: an illness in the first half of pregnancy can cause malformations and damage to the unborn child. Doctors speak of congenital varicella syndrome (CVS). It's rare but serious: for example, the children affected have underdeveloped limbs, eye defects, cramps, scarring, and skin ulcers. Some of the little patients die as a result.

It can also be life-threatening for the child if a pregnant woman develops chickenpox shortly before or after the birth. The child can get infected from the mother and then get chickenpox himself. These newborn varicella can be severe and even fatal. There are two reasons:

On the one hand, the child's immune system is not yet fully developed, so it cannot fight the pathogen effectively. On the other hand, because of the "fresh" infection, the mother does not yet have any antibodies that she could pass on to the child (via the umbilical cord or breast milk).

Shingles: examinations and diagnosis

Most patients suspected of having shingles go to their general practitioner or dermatologist. If the eye or ear area is affected, an ophthalmologist or ear, nose and throat doctor should be consulted.

The typical clinical picture usually leads the doctor quickly to the diagnosis of shingles: The course and type of symptoms are characteristic of the second disease caused by the varicella-zoster virus.

However, in the early stages of shingles, diagnosis can sometimes be difficult. The general symptoms and an initial rash can have many causes. Then certain tests help to reliably detect herpes zoster and to rule out other diseases with similar symptoms (such as herpes simplex). There are essentially two ways of doing this:

Direct detection: The virus can be detected directly using a wound swab, for example with the help of so-called PCR (polymerase chain reaction) or a cell culture.
Indirect detection: The patient's blood is tested for specific antibodies against the varicella zoster virus. If the brain is affected, a sample of the nerve water (liquor) can also be analyzed.

Shingles: treatment

The unpleasant symptoms of shingles can be relieved with medication: For example, mild pain relievers such as ibuprofen or paracetamol help against the pain. These also have a fever lowering effect. If necessary, the doctor can also prescribe more pain reliever medication.

Depending on the stage, the rash is treated with skin care products: for example, antipruritic agents in the form of ointments or tinctures are available. Some preparations also encourage the blisters to dry out or the crusts to peel off.

In addition to these purely symptomatic measures, a causal treatment can also be started for shingles: The patients receive antiviral drugs (virostatics) that fight the varicella-zoster virus.

You can read more about the different therapy options for shingles in the article Shingles - Treatment.

Shingles: disease course and prognosis

The prognosis for shingles is usually good. It heals within a few weeks in most people with a healthy immune system. After the blisters burst, they crust and after a few days the scab falls off. In contrast to chickenpox, patients usually don't get embarrassed because the pain prevents it from scratching.

Different stages of shingles

Shingles: complications

Sometimes shingles has complications. These include:

Secondary bacterial infection: The skin areas damaged by the zoster become infected with bacteria.
Pigment disorders, bleeding and melting of the skin as well as scarring
Symptoms of paralysis (paresis) and sensory disturbances (paresthesia) in the affected area of the body
Meningitis and brain inflammation when the zoster affects the central nervous system
Disseminated (generalized) herpes zoster: Here the whole body is attacked by the zoster viruses. Internal organs are also affected.

In addition, zoster can cause damage to the eyes and ears in particular, which can lead to blindness or deafness. These special shingles symptoms are described in more detail in the article "Shingles on the face".

People with immunodeficiency are particularly susceptible to such shingles complications. These include AIDS or cancer patients. Disseminated herpes zoster and the infestation of the central nervous system are particularly feared here. In addition, the herpes zoster symptoms are often atypical in the case of an immune deficiency.

Post-therapeutic neuralgia

In some patients, the neuropathic zoster pain persists or flares up repeatedly after the rash has healed. Doctors then speak of a "postherpetic neuralgia" or a "postherpetic neuralgia" (PHN). In the worst case, the symptoms persist for life. This complication is particularly feared in older patients with shingles. How exactly the pain occurs is not yet clear. In any case, the affected nerves are permanently damaged by the zoster.

These neuralgia can cause extremely severe pain. It is therefore very important to intervene with special medication as early as possible. This gives you a chance to prevent persistent shingles symptoms.

Prevent shingles

People with chickenpox or shingles should avoid scratching their often itchy rash. This reduces the risk of infecting other people. Because by scratching the vesicles, the highly infectious contents get on the fingers. From there it can be distributed to the surrounding area, for example on doorknobs or cutlery. If healthy people touch these objects and then subconsciously grab their mouth or nose, the viruses can be transmitted.

Chickenpox vaccine

People who have not yet contracted the varicella zoster virus can get vaccinated. This protects against childhood illness and thus also against any subsequent shingles. The VZV vaccination for children and adolescents is recommended as standard by the Standing Vaccination Commission (STIKO). Vaccination is also useful for high-risk patients who have not yet had chickenpox. Such persons at risk are, for example, women who want to have children, patients before organ transplants and people with severe neurodermatitis. In these cases, VZV infection can be dangerous.

Shingles vaccine

A vaccine against shingles has been available since May 2018, which the Robert Koch Institute recommends for people aged 60 and over. It lowers the risk of developing herpes zoster. Unlike the live vaccine previously used (which has been around since 2013 and is no longer recommended for the standard vaccination), it consists of killed pathogens and also contains a new potentiator. For the vaccination, two doses of the active ingredient are required at an interval of two to six months, which are administered intramuscularly (into the upper arm muscle).

In principle, the vaccination is standard for people aged 60 and over, and for people with chronic diseases such as diabetes, HIV, kidney weakness, etc. or an immune deficiency from the age of 50. This is what the STIKO recommends. Statutory health insurance bears the cost of the vaccination (only with the dead vaccine). If you are privately insured, it is best to clarify the assumption of costs directly with your private health insurance company in advance.

Read more about vaccination against shingles in the article Shingles vaccination.

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