|Also Listed As:
|| Chickenpox and Shingles;
Shingles and Chickenpox; Varicella and Herpes Zoster
Varicella-zoster virus (VZV) is known to cause two
diseases: chickenpox (varicella) and shingles (herpes zoster). Chickenpox is a
common contagious disease of children that usually has a benign course. However,
chickenpox in adults or people with weakened immune systems can have serious
complications. Second attacks of chickenpox are very rare. Shingles is caused by
a reactivation of the latent VZV. In other words, the virus lies dormant in
nerve cells in the spine and can re-emerge in the form of shingles years after
you have had chicken pox.
|Signs and Symptoms|
The typical rash of chickenpox is made up of groups of small, itchy blisters
surrounded by inflamed skin. The rash usually begins as one or two lesions,
quickly spreading throughout the body including the trunk, scalp, face, arms,
and legs. The total number of blisters varies greatly from person to person.
Over four days, each blister tends to dry out and form a scab, which then falls
off between 9 to 13 days later.
The rash is usually preceded by:
- Fever, usually low-grade
- Flu-lke symptoms
The typical rash of shingles begins as redness (erythema) followed by the
appearance of blisters that cover one concentrated area of the body on either
the face, trunk, shoulders and neck, or legs (unlike the rash of chicken pox,
which is generally diffuse, meaning that it is widespread throughout the body).
These eruptions follow the path of an infected nerve. Usually only a single
nerve is involved, confining the rash to one side and one section of the body
(called a dermatome). The trunk is the area affected in 50% to 60% of cases. The
next most common site is one side of the face, which may even involve the
tongue, the eye, or the ear.
Before the rash appears, you will have warning symptoms of pain experienced
as a sharp, aching, piercing, tearing, or burning sensation limited to the
specific part of the body where the rash appears 1 to 5 days later. That area
may also feel itchy, numb, and unbearably sensitive to touch, even just from
your clothes touching your skin in that section.
Other symptoms that you may experience include:
- Fever (not so common)
- Malaise (feeling bad overall) and other flu-like symptoms including
- Swollen lymph nodes
- Visual disturbances, drooping eyelid, loss of eye motion (if in a
nerve that affects one of your eyes or the muscles surrounding it)
- Taste abnormalities (if in a nerve that affects your tongue)
- Hearing loss (if in a nerve that affects one of your ears)
Anyone who has not had chickenpox or the vaccine, is at risk for contracting
the virus if exposed to someone with either chickenpox or shingles. The time
between exposure to the virus and appearance of symptoms (called an incubation
period) is between 10 and 20 days. The virus is spread through sneezing,
coughing, and breathing - in other words, when someone
with chickenpox sneezes or coughs, there are respiratory droplets with the VZV
virus in the air. Then, you can breathe in those infected droplets and, if you
have never had chickenpox or the vaccine, get chickenpox yourself.
Another possible way to get chickenpox, is to come into direct or indirect
(like the clothes of someone with shingles) contact with discharge from VZV skin
The virus is contagious from two days before the rash appears until all of
the lesions have crusted over.
While shingles is caused by the same virus that leads to chickenpox, the way
that you develop this painful skin lesion is quite different. After you have had
chickenpox, the virus lives in a dormant state (like it is hibernating) in nerve
cells along the spine. Later in life, when it is reactivated (usually from a
weakened immune system, aging, or other
risk factor), the virus travels down
the tract of the particular nerve where it was "hibernating", first causing the
pain and other sensations followed by the rash. The pattern or path that the
symptoms follow is called a dermatome, which essentially means the area of the
skin that the nerve supplies.
- Exposure to VZV if you have neither had chicken pox nor received the
- Age under 10
- Late winter and early spring is the most common time that the virus is
- Increasing Age
- Impaired immune system (see
- Having had chicken pox before age 1
Your health care provider will generally be able to diagnose chickenpox
easily because of its characteristic rash. If there is any doubt, however, the
doctor may take a scarping from one of your skin lesions to look at under the
microscope. This is called a Tzanck test.
