Best Shingles (Herpes Zoster) Treatment in Delhi, India

Shingles is a viral infection caused by the reactivation of the varicella-zoster virus, the same virus responsible for chickenpox. After a person recovers from chickenpox, the virus remains dormant in the nerve tissue and can reactivate years later, leading to shingles. It typically manifests as a painful, blistering rash on one side of the body or face, often accompanied by burning, tingling, or itching sensations. While the rash usually heals within two to four weeks, the pain can sometimes linger, developing into a condition called postherpetic neuralgia (PHN), which can be severe and long-lasting. Shingles is more common in older adults and individuals with weakened immune systems, and prompt treatment is crucial to alleviate symptoms and reduce the risk of complications.

Shingles is caused by the reactivation of the varicella-zoster virus, which is the same virus that causes chickenpox. After a person has chickenpox, usually during childhood, the virus becomes inactive and resides in the nerve tissue. It can remain dormant for years without causing any symptoms.

Several factors can trigger the reactivation of the virus, leading to shingles, including:

• Weakened Immune System: Conditions that weaken the immune system, such as HIV/AIDS, cancer, or autoimmune diseases, can increase the risk of developing shingles.
• Age: The risk of shingles increases with age, particularly in individuals over 50, as the immune system naturally weakens over time.
• Stress: High levels of stress can negatively impact the immune system, potentially triggering the reactivation of the virus.
• Injury or Illness: Physical trauma or other illnesses can also contribute to a weakened immune response, making it easier for the virus to reactivate.
• Certain Medications: Immunosuppressive medications, such as those used in organ transplants or chemotherapy, can increase the likelihood of shingles.

Understanding these triggers can help individuals take preventive measures, if they have previously had chickenpox.

Shingles typically progresses through three main stages with their own characteristic symptoms: 

Prodromal Stage

The prodromal stage occurs 1 to 5 days before the rash appears and is characterised by early symptoms that can signal the onset of shingles. During this time, individuals may experience:

• Pain, burning, or tingling: This discomfort often occurs in a specific area of the body where the rash will eventually develop, commonly on one side of the torso or face.
• Sensitivity to touch: The affected area may feel unusually sensitive, making even light touches painful.
• Itching: Individuals may notice localised itching in the area where the rash will appear.
• Flu-like symptoms: These can include low-grade fever, fatigue, headache, and malaise, which can make individuals feel unwell.
• Swollen lymph nodes: The lymph nodes in the area may become tender or enlarged as the body responds to the virus.

These early symptoms can last for a few days and may be mistaken for other conditions, making early recognition challenging.

Rash Stage

The rash stage is when the characteristic shingles rash appears and is marked by several key developments:

• Red patches: The rash typically begins as red patches on the skin, which may be mistaken for insect bites or other skin irritations.
• Fluid-filled blisters: Within a few days, the red patches develop into painful, fluid-filled blisters that can vary in size. These blisters usually cluster together in a band-like or strip pattern and are often located on one side of the body.
• Pain and discomfort: The rash is often accompanied by significant pain, which can range from a mild ache to severe burning sensations. This pain can persist even after the rash begins to heal.

The rash generally lasts about 7 to 10 days, with the blisters eventually crusting over and beginning to heal. During this stage, it is crucial to manage symptoms to reduce discomfort and prevent complications, such as bacterial infection of the blisters.

Healing Stage

In the healing stage, the body begins to recover from the shingles outbreak, and the following occurs:

• Drying and crusting: The fluid-filled blisters dry out, form crusts, and eventually fall off. This process may take an additional 2 to 4 weeks.
• Fading rash: As the crusts heal, the redness and inflammation decrease, and the skin may appear slightly discoloured where the rash was.
• Postherpetic neuralgia: Although the rash heals, some individuals may continue to experience pain or discomfort due to postherpetic neuralgia, a condition where nerve fibres are damaged during the shingles outbreak. This pain can persist for months or even years after the rash has resolved.

