While chickenpox is seen by many as just a pesky childhood disease, it can turn into something much more serious. Many years after having a bout of chickenpox as children, adults may be surprised to find themselves coming down with a much more painful variation of the same disease.
Shingles is a condition caused by varicella zoster, the same virus that causes chickenpox. While a person who has recovered from a case of chickenpox may think his body has been completely cleared of the disease, what actually happens is that the virus moves into the body’s nerve cells and remains dormant there for years, or even decades.
Though it had been suspected for a few decades, it wasn’t until 1958 that scientists confirmed that the same virus causes both chickenpox and shingles. It isn’t clear what causes the virus to suddenly reactivate years after the original illness, but it cannot emerge from hiding unless the person’s immune system somehow becomes compromised – by aging, by severe stress, or by taking medications that suppress the immune system (chemotherapy or certain steroids, for example).
While shingles is most commonly seen in older patients, it isn’t exclusive to adults. If a pregnant woman experiences a chickenpox infection in the third trimester, for example, the baby may be born with chickenpox and may develop shingles early in childhood, while the immune system is still not fully developed. Fortunately only about twenty percent of people who have had chickenpox will develop shingles later in life – adding up to about half a million cases per year.
The raised, fluid-filled bumps that are familiar to anyone who has had a case of chickenpox don’t bear much resemblance to the red, blistered shingles rash. Because the re-activated virus emerges from nerve cells at the onset of shingles, the rash appears in long swaths on the skin associated with the specific nerve that was infected: strips along the outside of one arm but not the other, for example, or following the contour of a rib from the spine to the middle of the belly.
While it’s difficult to diagnose shingles before the rash appears, the first symptoms to appear are usually headache and fever. Soon after, the patient may begin to experience localized pain in the affected nerve: this may be anything from mild aches to excruciating stabs.
The rash may accompany this pain or follow shortly thereafter, and typically dries up and is shed from the skin within one to two weeks. The pain may last much longer, though – up to a few months. In rare cases, patients may be left with chronic pain due to nerve damage from the infection, and a few people are even left blind if the specific nerve involved happens to serve the eyes.
Like chickenpox, shingles is fairly contagious – the virus can be passed to someone else from the time the rash first begins to appear until it has finally dried up and become crusty. A newly infected person will not develop shingles right away, but rather chickenpox – no one knows why the chickenpox form of the virus is always the first to appear.
While a vaccine for shingles does exist, it is not effective once someone is already showing symptoms of the disease. By the time a shingles case is in full swing, the options for treatment are limited to antiviral drugs and pain relievers: over-the-counter drugs and ointments in mild cases, and morphine and nerve blocks if the pain is more severe.
Patients may also need to be put on a course of antibiotics: while these drugs are not effective against a virus like the one that causes shingles, opportunistic bacteria may take advantage of the broken, blistered rash to infect the skin, and this must be treated alongside the shingles infection itself.