shingles

Shingles: short overview

• infection: Shingles gets, who was previously suffering from chickenpox (exception: vaccinated). Chickenpox is highly contagious (droplet infection). Direct infection with shingles patients by contact with rash or contaminated surfaces. Episode: Chickenpox – after 14 to 16 days incubation period!
• Trigger / Trigger: physical and mental stress, other viral infections, cancer, immune system suppressing drugs, UV light
• symptoms: general malaise, headache and body aches, slight fever, skin tingling, shooting pain (burning, stinging), belt-shaped skin rash with fluid-filled blisters, which later crust
• locations: Rash usually unilateral on the chest or abdomen, but also on the neck, on the face or on the scalp possible
• Treatment: relieving pain with painkillers (ibuprofen, paracetamol, gabapentin), ointments or tinctures. Causal therapy with antivirals

Shingles: causes and risk factors

Shingles (herpes zoster) is caused by varicella-zoster virus (VZV). The pathogen is one of the herpes viruses and is very contagious. He triggers in addition to the shingles yet another disease: the chickenpox (Varicella). This teething disorder occurs as a primary infection. This means:

If someone becomes infected for the first time with the varicella-zoster virus, they will get the chickenpox. After curing this childhood disease, the viruses remain in the body. They retreat into the so-called spinal ganglia. These are accumulations of nerve cell bodies along the spinal cord. Here the viruses can “sleep” inactive for life.

But they can also be active again, and even years or decades after the chickenpox disease. Then, the “awakened” viruses spread along nerve tracts, causing inflammation of the affected nerve tissue on their way. In the skin area in question develops the typical painful rash of the shingles.

Risk of infection & infection route

This means that only those people can get shingles that previously had chickenpox. This is important to know when it comes to shingles infection. After all, the infectiousness of the chickenpox is crucial, and that is extremely high: Of 100 infectious people, 90 of the chickenpox, if they had contact with a patient. Infectious one is, if you have not had the childhood disease and is not vaccinated against it.

But what does “contact with a patient” mean? In the case of chickenpox, it means that a contagious person stays within a few yards of a patient. The varicella are namely a so-called droplet infection passed. This means that the pathogens are transmitted by air. So you do not even have to touch an infected person to get infected. It is sufficient to inhale the tiny, virus-containing droplets that the patient spreads when breathing or coughing in the ambient air.

In a different way is Shingles contagious: The varicella zoster viruses are transmitted via the direct contact transferred with the virus content of the skin. This can happen, for example, when a healthy person touches the rash of a patient. Even when touching objects that the patient previously had in his contaminated hand, viruses can be transmitted (indirect contact). The person concerned then gets the chickenpox, if he did not have it yet and is not vaccinated against it. A direct infection with shingles is not possible, since this can only break out, when viruses reinstated in nerve cells are reactivated.

Many people do not get chickenpox because they have been vaccinated against childhood disease. However, you 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 undergone the chickenpox. In addition, the disease runs milder then. The shingles usually show up near the original injection site.

How long is shingles contagious?

Shingles patients are contagious from the appearance of skin sores to their complete crust. In general, this takes five to seven days.

For comparison, chickenpox patients are contagious just one to two days before the rash occurs. The risk of infection exists until crusting of the skin. Again, this usually takes five to seven days after the appearance of the first bubbles.

What can trigger a shingles?

As explained above, in principle, only those people can get a shingles, the previously had chickenpox. The “dormant” Varicella zoster viruses are normally kept in an inactive state by the immune system. If the body defenses are weakened, the pathogens can “wake up” and trigger a shingles. The reasons for an immunodeficiency and thus the Risk factors for shingles are diverse. The most important are:

• great stress (also mental stress)
• UV radiation: In too high doses, UV radiation can cause shingles. So it happens quite that the herpes zoster follows a strong sunburn.
• Other infections that precede the herpes zoster: They can promote shingles. Sometimes even a flu infection is enough.
• AIDS: This syndrome caused by the HI virus destroys certain cells of the immune system (T cells).
• Cancers: These often weaken the immune system.
• Chemotherapy: The drugs used to combat cancers also affect defense cells, among other things.
• Drugs that dampen the body’s immune system (so-called immunosuppressants): for example, TNF-blocker as part of a rheumatic therapy.
• Inborn immunodeficiencies: Here are from birth certain components of the body’s defense reduced or missing completely.

