Shingles is a painful blistering rash caused by reactivation of Chicken Pox virus. Chickenpox (varicella) is the primary infection with the virus, Herpes zoster. During this widespread infection, which usually occurs in childhood, virus is "seeded" to nerve cells in the spinal cord, usually of nerves, which supply sensation to the skin.
The virus remains in a resting phase in these nerve cells for years before it is reactivated and grows down the nerves to the skin to produce shingles (zoster). Shingles occurs sporadically. The annual incidence is about 3.4 per 1000. It is uncommon in childhood and the incidence increases with age. The sexes are equally affected. Shingles patients are infectious, both from virus in the lesions and in some instances the nose and throat. In susceptible contacts of shingles, chickenpox, sometimes severe, can occur.
The first sign of shingles is usually pain, which may be severe, and may be accompanied by fever, headache, feeling unwell and tenderness localized to the areas of one or more sensory nerves where they emerge from the spine. The pain may be sharply localized to the same area or may be more diffuse.
The time between the start of the pain and the onset of the eruption averages 1.4 days in shingles of the face and 3.2 days in trunk shingles. Closely grouped red papules, rapidly becoming blistered and then pustular, develop in a continuous band in the area of skin supplied by one, occasionally two, and, rarely more neighboring spinal nerves. Inside of the mouth can also be involved. New vesicles (blisters) continue to appear for several days.
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