Chickenpox & Shingles

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Overview

Chickenpox (varicella) and shingles (herpes zoster) are distinct diseases caused by the varicella-zoster virus (VZV). The VZV is a herpesvirus.

Chickenpox is a highly contagious rash that usually occurs in childhood. It is the manifestation of a primary infection. Shingles is usually a localized, unilateral (occurs on one side of the body) eruption that follows a linear pattern along a nerve. Shingles is a reactivation of a dormant varicella-zoster virus.

Causes

Approximately 90% of chickenpox cases occur in children under 10 years of age. The infection is usually transmitted by airborne droplets containing the virus. Less often, the virus is spread by direct contact with the blisters. After exposure, the typical incubation period is 2 weeks. One is contagious a couple of days before the rash appears. Rarely, chickenpox is transmitted through the blood of an infected mother to a fetus.

Shingles cannot be acquired from another person. Shingles is caused by reactivation of the dormant virus. While shingles can occur at any age, more than two-thirds of cases occur in people over 50 years of age. Shingles is 20 to 100 times more common in immune compromised individuals, such as HIV patients and the elderly, as well as those whose immune systems are suppressed by medication or chemotherapy. An individual who has never had chickenpox could develop the infection by coming into contact with shingles blisters.

Signs and Symptoms

In young children, the illness usually begins with rash, a low-grade fever, and general malaise. In adults, a fever, chills, malaise, headache, and possibly, sore throat appear 2 or 3 days before the rash. The infection is usually more severe in adults.

The rash appears first on the face and scalp, then on the trunk, and then on the arms and legs. The very itchy blisters initially appear like water drops on a pink base. New blisters appear as older ones form scabs and heal. The scabs resolve in 1 to 3 weeks, usually without scarring. Once all the lesions are crusted over, one is no longer contagious. Complications are rare. They can include pneumonia and involvement of the nervous system.

The first symptoms of shingles (zoster) are usually pain, burning, and discomfort in the area of nerve distribution. This can vary from mild to severe and generally precedes the eruption by several days. The rash is usually seen as a bandlike eruption on one side of the body. Redness is first seen in the area followed by bumps that rapidly become water blisters that become pus filled. The lesions scab over and heal in about a week. Persistent, severe pain after the rash has subsided, called postherpetic neuralgia, occurs in 10% to 15% of cases and is common in the elderly.

Diagnosis

Chickenpox and shingles are diagnosed by clinical examination and symptoms. Although not routine, definitive diagnosis of varicella-zoster virus can be obtained by culturing infected cells.

Treatment

Treatment options for shingles include oral medication such as valacyclovir (Valtrex®) and famciclovir (Famvir®). For severe infections and in immunosuppressed patients, intravenous medication may be administered in the hospital.

With chickenpox, an important part of treatment is symptomatic relief from itching. Calamine® or similar anti-itching lotions can be applied. Oatmeal baths and aloe vera gel offer some relief. Refrigerating the lotions can aid relief because the cool sensation helps control the itching. It is important to keep fingernails short, especially in young children, to minimize potential scarring and secondary bacterial infection from scratching.

Initiating oral treatment within 72 hours of the onset of shingles can minimize pain and shorten the course of the outbreak. Sometimes pain medication is prescribed.

Although the drugs used to treat shingles can lessen the severity and duration of the condition, approximately 20% of patients diagnosed with shingles later develop a painful chronic condition called postherpetic neuralgia (PHN).

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