Editing Shingles (section)

{{Short description|Viral disease caused by the varicella zoster virus}}
{{Other uses|Shingle (disambiguation)}}
{{Redirect|Zoster}}
{{Good article}}
{{Use dmy dates|date=May 2024}}
{{Infobox medical condition (new)
| name            = Shingles
| synonyms        = Herpes zoster
| image           = Herpes zoster neck.png
| caption         = Herpes zoster blisters on the neck and shoulder
| field           = [[Dermatology]]
| symptoms        = Painful rash
| complications   = [[Meningitis]], [[facial nerve palsy]], [[keratitis]], [[postherpetic neuralgia]]<ref name=Pink2015/>
| onset           = 
| duration        = 2–4 weeks<ref name=CDC2014Sym/>
| causes          = [[Varicella zoster virus]] (VZV)<ref name=Pink2015/>
| risks           = Old age, [[Immunosuppression|poor immune function]], having had chickenpox before 18 months of age<ref name=Pink2015/>
| diagnosis       = Based on symptoms<ref name=NEJM2013/>
| differential    = [[Herpes simplex]], chest pain, [[insect bite]]s, [[cutaneous leishmaniasis]]<ref>{{cite web | title=Herpes Zoster Diagnosis, Testing, Lab Methods | date=April 2022 | publisher=[[Centers for Disease Control and Prevention]] (CDC) | url=https://www.cdc.gov/shingles/hcp/diagnosis-testing.html | access-date=10 June 2022 | archive-date=3 June 2022 | archive-url=https://web.archive.org/web/20220603200709/https://www.cdc.gov/shingles/hcp/diagnosis-testing.html | url-status=live }} {{PD-notice}}</ref>
| prevention      = [[Shingles vaccine]]<ref name=Pink2015/>
| treatment       = 
| medication      = [[Aciclovir]] (if given early), pain medication<ref name=NEJM2013/>
| frequency       = 33% (at some point)<ref name=Pink2015/>
| deaths          = 6,400 (with chickenpox)<ref name=GBD2015De>{{cite journal| vauthors = ((GBD 2015 Mortality and Causes of Death Collaborators)) |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015|journal=Lancet|date=8 October 2016|volume=388|issue=10053|pages=1459–1544|pmid=27733281|pmc=5388903|doi=10.1016/s0140-6736(16)31012-1}}</ref>
}}

'''Shingles''', also known as '''herpes zoster''' or '''zona''',<ref>{{Cite web |date=2024-09-18 |title=Herpes zoster {{!}} Shingles, Varicella-Zoster, Pain Relief {{!}} Britannica |url=https://www.britannica.com/science/herpes-zoster |access-date=2024-10-26 |website=www.britannica.com |language=en}}</ref> is a [[viral disease]] characterized by a painful [[skin rash]] with blisters in a localized area.<ref name=CDC2014Sym/><ref>{{cite book | vauthors = Sivapathasundharam B, Gururaj N, Ranganathan K | chapter = Viral Infections of the Oral Cavity | veditors = Rajendran A, Sivapathasundharam B |title=Shafer's textbook of oral pathology|date=2014|isbn=978-8131238004|page=351|edition=Seventh| chapter-url = https://books.google.com/books?id=WnhtAwAAQBAJ&pg=PA351|publisher=Elsevier Health Sciences ]|access-date=11 September 2017|archive-date=17 December 2019|archive-url=https://web.archive.org/web/20191217060733/https://books.google.com/books?id=WnhtAwAAQBAJ&pg=PA351|url-status=live}}</ref> Typically the rash occurs in a single, wide mark either on the left or right side of the body or face.<ref name=Pink2015/> Two to four days before the rash occurs there may be [[paresthesia|tingling]] or local pain in the area.<ref name=Pink2015/><ref name=":1">{{Cite journal |last1=de Oliveira Gomes |first1=Juliana |last2=Gagliardi |first2=Anna Mz |last3=Andriolo |first3=Brenda Ng |last4=Torloni |first4=Maria Regina |last5=Andriolo |first5=Regis B. |last6=Puga |first6=Maria Eduarda Dos Santos |last7=Canteiro Cruz |first7=Eduardo |date=2 October 2023 |title=Vaccines for preventing herpes zoster in older adults |journal=The Cochrane Database of Systematic Reviews |volume=2023 |issue=10 |pages=CD008858 |doi=10.1002/14651858.CD008858.pub5 |issn=1469-493X |pmc=10542961 |pmid=37781954}}</ref> Other common symptoms are fever, headache, and tiredness.<ref name=Pink2015/><ref name=Dwo2007/> The rash usually heals within two to four weeks,<ref name=CDC2014Sym>{{cite web|title=Shingles (Herpes Zoster) Signs & Symptoms|url=https://www.cdc.gov/shingles/about/symptoms.html|access-date=26 May 2015|date=1 May 2014|url-status=live|archive-url=https://web.archive.org/web/20150526151203/http://www.cdc.gov/shingles/about/symptoms.html|archive-date=26 May 2015| publisher=[[Centers for Disease Control and Prevention]] (CDC) }}{{PD-notice}}</ref> but some people develop ongoing [[neuropathy|nerve pain]] which can last for months or years, a condition called [[postherpetic neuralgia]] (PHN).<ref name=Pink2015/> In those with [[Immunosuppression|poor immune function]] the [[#Disseminated shingles|rash may occur widely]].<ref name=Pink2015/> If the rash involves the eye, [[vision loss]] may occur.<ref name=CDC2014Sym/><ref name=PMID26478818>{{cite journal | vauthors = Johnson RW, Alvarez-Pasquin MJ, Bijl M, Franco E, Gaillat J, Clara JG, Labetoulle M, Michel JP, Naldi L, Sanmarti LS, Weinke T | display-authors = 6 | title = Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective | journal = Therapeutic Advances in Vaccines | volume = 3 | issue = 4 | pages = 109–120 | date = July 2015 | pmid = 26478818 | pmc = 4591524 | doi = 10.1177/2051013615599151 }}</ref>

