Shingles (ring of fire, herpes zoster)

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What is it about ?

Shingles, also known as fire belt or herpes zoster, is a belt-like rash that appears on one half of the body, on the rib cage, trunk, or face, and rarely on the body. the members. The cause of this rash is the chickenpox virus. This virus, after chickenpox, can indeed take refuge in certain nerve cells responsible for sensation (sensory neurons), remain there ‘dormant’ for many years, and reactivate under certain circumstances. The virus then causes inflammation of these nerve pathways. Herpes is contagious. The risk of shingles is highest after the age of 60.

What is its frequency?

In Belgium, each general practitioner sees an average of 5 new cases of shingles per 1,000 patients seen per year. The number of new cases increases with age: from minus 2 per 1,000 before the age of 50 to 11 per 1,000 after the age of 80.

How to recognize it?

A few days before the rash appears, a burning sensation, pain or itching may be felt locally. Then come the red pimples and blisters (vesicles), on one half of the body, in the rib cage, trunk or face. During the flare-up, you may also have a flu-like condition and a mild fever. Pimples and blisters may continue to multiply for a week. Then they dry out and form scabs. Healing usually occurs after 1 to 2 weeks and does not leave scars. Often the skin remains slightly colored for a while.

Pain may persist for several months after infection (postherpetic neuralgia). This is caused by inflammation of the affected nerve.

If you develop shingles on your face, your eye may also become inflamed: it turns red and partially loses sensitivity, affecting your ability to see (visual acuity).

How can the doctor recognize it?

Most often, you will know if you have ever had chickenpox. But, even if you don’t know it, your doctor can diagnose shingles based on your complaints and the characteristic appearance of the lesions. Additional tests are not usually necessary unless the eye is affected (herpes zoster ophthalmic). In this case, an eye doctor (ophthalmologist) should be consulted.

What can you do ?

Usually shingles heals on its own and does not require special treatment. You can take showers and baths as usual. If you have blisters, dry yourself by dabbing your skin without rubbing. Do not rub or scratch them under any circumstances, as the virus is locked in the fluid they contain and can pass chickenpox to people who have not yet had it. Strict hand hygiene is therefore essential. Open blisters can be disinfected.

What can your doctor do?

Who to treat?
The doctor will prescribe treatment for people with weakened immune systems (immunocompromised people) or who are at risk of complications, for example with AIDS or treatment with cancer medicines or cortisone.

Shingles affecting the face is associated with a risk of eye damage. You will be referred to an ophthalmologist for a check-up.

In some people, the disease is often more serious. These are, for example, people over 60 and diabetic patients. In people at risk, treatment should preferably be started within 3 days of the onset of the disease.

What treatment?
In patients at risk, the doctor will prescribe antiviral drugs to be taken for 7 days. Aciclovir 800 mg 5x / day or valaciclovir 1g 3x / day. After this treatment, the skin lesions will not yet have disappeared, but the proliferation of the virus is stopped. The treatment also decreases the duration of the disease.

People with severe immunosuppression sometimes receive this infusion therapy. This infusion treatment is performed in the hospital.

Creams are not very effective.

In case of pain during the flare-up of the disease, paracetamol is the first choice.

If the pain persists after the outbreak, drugs that act specifically on nerve pain (neuralgia) will be offered: these are certain antidepressants or certain antiepileptics.

For those at risk, there is a vaccine that reduces the likelihood of developing shingles and postherpetic neuralgia.

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