Similarly, if you have shingles, it is rare that your provider needs to
perform any tests because the history of pain and other symptoms and the rash
itself are very typical. If the doctor is not certain, however, a Tzanck test
may be performed or some blood tests.
- Chicken Pox vaccine (which has been available since 1995) is given to
every child over 1 year old; if you (or your child) receive the vaccine before
age 13, then you only need one dose. If you receive the vaccine when you are
older than 13 (which may be recommended if you have not yet had chickenpox or
received the vaccine), then you should get a second dose 1 to 2 months later.
- If you have never had chickenpox or the vaccine, avoid contact with
anyone who has chickenpox and avoid contact with the skin lesions of anyone with
- To avoid spreading to others, children with chickenpox should be kept
out of school or day-care until all of the blisters have scabbed over.
- Capsaicin cream (from cayenne pepper) may help prevent post-herpetic
neuralgia, a possible complication from shingles (see
Both chickenpox and shingles generally resolve spontaneously in those not at
high risk for
complications. The goal,
therefore, is to make you as comfortable as possible while you have either
condition and to shorten the length of time that you have the pain and itching
associated with shingles in particular. Many
lifestyle approaches and
medications may be helpful for these
Mind/Body techniques for
relaxation can also help alleviate pain and reduce stress associated with
Certain measures, in the list that follows, can reduce itching from
chickenpox and its complications. The less you scratch, the less likely it is
that you will develop a secondary baterial infection of the skin (see
- Apply cool water compresses to your skin or soak in a bathtub filled
with cool water
- Add finely gound oatmeal (there are special brands sold in drugstores)
to the bathtub
- Apply calamine lotion to the affected areas of your skin
- Trim your fingernails to avoid infection
- For infants with chickenpox, try loose fitting, soft cotton or flannel
- Acetaminophen—for fever and pain reduction
- Acyclovir—this may be prescribed for children
over 2 years old and adults with chickenpox in whom symptoms are severe, for
those who are immunocompromised (see
Special Populations), and for
people with shingles
- Other acyclovir-like medications that may also shorten the course of
shingles, reduce pain, reduce complications, and/or protect you if you are
immunocompromised include famciclovir and valacyclovir. For best results, one of
these medications should be started within 24 hours of the onset of pain or
similar sensations described in the Signs and Symptoms section and before the
- Prednisone or other corticosteroids, prescribed with acyclovir, may be
used to reduce pain from shingles
- Antihistamines, like diphenhydramine, may be considered to control
itching, especially at night for children
- Tricyclic antidepressants, such as nortriptyline, amitriptyline, and
desipramine, are prescribed for post-herpetic neuralgia (pain from shingles that
persists for months after the rash has resolved; see
Prognosis and Complications)
|Nutrition and Dietary Supplements|
Because supplements may have side effects or interact with medications, they
should be taken only under the supervision of a knowledgeable healthcare
Taking lysine supplements may speed recovery time from shingles and reduce
the chance of recurrent breakouts of this skin condition. More research is
The use of herbs is a time-honored approach to strengthen the body and treat
disease. Herbs, however, contain active substances that can trigger side effects
and interact with other herbs, supplements, or medications. For these reasons,
herbs should be taken with care and only under the supervision of a practitioner
knowledgeable in the field of herbal medicine.
In certain parts of the world, herbs are the standard form of medicine for
conditions such as shingles. In an observational study in Uganda, for example,
people receiving hrebal medicine for this skin condition were compared to people
attending a clinic who received typical Western therapy. Those who were treated
by the herbal therapists with traditional medicinal herbs suffered from less
pain associated with the shingles and were less likely to have post-herpetic
Prognosis and Complications)
than those who received Western medical therapy.
Cayenne (Capsicum frutescens/Capsicum spp.)
