Shingles (Herpes Zoster)
Learn more about common pain disorders, their development, and pain mechanisms.
Overview
Shingles, or Herpes Zoster, is a skin manifestation caused by the reactivation of the Varicella-Zoster Virus (VZV). More than 90% of the population contracts chickenpox (varicella) during childhood or early adulthood, thereby carrying the virus within their bodies. When the immune system weakens, VZV can no longer be suppressed, leading to the typical, often very painful, skin changes. Predominantly, older adults over the age of 60 are affected by shingles. Over 10% of patients continue to suffer from severe nerve pain for months despite the resolution of the rash.
Causes
Common causes of VZV reactivation and subsequent postherpetic neuralgia include stress, acute infections, or a weakened immune system due to chronic illness, chemotherapy, or aging. This condition involves inflammatory nerve damage caused by VZV. Early and optimal therapy reduces the risk of chronic pain disease.
Symptoms
Unlike chickenpox, the shingles rash is usually localized. Only a single, stripe- or belt-shaped skin area is affected, most commonly on the torso, shoulder, or neck. However, other body regions can also be affected. If accompanied by postherpetic neuralgia, various pain symptoms can occur in the affected (belt-shaped) skin segments. These include skin hypersensitivity to touch (allodynia) and burning, boring, electric-shock-like, or pulling pain.
Diagnosis
The diagnosis is clinical, based on symptoms and the typical appearance of the rash.
Treatment
In the acute stage with a rash, primary treatment involves antiviral medications and drying skin lotions. Concurrently, for postherpetic neuralgia, antineuropathic co-analgesics such as tricyclic antidepressants, SSNRI antidepressants, and antiepileptics are used to alleviate nerve pain. Opioids are only considered as a 3rd or 4th choice. Conversely, topical medications (creams/gels), local anesthetics (lidocaine gel/patch), and capsaicin patches (8% Qutenza®) are highly valued. Additionally, depending on the affected skin area, interventional treatments (peripheral nerve blocks, pulsed radiofrequency treatment, cryoneurolysis, spinal cord stimulation), as well as transcutaneous electrical nerve stimulation (TENS), may be considered.
Prevention
In recent years, VZV vaccination has been available, reducing the likelihood of developing shingles and the associated potential postherpetic neuralgia (PHN).
