By Chinedu Akpa. B. Pharm. Freelance Health Writer. Medically reviewed by: A. Odutola, MB.BS. PhD. FRCSEd.
Fluid-filled shingles blisters on the right torso of a black man
Shingles is a painful skin infection caused by a germ (virus). The virus that causes shingles is the varicella zoster virus - the same virus that causes chickenpox. After getting and recovering from chickenpox as a child, the virus remains in your body for the rest of your life. Many years later in your adulthood, the virus may become active and cause shingles.
This article aims to educate you about the cause, symptoms and signs, diagnosis, treatment and prevention of shingles.
Shingles also known as herpes zoster is a non-life threatening but painful viral disease that occurs as a result of the reactivation of varicella zoster virus (VZV), the virus that causes chickenpox). [1]
How shingles occur. Click on image to enlarge.
When someone has a VZV infection, they develop chickenpox which typically occurs in childhood. However, when chickenpox heals, the virus remains dormant in the nerve cells of the body, and after years of inactivation it can reoccur as herpes zoster virus commonly called shingles. [1]
Although this disease can affect any age, the elderly and those with weakened immune systems are mostly affected. [1] It's an uncommon disease in those who are vaccinated against chickenpox and those who maintain a high immune system.
Most of the data about the prevalence of shingles around the world come from Europe and America as data from Africa is either scanty or non-existent. [1]
Globally, every year there are about 4.2 million cases of VZV infection, which result in admissions into the hospital or death. [1] In high income countries, 13-16 cases of the virus were reported annually for every 1000 people before the use of vaccines. Among those mostly affected were children aged 1-9 years. [1] However, in tropical regions like Africa primary infection of the virus tends to occur at a later age, thereby resulting in a higher population of vulnerable adults and potentially leading to a more severe form of the infection.
The occurrence of infection shingles tends to increase with age, as people over 50 years are more susceptible. In effect, more than half of those over 85 years have experienced shingles in their lifetime. [1]
Although there is little information on the prevalence of varicella in Africa, it is believed that the continent will have a higher incidence of shingles than other continents because it is the epicenter of HIV worldwide [2] and because people living with HIV are 12–17 times more likely to get herpes zoster. [1]
Studies from Europe and America show that about 3% of those with zoster are usually hospitalized with about 0.25 deaths per 1 million people, mostly among the aged population. [1]
Certain conditions can increase your risk of shingles. They include the following: [3]
The different stages of shingles infection make it possible to monitor the progression of the disease and allow you to act promptly.
There are three stages that include: [3]
The dormant chickenpox virus (varicella-zoster) resides in the cranial and spinal ganglia, which are clusters of sensory nerve cells that connect the body to the spinal cord. When reactivated—often due to a weakened immune system or other factors—the virus travels along specific nerves from the spinal cord to the skin. Since these nerve cells carry sensory information, the area of skin innervated by the affected nerve typically develops symptoms of shingles, which include:
Other symptoms may include:
To diagnose shingles, your physician will typically make enquiries into your medical history and questions such as your complaints (symptoms), past history of illnesses, including chickenpox, etc., would be asked. They may then proceed by taking a close look at the rash or blisters to distinguish it from other skin diseases. If there are any doubts about the cause of the rash, your physician will scrape a portion of the fluid-filled blister and send it to the laboratory to be examined. The zoster virus is usually contained in these blisters.
The symptoms and appearance of shingles rash can sometimes resemble other skin health conditions. This can cause a bit of confusion for the physician. Diseases whose symptoms resemble shingles and need to be differentiated from shingles are:
Shingles can lead to serious complications if poorly treated or left untreated. This virus has the ability to migrate to different parts of the body, resulting in various health issues. Below are some of the potential complications of shingles: [3]
When clear shingles blisters or rash are seen around the ear in someone with total paralysis (weakness) of muscles of one side of the face, a neurological disorder known as Ramsay Hunt Syndrome (RHS) is diagnosed. The condition may also be associated with hearing and balance difficulties.
Shingles can affect the nerves in the mouth, leading to oral lesions. These lesions can occur alone or alongside the typical skin symptoms. Untreated oral involvement may contribute to additional complications such as gum disease, tooth damage, and pulp necrosis (death of the tooth’s soft tissue).
When the herpes zoster virus affects blood vessels of the skin, they cause inflammation and produce small palpable bumps (purpura).
Shingles affecting the nerves supplying the eye can result in ocular shingles, which occurs in up to 10-25% of cases. Complications include:
Shingles can also spread to the brain and cause increased risk of:
Related: Shingles in Africans: Treatment and Prevention
Published: January 4, 2025
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