Understanding these stages and symptoms can help individuals recognize shingles early, seek appropriate medical care, and effectively manage their condition.

Diagnosing shingles typically involves a combination of a physical examination, medical history review, and, in some cases, laboratory tests. Here’s how the diagnosis process generally unfolds:

Physical Examination

The doctor will begin by examining the characteristic rash and blisters associated with shingles. The rash often appears as a band or strip on one side of the body or face, which can help distinguish it from other skin conditions. The provider will also assess any accompanying symptoms, such as pain, burning, or tingling in the affected area.

Medical History

The doctor will then inquire about the patient's medical history, including any previous episodes of chickenpox or shingles. Information about current symptoms, their onset, and any relevant medical conditions or medications will also be considered. This history helps to identify risk factors and confirm the likelihood of shingles.

Laboratory Tests

In most cases, a clinical diagnosis based on the rash and symptoms is sufficient. However, if there is uncertainty or if the patient is immunocompromised, laboratory tests may be conducted. These tests can include:

• Polymerase Chain Reaction (PCR) Test: This highly sensitive test detects the presence of varicella-zoster virus DNA in fluid from the blisters or blood samples.
• Viral Culture: A sample from a blister may be taken and cultured to see if the varicella-zoster virus grows.
• Serological Tests: Blood tests can determine if there are antibodies present, indicating a previous infection with the virus.

Treating shingles focuses on alleviating symptoms, reducing the duration of the outbreak, and preventing complications. Here are the main approaches to treatment:

Antiviral Medications

Antiviral medications are commonly prescribed to help speed up recovery and reduce the severity of symptoms. These medications are most effective when taken within the first few days of the rash appearing. They work by inhibiting the replication of the varicella-zoster virus, which can help lessen the duration of the rash and pain.

Pain Management

Managing pain is a critical aspect of shingles treatment. Over-the-counter pain relievers may be recommended to help alleviate mild to moderate pain. For more severe pain, prescription medications, including opioids or nerve pain medications, may be necessary. Topical treatments can also provide localised relief from pain.

Corticosteroids

In some cases, corticosteroids may be prescribed to reduce inflammation and pain, especially if the rash is widespread or if the patient is experiencing severe discomfort. 

Supportive Care

Supportive care measures can help soothe the skin and improve overall comfort during the healing process. These may include:

• Cool compresses: Applying cool, damp cloths to the affected area can help alleviate itching and discomfort.
• Oatmeal baths: Soaking in colloidal oatmeal baths can provide relief from itching and irritation.
• Moisturisers: Using fragrance-free moisturisers on the rash can help prevent dryness and soothe the skin.

Postherpetic Neuralgia (PHN) Treatment

If postherpetic neuralgia develops, additional treatments may be required to manage the chronic pain. Options can include medications specifically designed for nerve pain, topical treatments, and therapies like physical therapy or acupuncture.

Shingles can lead to several complications, some of which may have a lasting impact on a person's health. Here are the most common complications associated with shingles:

Postherpetic Neuralgia (PHN)

One of the most common complications is postherpetic neuralgia, a condition characterised by severe pain that persists in the area where the shingles rash occurred, even after the rash has healed. This pain can be debilitating and may last for months or even years. PHN can significantly affect a person's quality of life, leading to difficulties in daily activities, sleep disturbances, and emotional distress.

Vision Problems

If shingles affects the ophthalmic branch of the trigeminal nerve, it can lead to serious eye complications, including:

• Herpes zoster ophthalmicus: This condition can cause redness, swelling, and pain in the eye, potentially leading to vision loss if not treated promptly.
• Keratitis: Inflammation of the cornea can occur, resulting in blurred vision, pain, and light sensitivity.

Skin Infections

The blisters caused by shingles can become infected with bacteria if not properly cared for. This can lead to further skin infections that may require additional treatment with antibiotics.

Neurological Complications

In rare cases, shingles can lead to more severe neurological complications, such as:

• Meningitis: Inflammation of the membranes surrounding the brain and spinal cord.
• Encephalitis: Inflammation of the brain, which can result in confusion, seizures, and other neurological symptoms.

