First the good news: Only those who have had chickenpox before can later develop shingles, i.e. herpes zoster. Because shingles is a reactivation of the chickenpox pathogen, the varicella-zoster virus. After the chickenpox infection, they have retreated into nerve knots (ganglia) in the nerves of the spine and cranial nerves, so they remain latent in the spinal cord. The bad news is that around one in three gets herpes zoster, with the risk increasing with age.
The risk of shingles increases for 2 reasons:
1. Almost all of today’s over 50-year-olds had chickenpox in their childhood, i.e. they have carried the inactive varicella in the ganglia on the spine for decades.
2. The higher the age, the weaker the immune system becomes. Under certain circumstances, you can no longer keep the viruses in check. The pathogens become active and migrate from the nerve node along the nerve fibers back to the surface of the skin. Although the viruses lie dormant in many nerve nodes, reactivation usually only takes place in one or a few neighboring ones. Accordingly, a nerve fiber or some are affected by the reinfection.
Only the acute symptom of shingles is noticeable
Herpes zoster has two stages of the disease, an acute and a prodromal stage, i.e. an early stage: in the acute stage, the rash typical of herpes zoster occurs. The reactivated viruses reach the surface of the skin along the nerve fibers, form red blisters that itch and burn, fill with fluid, mature, then burst open, become crusted and then heal.
The rash is – unlike in the case of large-scale chickenpox, which spreads over the entire body – mostly limited to a limited region. This is the area of skin (dermatome) that is supplied by the affected nerve fibers. Depending on where the rash occurs, the dermatome can be used to determine which nerve and nerve node is involved.
Don’t overlook the early symptoms of shingles
When the rash appears, it’s high time for treatment. The special antiviral medication must then be taken within the first 72 hours, otherwise it will no longer work optimally. Otherwise there is a risk of complications and secondary diseases, especially post-herpetic neuralgia. This is sometimes severe pain that can torment the affected skin region and nerve fibers for months or years.
Therefore, pay attention to symptoms that appear in the early stages, i.e. before the rash, and if in doubt talk to your doctor about it.
Up to about a week before the blisters appear, the following are possible:
- Significant tiredness and poor performance
- light fever
- lymph node swelling
- Pain that can be quite severe and runs from the back to the front, i.e. in the affected area. This nerve pain arises on the path of the virus on the nerve fibers because the pathogens can damage the nerves. Many sufferers describe this pain as burning, sometimes very severe.
Two to three days before the blisters form:
- The skin area is suddenly sensitive to touch, some compare it to the feeling of brushing past stinging nettles. These sensitivity disorders can be very different.
- The skin area can tingle, sting, itch
- The area of skin reddens, is slightly raised, and then the blisters form – it’s high time to see a doctor.
Symptoms of shingles either on the right or left
The signs of touch sensitivity and then the rash are always unilateral. It is typical of shingles that nerves are only affected on one side of the body. The pain and rash therefore run from the back sideways to the abdomen, like a belt, hence the name shingles. Starting from the back, the nerve fibers always run in one half of the body and, to put it simply, do not grow all around. So the complaints never go beyond the central axis of the body. This is the sternum in front and the spine in back.
Usually one breast or the upper abdominal area is affected on one side, sometimes the back as well. The streaky rash can also appear on an arm or leg, or on one side of the head.
It can take up to four weeks from the early symptoms to the healing of the blisters. However, the first signs of this reinfection are not known to many. Above all, however, the inexplicable pain and the unpleasant sensory disturbances in a limited area of the body on one side should be a warning sign. This is especially true for people over 50 who have had chickenpox in the past and have not been vaccinated against herpes zoster.