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Shingles (herpes zoster virus) is an extremely painful viral infection of the nerve roots resulting in a skin rash caused by the same virus that causes the childhood illness chickenpox. The reactivated virus responsible for these conditions is called the Varicella zoster virus (VZV).

After an individual has chickenpox, the virus lives in the nervous system where it "sleeps" (is dormant) in the nerve roots. In some people, it remains dormant forever. In others, a weakened immune system can cause the virus to "wake up," reproduce, and travel along the path of the nerve fiber to the skin's surface, resulting in shingles. If the virus becomes active again, it can only cause shingles, not chickenpox.

Anyone who has ever had chickenpox is at risk for the development of shingles, although it occurs most commonly in people over the age of 60. Weakened immune systems, emotional stress, immune deficiency (from AIDS or chemotherapy), or cancer can cause the virus to reactivate. It has been estimated that up to 500,000 cases of shingles occur each year in the U.S.

Pain, itching, tingling, or burning of the skin are symptoms of shingles that often precede an outbreak. Shingles starts as small blisters on a red base with new blisters continuing to form for three to five days. The painful rash resembles the lesions of chickenpox and is usually localized to a concentrated area. If you think you have shingles, you should see a doctor as soon as possible.

The cluster of blisters fill with fluid, pop, and start to ooze. Eventually, the affected areas will crust over and heal like the rash shown here. The whole process may take three to four weeks from start to finish. Once all of the blisters are crusted over, the virus can no longer be spread.

Yes, shingles is contagious. It can be spread from an infected person to anyone who hasn't had chickenpox as long as there are new blisters forming and old blisters healing. But instead of developing shingles, these people develop chickenpox. Once they've had chickenpox, people cannot catch shingles from someone else. They do, however, have the potential to develop shingles later in life.

Generally, shingles heals well, resulting in few problems. However, on occasion, blisters can become infected and are usually treated with antibiotics. The most common complication of shingles is postherpetic neuralgia, where damaged nerves cause pain to persist even after the rash is gone. A more worrisome complication is when shingles affects the face (forehead and nose), which may spread to the eye and lead to loss of vision.

There is no cure for shingles, but treatment may help you get well sooner and prevent other problems. Bathing is permitted, and the affected area can be cleansed with soap and water. Cool compresses and anti-itching lotions (calamine lotion) may also provide relief. Steroids, antiviral medicines, and pain medicines can also help ease recovery. Most people with intact immune systems recover completely from shingles although recurrences are possible.

In 2006, the FDA approved the first vaccine for adult shingles. The vaccine, Zostavax, is approved for adults over 60 who have had chickenpox. It contains a booster dose of the chickenpox vaccine usually given to children. The single-dose vaccine is more than 60% effective in reducing shingles symptoms, and it reduces the incidence of postherpetic neuralgia by at least two-thirds. Studies are ongoing to evaluate the long-term effectiveness of the vaccine.

• Shingles (Herpes Zoster) Feature Article http://www.medicinenet.com/shingles/article.htm
• Chickenpox (Varicella) Feature Article http://www.medicinenet.com/chickenpox_varicella/article.htm
• Herpes of the Eye http://www.medicinenet.com/herpes_of_the_eye/article.htm
• Ramsay Hunt Syndrome http://www.medicinenet.com/ramsay_hunt_syndrome/article.htm
• Common Skin Rashes http://www.medicinenet.com/rash/article.htm
• Uveitis (Inflammation of the Eye) http://www.medicinenet.com/uveitis/article.htm