The fact that shingles usually occurs only at the age of 40 years, is also related to the immune system: With age, the body’s defenses less powerful. Shingles in children or young adults is rare.

Shingles: incubation period?

The incubation period is the time between infection with a pathogen until the onset of the first symptoms. In the case of shingles, however, there is no infection: The pathogen is indeed already nestled in the body since the chickenpox infection. From an incubation period, one can only speak of chickenpox. It is usually 14 to 16 days here.

Shingles: symptoms

The symptoms of shingles are not consistent. They may vary from case to case, especially as regards their severity. Most of the shingles symptoms follow a certain pattern:

There are no specific symptoms in the early phase of the disease. The patients only report about general disease signs like fatigue, headache and body aches or a slight fever. Sensations such as tingling can occur on the affected area of ​​the skin. They go in after two to three days Pain over, and the typical Shingles rash forms.

Pain

The pain can occur before, during and in unfavorable cases even after the rash. Since the viruses in the shingles attack the nerves, it is called neuropathic pain. These express themselves by a burning or stinging, are sometimes dull and shoot again and again. Shingles pain can be felt to be very strong. Especially the nerve pain after the eruption (postherpetic neuralgia) often causes big problems.

skin rash

The typical feature of shingles is the characteristic rash, which is also called zoster designated. It usually begins with a nonspecific redness at the affected area with small skin nodules. From these nodules develop within hours small skin blisters, which can itch. They are filled with an initially clear liquid that becomes cloudy in the process.

The phase of skin blisters persists for up to five days. After bursting, the bubbles dry out within two to ten days. This often forms yellowish crusts, with their fall, the rash finally disappears. Overall, it generally takes two to four weeks for the skin lesions of a shingles to disappear again.

It is also possible that one Shingles without rash (only with pain) occurs. Physicians then speak of a “zoster sine herpete”.

Which body region is affected?

Striking in shingles is the spread pattern of the rash. The viruses migrate along certain nerve tracts on the skin surface (technical term: Dermatome). Therefore, the rash often forms a strip.

The most common form of shingles develops on the back or chest. Here, the rash often looks like a belt. Hence the German name of the disease.

In principle, however, herpes zoster can affect all parts of the body. Often head or neck are affected. In other people, the shingles 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. With a severely weakened immune system, the shingles rash can also spread over the entire body surface. This generalized herpes zoster is then difficult to distinguish from a chickenpox disease.

Shingles on the face

Occasionally, the shingles develop on the face. This can be problematic: sometimes the cornea of ​​the eye is affected. Then corneal inflammation (keratitis) may develop.

The auditory and taste nerves can also be affected. In some patients even a half-sided facial nerve paralysis develops (facial paralysis).

Read everything important about herpes zoster on the face and the possible complications in contributing shingles on the face.

Shingles: pregnancy and newborns

According to current knowledge, if a pregnant woman gets shingles, this is not a problem for the unborn child: it is not affected by the disease. In general, there is no risk of shingles around the birth date: it is unlikely that you will be infected with varicella-zoster virus at this stage.

More dangerous are the chickenpox

However, a primary infection with the varicella-zoster virus during pregnancy, ie a chickenpox infection, can become dangerous: A disease in the first half of pregnancy can cause malformations and damage to the unborn child. Doctors speak of this Congenital Varicella Syndrome (CVS), It is rare but serious: the affected children, for example, have underdeveloped limbs, eye defects, cramps, scarring and skin ulcers. Some of the small patients die in the episode.

It can also be life-threatening for a child if a pregnant woman suffers from chicken pox shortly before or after birth. The child can become infected with the mother and then contract chickenpox himself. These Neonatal varicella can be severe and even deadly. There are two reasons:

For one thing, the child’s immune system is not yet mature, so it can not effectively fight the pathogen. On the other hand, because of the “fresh” infection, the mother still has no antibodies that she could pass on to the child (via the umbilical cord or breast milk).