Shingles is caused by the [[varicella zoster virus]] (VZV) that also causes [[chickenpox]]. In the case of chickenpox, also called varicella, the initial infection with the virus typically occurs during childhood or adolescence.<ref name=Pink2015/> Once the chickenpox has resolved, the virus can remain [[virus latency|dormant]] (inactive) in human [[nerve cell]]s ([[Dorsal root ganglion|dorsal root ganglia]] or [[cranial nerves]])<ref name="pmid35340552">{{cite journal | vauthors=Pan CX, Lee MS, Nambudiri VE | title=Global herpes zoster incidence, burden of disease, and vaccine availability: a narrative review | journal=[[SAGE Publishing|Therapeutic Advances in Vaccines and Immunotherapy]] | volume=10 | year=2022 | doi = 10.1177/25151355221084535 | pmc=8941701 | pmid=35340552 }}</ref> for years or decades, after which it may reactivate and travel along nerve bodies to nerve endings in the skin, producing blisters.<ref name=Pink2015/><ref name=":1" /> During an outbreak of shingles, exposure to the varicella virus found in shingles blisters can cause chickenpox in someone who has not yet had chickenpox, although that person will not suffer from shingles, at least on the first infection.<ref>{{cite web|title=Shingles (Herpes Zoster) Transmission |url=https://www.cdc.gov/shingles/about/transmission.html|access-date=26 May 2015|date=17 September 2014|url-status=live|archive-url=https://web.archive.org/web/20150506112409/http://www.cdc.gov/shingles/about/transmission.html|archive-date=6 May 2015| publisher=[[Centers for Disease Control and Prevention]] (CDC)}}{{PD-notice}}</ref> How the virus remains dormant in nerve cells or subsequently re-activates is not well understood.<ref name=Pink2015/><ref>{{Cite web |title=Researchers discover how chickenpox and shingles virus remains dormant |url=https://www.uclhospitals.brc.nihr.ac.uk/news/researchers-discover-how-chickenpox-and-shingles-virus-remains-dormant |access-date=25 April 2023 |website=UCLH Biomedical Research Centre |date=20 April 2018 |language=en}}</ref>

The disease has been recognized since [[Ancient history|ancient times]].<ref name=Pink2015>{{cite book | vauthors = Lopez A, Harrington T, Marin M | chapter = Chapter 22: Varicella  | publisher = U.S. [[Centers for Disease Control and Prevention]] (CDC) | veditors = Hamborsky J, Kroger A, Wolfe S | title = Epidemiology and Prevention of Vaccine-Preventable Diseases  | edition = 13th | location = Washington D.C. | year = 2015 | chapter-url = https://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html | isbn = 978-0990449119 | url = https://www.cdc.gov/vaccines/pubs/pinkbook/index.html | access-date = 9 January 2020 | archive-date = 30 December 2016 | archive-url = https://web.archive.org/web/20161230001534/https://www.cdc.gov/vaccines/pubs/pinkbook/index.html | url-status = live }}{{PD-notice}}</ref> Risk factors for reactivation of the dormant virus include old age, [[Immunodeficiency|poor immune function]], and having contracted chickenpox before 18 months of age.<ref name=Pink2015/> Diagnosis is typically based on the signs and symptoms presented.<ref name=NEJM2013/> ''Varicella zoster virus'' is not the same as ''[[herpes simplex virus]]'', although they both belong to the alpha subfamily of [[herpesvirus]]es.<ref name=CDC2014Over/>

