Herpes Zoster (Shingles)

Herpes Zoster is known colloquially in Singapore as 生蛇 in Mandarin , kayap in Malay and shingles in English.

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What is Herpes Zoster?

Herpes Zoster is a painful blistering skin condition caused by the same virus that causes chicken pox (Varicella Zoster Virus).

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How does one get Herpes Zoster?

After the initial chicken pox infection, the virus is not cleared but instead infects the nerves cells near the spinal cord. Subsequently the virus becomes dormant in these nerve cells (think of the virus going to sleep) and does not lead to any signs or symptoms.

During episodes of decreased immunity, for example in advanced age, stress or illness, the virus can reactivate (the virus awakens), leading to the pain and the blisters of shingles.

The rashes only affect one side of the body as they follow dermatomes, which are a single contiguous area of the body innervated by a single nerve root. However, if the eye is involved with facial shingles, one will most likely require the help of an ophthalmologist as there can be scarring of the lens of the eye and even permanent damage to vision.

Common signs & symptoms

Herpes Zoster typically starts off as a rash with red spots over an area of the skin. Within a few days, the spots will turn into blisters and over the next few weeks, pus will appear and start to crust over with eventual resolution.

In approximately 75% of cases, patients will experience pain before the appearance of the rash. The pain is commonly described as “throbbing”, “burning”, “stabbing” and might be severe enough for the need for strong pain-killers. This phenomenon is known as herpetic neuralgia.

Can it be cured?

Herpes Zoster can never be eradicated, but each episode of shingles can be treated and controlled.

Is it contagious?

Shingles is less contagious compared to chickenpox. However, it can still be spread to others, especially to susceptible patients (patients who never had chickenpox before or patients who are already ill). Patients with shingles should be wary about coming into contact with the young, the elderly or anyone who is pregnant.

Prevention & Treatment

Antiviral medications, such as Acyclovir or Valacyclovir can be given early during the disease course to reduce the length of severity of each shingles flare up. If the rashes and blisters are extensive and infected, a course of antibiotics may also be given to treat any secondary bacterial infection.
Pain-killers are also commonly given to reduce the pain associated with herpetic neuralgia. These medications can be as simple as Paracetamol to antidepressants given for herpetic neuralgia.
A vaccine (Zostavax) is available for prevention of recurrent shingles. This vaccine is indicated for patients who are older than 50 years ago and with previous herpes zoster.