Shingles: examinations and diagnosis

Most patients with suspected shingles go to family doctor or to Dermatologists, If the eye or ear area is affected, it is essential to consult an ophthalmologist ENT doctor be visited.

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

However, in the first stage of shingles, the diagnosis can sometimes be difficult. The general signs of illness and an initial rash can have many causes. Then certain help Testingto recognize a herpes zoster safely and to exclude other diseases with similar symptoms (such as herpes simplex). There are two main ways to do this:

• Direct evidence: The virus can be directly detected by means of a wound swab, for example by means of the so-called PCR (polymerase chain reaction) or a cell culture.
• Indirect evidence: The patient’s blood is assayed for specific antibodies to the varicella-zoster virus. Once the brain is affected, a sample of the cerebrospinal fluid (CSF) can also be analyzed.

Shingles: treatment

The unpleasant discomfort of a shingles can be relieved with medication: For example, help against the pain easy Painkiller like ibuprofen or acetaminophen. These also reduce fever. If necessary, the doctor can also prescribe more painkillers.

The rash will depending on the stage with Skin care products Treated: There are, for example, anti-pruritic agents in the form of ointments or tinctures. Some preparations also promote the drying out of the blisters or the detachment of the crusts.

In addition to these purely symptomatic measures can be in Shingles also start a causal treatment: The patients get to antiviral Medicines (antivirals)who fight the varicella-zoster virus.

More about the different treatment options for a shingles read in the article shingles – treatment.

Shingles: disease course and prognosis

Usually, the prognosis of a shingles is good. It heals in most people with a healthy immune system within a few weeks. After the blisters burst, they crust and after a few days the scab falls off. In contrast to the chickenpox, patients usually do not get the chance to scratch because the pain prevents it.

Shingles: complications

Sometimes a shingles with complications. These include:

• Bacterial secondary infection: In the process, the skin areas damaged by the zoster additionally become infected with bacteria.
• Pigmentation, bleeding and melting of the skin and scarring
• Paralysis symptoms and sensory disturbances (paraesthesia) in the affected body region
• Meningitis and brain inflammation when the zoster attacks the central nervous system
• Disseminated (generalized) herpes zoster: In this case, the whole body is attacked by the zoster viruses. Internal organs are also affected.

In addition, the zoster can cause damage especially to the eyes and ears leading to blindness or deafness. These special shingles symptoms are described in more detail in the article “shingles on the face”.

Especially people with one are susceptible to such shingles complications immunodeficiency, These include AIDS or cancer patients. Especially the disseminated herpes zoster and the attack of the central nervous system are feared here. In addition, the herpes zoster symptoms are often atypical for immunodeficiency.

Postherpetic neuralgia

In some patients, the neuropathic zoster pain persists or flares up even after the rash has healed. Physicians then speak of “postherpetic neuralgia” or “postherpetic neuralgia” (PHN). In the worst case, the complaints remain lifelong. Especially in older patients with shingles this complication is feared. How exactly the pain develops, is not yet clear. In any case, the affected nerves are permanently damaged by the zoster.

These neuralgias can cause extremely severe pain. It is therefore very important to intervene as early as possible with special medication. So there is 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 bubbles of highly infectious content reaches the fingers. From there it can be distributed to the environment, such as on doorknobs or cutlery. When healthy people touch these objects and then unconsciously reach for the mouth or nose, the viruses can be transmitted.

Chickenpox vaccine

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

Shingles vaccine

Since May 2018 there has been a vaccine against shingles, which the Robert Koch Institute recommends for people over 60 years of age. It reduces the risk of developing herpes zoster. Unlike the previously used live vaccine (which has existed since 2013 and is no longer recommended for standard vaccination), it consists of killed pathogens and also contains a new enhancer. The vaccine requires two doses of the drug every two to six months, administered intramuscularly (in the humerus).

Basically, the vaccination for people over 60 years to become the standard, for people with chronic diseases such as diabetes, HIV, etc., or immunodeficiency already from 50 years. That recommends at least the STIKO. This means that even most public health insurance companies are paying the cost of the vaccine shingles take over in these cases. Anyone who wants to get vaccinated, should clear the cost before with his health insurance.