Remember that chickenpox virus you had as a child? The shingles rash you now have may be a reactivation of that same virus which has remained in your body. Although shingles can sometimes be painful, there are certain medications and even some home remedies that can make you more comfortable until the rash resolves. By understanding what happens when you have shingles, you can take steps to make this “second time around” less discomforting than the first.

What causes shingles?
Shingles, also known as herpes zoster, is an infection caused by the varicella-zoster virus–the same virus that causes chickenpox. Herpes zoster is caused by the activation of the chickenpox virus that remained in your body since you had chickenpox, perhaps as a child. Some patients mistakenly believe that “nervousness” cause shingles. Although the precipitating cause for activation of the herpes zoster is not well known, it is believed to be related to the stress of an infection in the same area or surgical manipulation, radiation, or other trauma.

How can I tell if I have shingles?
Before the appearance of the shingles rash, you may have a slight fever and feel mildly fatigued. Because shingles involves infection of a nerve, you may experience some stinging, burning or pain even before the rash appears; however, this is sometimes mistaken for the pain of an ulcer, heart attack, ruptured disk, or other disease. The fever will subside at about the same time as the rash breaks out. The rash begins as red patches; these develop into blisters within 24-48 hours. The blisters may remain small or in some cases, become enlarged. These blisters may continue to appear for several days and last for 1-2 weeks.

As shingles progresses, it is usual for these blisters to fill with pus and turn from blisters into pustules within 48-72 hours. They will then go on to crust, scab, and heal. As long as you do not open or puncture them, they should not become infected and will heal on their own.

The rash appears most commonly on the trunk and the back, in a band-like distribution. In some cases, however, shingles may affect the eye and the face, and blisters may appear on the tip of the nose; if this occurs, you should see your doctor immediately so that medication to prevent spreading of the blisters can be administered.

Does the shingles rash itch?
Initially, the shingles rash may sting or burn, but as the vesicles dry up after 1-2 weeks, you may experience some itching. As long as there is blistering or crusting of the vesicles, compressing the blisters with a modified Burow’s solution (using Domeboro powder packets or an effervescent tablet diluted in water) for 30 minutes four times a day may make you more comfortable. Stop the compresses when the blisters have dried up. Be sure to treat your rash gently. Don’t open your blisters; this could lead to secondary bacterial infection. After a week or two, when the crusts and scabs are separating, your skin may become dry and cracked. If that happens, you may want to rub on a small amount of white petroleum (plain Vaseline) three or four times a day for relief.

Is shingles contagious?
If your doctor tells you that you have shingles, you do not need to quarantine yourself; contact with healthy adults who have had chicken pox is usually safe. Until your rash has healed, however, you should keep away from persons who have never had chickenpox, who are ill, or who are unable to fight infection because of a disease or medication. These people are most susceptible to the varicella-zoster virus and may develop more severe cases of shingles. Also, avoid contact with small children or infants, because they can catch chickenpox from someone who has the shingles virus.

How long will the discomfort last?
This differs from patient to patient and depends on the severity of the virus and on your body’s ability to fight the infection. In most patients, the pain and discomfort last for a few weeks until the rash disappears. Some patients, however, complain of discomfort for months after the rash has subsided; this pain is referred to as “postherpetic neuralgia” and is described as an itching, burning or aching pain. Occasionally, it may be accompanied by attacks of sharp pain. If you continue to experience pain more than two months after the shingles disappear, or if you suffer sleep disturbances, lose your appetite, or tire very easily after the rash subsides, let your doctor know. Such prolonged clinical courses are unusual in young adults, however.

Is there any medication that can help relieve the discomfort of shingles or postherpetic neuralgia?
There are a number of medications available that have been helpful to many patients. Depending on whether you are suffering from shingles or from postherpetic neuralgia, your doctor may prescribe a pill, an ointment, a lotion, or another form of therapy that will help to relieve your feeling of discomfort.