[[Shingles vaccine]]s reduce the risk of shingles by 50 to 90%, depending on the vaccine used.<ref name=Pink2015/><ref name=Cun2016>{{cite journal | vauthors = Cunningham AL | title = The herpes zoster subunit vaccine | journal = Expert Opinion on Biological Therapy | volume = 16 | issue = 2 | pages = 265–271 | date = 2016 | pmid = 26865048 | doi = 10.1517/14712598.2016.1134481 | name-list-style = vanc | s2cid = 46480440 }}</ref> Vaccination also decreases rates of [[postherpetic neuralgia]], and, if shingles occurs, its severity.<ref name=Pink2015/> If shingles develops, antiviral medications such as [[aciclovir]] can reduce the severity and duration of disease if started within 72 hours of the appearance of the rash.<ref name=NEJM2013>{{cite journal | vauthors = Cohen JI | title = Clinical practice: Herpes zoster | journal = The New England Journal of Medicine | volume = 369 | issue = 3 | pages = 255–263 | date = July 2013 | pmid = 23863052 | pmc = 4789101 | doi = 10.1056/NEJMcp1302674 | name-list-style = vanc }}</ref> Evidence does not show a significant effect of antivirals or [[Corticosteroid|steroids]] on rates of postherpetic neuralgia.<ref>{{cite journal | vauthors = Chen N, Li Q, Yang J, Zhou M, Zhou D, He L | title = Antiviral treatment for preventing postherpetic neuralgia | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 2 | pages = CD006866 | date = February 2014 | pmid = 24500927 | pmc = 10583132 | doi = 10.1002/14651858.CD006866.pub3 }}</ref><ref name=":0">{{cite journal | vauthors = Jiang X, Li Y, Chen N, Zhou M, He L | title = Corticosteroids for preventing postherpetic neuralgia | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 12 | pages = CD005582 | date = December 2023 | pmid = 38050854 | pmc = 10696631 | doi = 10.1002/14651858.CD005582.pub5 }}</ref> [[Paracetamol]], [[NSAID]]s, or [[opioid]]s may be used to help with acute pain.<ref name=NEJM2013/>

It is estimated that about a third of people develop shingles at some point in their lives.<ref name=Pink2015/> While shingles is more common among older people, children may also get the disease.<ref name=CDC2014Over>{{cite web|title=Overview|url=https://www.cdc.gov/shingles/about/overview.html|access-date=26 May 2015|date=17 September 2014|url-status=live|archive-url=https://web.archive.org/web/20150516220957/http://www.cdc.gov/shingles/about/overview.html|archive-date=16 May 2015| publisher=[[Centers for Disease Control and Prevention]] (CDC)}}{{PD-notice}}</ref> According to the US [[National Institutes of Health]], the [[Incidence (epidemiology)|number of new cases per year]] ranges from 1.2 to 3.4 per 1,000 person-years among healthy individuals to 3.9 to 11.8 per 1,000 person-years among those older than 65 years of age.<ref name=Dwo2007>{{cite journal |vauthors = Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF, Gershon AA, Haanpaa ML, McKendrick MW, Nurmikko TJ, Oaklander AL, Oxman MN, Pavan-Langston D, Petersen KL, Rowbotham MC, Schmader KE, Stacey BR, Tyring SK, van Wijck AJ, Wallace MS, Wassilew SW, Whitley RJ | display-authors = 6 | title=Recommendations for the management of herpes zoster| journal=[[Clin. Infect. Dis.]]| volume=44| pages=S1–26| year=2007| issue = Suppl 1 | pmid=17143845| doi=10.1086/510206| doi-access=free}}</ref><ref name="Nair">{{cite book | vauthors = Nair PA, Patel BC | chapter =''Herpes zoster'' | title = StatPearls | via = NCBI Bookshelf | date=2 November 2021 | pmid=28722854 | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK441824/ | access-date=10 June 2022 | archive-date=10 June 2022 | archive-url=https://web.archive.org/web/20220610043425/https://www.ncbi.nlm.nih.gov/books/NBK441824/ | url-status=live }}</ref> About half of those living to age 85 will have at least one attack, and fewer than 5% will have more than one attack.<ref name=Pink2015/><ref>{{cite book | vauthors = Schmader KE, Dworkin RH | chapter = Herpes Zoster and Postherpetic Neuralgia | veditors = Benzon HT |title=Essentials of Pain Medicine|date=2011|publisher=Elsevier Health Sciences|location=London|isbn=978-1437735932|page=358|edition=3rd| chapter-url = https://books.google.com/books?id=9UuAWD2FTFsC&pg=PA358|access-date=11 September 2017|archive-date=17 December 2019|archive-url=https://web.archive.org/web/20191217053808/https://books.google.com/books?id=9UuAWD2FTFsC&pg=PA358|url-status=live}}</ref> Although symptoms can be severe, risk of death is very low: 0.28 to 0.69 deaths per million.<ref name="pmid35340552"/>