Hearing Problems

If shingles affect the facial nerve, it may lead to hearing complications, such as tinnitus (ringing in the ears) or even hearing loss.

Disseminated Zoster

In individuals with weakened immune systems, shingles can lead to disseminated zoster, where the rash spreads to multiple areas of the body. This condition can be more severe and requires immediate medical attention.

Impact on Mental Health

The chronic pain and physical limitations caused by shingles and its complications can lead to anxiety, depression, and other mental health issues. The emotional toll of dealing with ongoing pain and discomfort should not be underestimated.

The most effective way to prevent shingles is through vaccination. Shingrix is a recombinant zoster vaccine that is recommended for adults aged 50 and older, regardless of whether they have had shingles or chickenpox. Shingrix is administered in two doses, with the second dose given two to six months after the first. It has been shown to be over 90% effective in preventing shingles and its complications, including postherpetic neuralgia.

1. Can shingles be transmitted from one person to another?

Shingles itself is not contagious, but the varicella-zoster virus can be transmitted from someone with shingles to a person who has never had chickenpox. This transmission can occur through direct contact with the shingles rash. If infected, the individual may develop chickenpox, not shingles. Once someone has had chickenpox, they are at risk of developing shingles later in life.

2. How long does it take for shingles to heal?

Shingles typically takes about two to four weeks to heal. The rash usually progresses from red patches to blisters and then crusts over. Pain may persist even after the rash has healed, especially in cases of postherpetic neuralgia. Prompt treatment can help shorten the duration of the outbreak and reduce discomfort.

3. Can shingles affect my ability to work or perform daily activities?

Yes, shingles can significantly impact a person's ability to work or engage in daily activities due to pain, discomfort, and fatigue. The severity of symptoms varies, but some individuals may find it challenging to concentrate or perform tasks while experiencing an outbreak. Rest and self-care are essential during this time, and individuals should consider taking time off work if needed.

4. What are the common misconceptions about shingles?

Common misconceptions about shingles include the belief that it is only an illness for older adults, or that it cannot occur more than once. While shingles is more common in older adults, it can affect anyone who has had chickenpox, including children and younger adults. Additionally, while many people may only experience shingles once, it is possible to have multiple episodes throughout one’s lifetime.

5. How can I differentiate between shingles and other skin conditions?

Shingles typically presents as a painful, blistering rash that appears in a band or strip on one side of the body or face. In contrast to other skin conditions, shingles often begins with prodromal symptoms like burning or tingling in the affected area. If unsure, it is important to consult a doctor for an accurate diagnosis, as other conditions, such as contact dermatitis or eczema, may have similar appearances.

6. Are there any specific dietary recommendations during a shingles infection?

While there are no specific dietary restrictions during a shingles outbreak, consuming a well-balanced diet rich in vitamins, minerals, and antioxidants can help support the immune system. Foods high in vitamin C, such as citrus fruits, and those rich in vitamin E, like nuts and seeds, may be beneficial. Staying hydrated and avoiding overly processed foods or excessive sugar may also promote better overall health during recovery.

7. Can children get shingles, and if so, how does it differ from adults?

Yes, children can get shingles, especially if they have had chickenpox in the past. However, shingles is less common in children compared to adults. When children do develop shingles, they often experience milder symptoms and a shorter duration of the rash compared to adults. The risk of complications, such as postherpetic neuralgia, is also generally lower in children.

8. What should I do if I think I have shingles?

If you suspect you have shingles, it is essential to contact a healthcare provider as soon as possible. They can assess your symptoms and confirm the diagnosis. Early treatment with antiviral medications can help reduce the severity and duration of the outbreak. Additionally, avoid close contact with individuals who are immunocompromised, pregnant, or have never had chickenpox until the rash has healed.

Reviewed By Dr Kashish Kalra - Head of Dept and Consultant Dermatology on 11 Oct 2024.