Capsaicin cream made from cayenne pepper has very powerful pain-relieving
properties when applied to the surface of the skin. Capsaicin may help relieve
the pain of post-herpetic neuralgia (see description of this potential shingles
German Chamomile (Matricaria recutita)
Traditionally, this herb has been used to treat skin conditions and childhood
illness like chickenpox. Research on how well this herbal remedy alleviates the
symptoms of chickenpox is lacking, however. Therefore, specific recommendations
regarding effectiveness and safety of chamomile for this condition cannot be
made. An herbal specialist would be able to direct you in terms of whether it is
appropriate to try this herb and how to do so.
Peppermint Oil (Mentha x piperita)
A case report in the scientific literature suggests that applying peppermint
oil to the painful area may help relieve symptoms of postherpetic neuralgia, a
potential complicaion of shingles (see
Although not studied scientifically for VZV specifically, some herbalists may
consider one of the following herbs because either it has been used
traditionally for skin lesions or because the herb has been used for another
virus in the same group as VZV, namely herpes simplex virus. All of the herbs
mentioned below would be prescribed to be used topically for shingles or chicken
- Aloe (Aloe vera/Aloe barbadensis/Aloe ferox)
- for herpes and other skin conditions
- Burdock root (Arctium lappa) - used
traditionally for skin lesions
- Lemon balm (Melissa officinalis) -
used topically for herpes lesions
- Licorice root (Glycyrrhiza glabra) -
used traditionally for skin lesions; demonstrates activity against VZV in
test-tubes; and, glycyrrhizin (an active component derived from licorice) may
help reduce pain associated with shingles more quickly; this herb should not be
used if you have high blood pressure
- Madonna lily (Lilium candidum) -
medicinal plant used traditionally in Northern Italy for shingles
Although research results have been somewhat mixed, acupuncture may help
relieve the nerve pain associated with shingles, especially when combined with
standard medications. Acupuncturists treat people based on an individualized
assessment of the excesses and deficiencies of qi located in various meridians.
In the case of shingles, a qi deficiency is usually detected in the liver
meridian with relative excess in the gallbladder meridian. Acupuncturists will
often provide needle or moxibustion treatment (a technique in which the herb
mugwort is burned over specific acupuncture points) around painful
Although very few studies have examined the effectiveness of specific
homeopathic therapies, professional homeopaths may consider the following
remedies for the treatment of chicken pox and shingles based on their knowledge
and experience. Before prescribing a remedy, homeopaths take into account a
person's constitutional type. A constitutional type is defined as a person's
physical, emotional, and psychological makeup. An experienced homeopath assesses
all of these factors when determining the most appropriate treatment for each
- Antimonium crudum -- for irritable children who are extremely
sensitive to touch and may have a thick white coating on the tongue
- Antimonium tartaricum -- for large, slowly appearing pox
lesions accompanied by
- Mercurius -- for large, pus-filled pox which may ooze; this
remedy is most appropriate for individuals who sweat profusely and may have
enlarged lymph nodes
- Pulsatilla -- for fever associated with chicken pox; children
who tend to be whiny, clingy, and weepy but have very little thirst despite the
- Rhus toxicodendron -- for severe itching that worsens at night
and improves with warm compresses or a bath; this remedy is the most commonly
- Sulphur -- for extremely itchy lesions that worsen with heat or
bathing and which children will often scratch to the point of bleeding
- Arsenicum -- for intense burning sensation that improves with
warmth and worsens with cold
- Lachesis -- for particularly dark, sometimes purple, lesions on
the left side of the body
- Mezereum -- for burning, sharp pains that worsen with touch;
this remedy is most appropriate for individuals who are naturally chilly and
sensitive to cold
- Rananunculus bolbosus -- for lesions located on the chest or
back; pain worsens with touch and movement
- Rhus toxicodendron -- for intense itching and pain that may be
relieved by touch
The following relaxation techniques may help reduce the pain and stress
associated with shingles and its potential
- Breathing exercises
- Progressive muscle relaxation
Also, cognitive behavioral therapy can help you restructure your thinking
about the pain from feeling completely helpless to feeling like the pain is only
one negative aspect of your overall positive life.
