Shingles

Shingles is an infection caused by the varicella-zoster virus, which commonly affects people over 50. Patients typically first come into contact with the virus during childhood when they develop chickenpox. Once the illness resolves, the virus can remain dormant in nerve endings or ganglia and reactivate when the immune system is weakened.

Its characteristic clustered blisters, arranged in a belt-like pattern (zoster in Greek) along the affected nerve, have led to the common name shingles.

Since it is a contagious disease, direct contact with the lesions of an infected individual can transmit the virus to unvaccinated individuals or those who have never had chickenpox.

In most cases, shingles resolves on its own within one to two weeks without the need for specific treatment, as it is a viral infection.

Symptoms

The most characteristic symptoms of shingles include:

• A skin rash consisting of small, clustered vesicles, usually on the torso or lower back.
• Pain, itching, or burning sensation in the skin, often appearing a few days before the blisters.
• Crusting over of the lesions approximately four to five days after they form.

Some patients may also experience:

• Vision disturbances in rare cases where the virus affects the optic nerve.
• Sensitivity to light.
• Fever.
• Headache.

Causes

Shingles is caused by the varicella-zoster virus, which remains in the body after a person has had chickenpox. The reasons why the virus remains dormant and later reactivates are still unknown.

Risk Factors

Several factors increase the risk of developing shingles:

• Having had chickenpox in the past.
• Being over 50, especially over 80 (the risk triples).
• Having a weakened immune system.
• Being physically weak or extremely fatigued.
• Taking certain medications, such as long-term corticosteroids.

Complications

In most cases, shingles does not cause complications and resolves on its own within a few days. However, some patients may develop:

• Postherpetic neuralgia: Persistent nerve pain that can last for years.
• Blindness, if shingles affects the eye (herpes zoster ophthalmicus).
• Hearing loss, vertigo, or facial paralysis if the virus impacts the facial nerve.
• Neurological and vascular complications, which may lead to a stroke.
• Meningitis.
• Encephalitis.

Prevention

The best way to prevent infection and reduce the risk of complications is vaccination against the varicella-zoster virus. In Spain, children receive their first dose at 15 months and a second dose at 6 years old. If not vaccinated in childhood, immunity can be acquired between the ages of 4 and 59 with two doses spaced at least one month apart.

Additionally, all Spanish autonomous communities offer shingles vaccination for high-risk groups. Although there are some regional differences, the general guidelines are:

From age 18:

• Solid organ transplant recipients or those awaiting a transplant.
• Patients undergoing anti-JAK therapy.
• Individuals with HIV.
• Those with malignant hematologic disorders.
• Patients with rheumatoid arthritis.
• Patients undergoing chemotherapy for solid tumors.
• Individuals with recurrent shingles (two or more episodes).

From age 50:

• Patients receiving immunosuppressive or immunomodulatory treatments.
• Systematic vaccination of all adults over 65, starting with those over 80.

Which Doctor Treats Shingles?

Shingles is diagnosed and treated by specialists in family medicine, geriatrics, or infectious diseases.