Another practice from which people with post-herpatic neuralgia have reported
some relief is:
|Traditional Chinese Medicine|
In a case series (a type of study that observes groups of people) of 56
people with post-herpetic neuralgia (see
Prognosis and Complications
for description of this post-shingles pain syndrome), the addition of the
following traditional Chinese medical techniques to usual Western medical care
helped reduce their pain of the participants in the trial:
- Cupping (cups with suction are applied to areas of the skin to
- Chinese herbs
In addition, a traditional Chinese herb called Clinacanthus nutans
(Bi Phaya Yaw) is able to kill VZV and other herpes viruses in test
tubes. An extract of this herb has been compared to placebo in small numbers of
people with shingles. It appears that a topical form of C. nutans extract may
shorten the length of time that one has skin lesions from this condition. More
research would be helpful. In the interim, it may be worthwhile to work with a
certified Traditional Chinese physician in your area. Be sure to discuss this
with your regular doctor as well.
If you acquire chickenpox when you are pregnant, the infection may spread to
If you have a compromised immune system, shingles lesions may be widespread
rather than localized to one area of the body and it will likely take longer for
the symptoms to heal, maybe lasting for months. Conditions that compromise your
immune function include:
- Human Immunodeficiency Virus (HIV) infection
- Acquired Immunodeficiency Syndrome (AIDS)
- Organ transplant recipient on medications to avoid rejection of the
- Cancer, especially leukemia, Hodgkin's disease and other lymphomas, or
if you are receiving chemotherapy
- If you have an autoimmune disease (like rheumatoid arthritis, lupus,
multiple sclerosis, and Crohn's disease) and are taking drugs that suppress your
immune system in order to control the inflammation from any of these conditions
|Warnings and Precautions|
- Aspirin must not be used in children with chickenpox or shingles
because of risk of Reye's Syndrome which can cause liver and brain damage.
- Call the health care provider if symptoms of confusion, vomiting, or
weakness, even paralysis, of the arms, legs, trunk, or face begin during or soon
after a chickenpox or shingles infection.
|Prognosis and Complications|
While chickenpox usually goes away on its own with non-serious complications
like itching and scarring, severe and sometimes fatal infections may occur,
particularly in newborn infants, adults, and people whose immune systems are
weakened (see Special Populations just above). Such potential infections
- Encephalitis (a brain infection)
- Myocarditis (an infection of the heart muscle)
- Secondary bacterial skin infection
Shingles usually clears in 2 to 3 weeks and rarely recurs. Your chance of
getting another bout of shingles is only 1% to 5% if you have a normal, working
immune system. If you are immunocompromised (see Special Populations above),
your risk for recurrence is higher.
Potential complications from shingles include:
- Shingles lesions involving the mouth or eye; the latter may lead to
blindness if not treated.
- Post-herpetic neuralgia, which occurs in 10% to 20% of those with
shingles; this is persistent pain for months to years even after the skin
lesions have cleared up.
- Secondary bacterial skin infections.
- Encephalitis (a brain infection) or sepsis (an infection in your blood
stream, affecting many organs in the body) if you are immunocompromised.
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|Review Date: June 2003|
|Reviewed By: Participants in the review process include: Shiva Barton, ND, Wellspace,
Cambridge, MA; Jacqueline A. Hart, MD, Department of Internal Medicine,
Newton-Wellesley Hospital, Boston, Ma and Senior Medical Editor A.D.A.M., Inc.;
Dahlia Hirsch, MD, Center for Holistic Healing, BelAir, MD; Richard A. Lippin,
MD, President, The Lippin Group, Southampton, PA; Sherif H. Osman, MD,
President, Medical Staff Harford Memorial Hospital, Falston General Hospital,
Bel Air, MD; Marcellus Walker, MD, LAc, (Acupuncture section October 2001) St.
Vincent's Catholic Medical Center, New York, NY; Ira Zunin, MD, MPH, MBA,
(Acupuncture section October 2001) President and Chairman, Hawaii State
Consortium for Integrative Medicine, Honolulu,
Copyright © 2004 A.D.A.M., Inc
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