Most healthy individuals make an uneventful recovery. Although it's difficult to resist scratching the itchy rash, it is best to keep hands off, to prevent a bacterial infection that may require antibiotic treatment. After an infection, the skin may be left with significant scarring, which may be serious enough to require plastic surgery.
Another complication, Ramsay Hunt syndrome, occurs when the varicella-zoster virus spreads to the facial nerve, causing facial paralysis, intense ear pain and vesicles in the auditory canal and outer ear structures (auricle). The rash might appear on the outer ear, inside the ear canal, on the soft palate (part of the roof of the mouth), or around the mouth and on the face, neck, and scalp. The hearing loss, vertigo, and facial paralysis that may result are usually, but not always, temporary.
Occasionally, the rash will appear as a single spot or cluster of spots on the tip of the nose. This symptom is called Hutchinson's sign. The ophthalmic nerve is often involved and the eye may become affected, causing temporary or permanent blindness. If the eye is affected (ophthalmic herpes) or looks like it may become affected, an eye specialist (ophthalmologist) should be consulted.
Shingles is a serious threat to immunosuppressed individuals - for example, those with HIV infection, individuals who are receiving cancer treatments and those that have received organ transplants. In those whose immune systems are extremely weakened, the varicella zoster virus can also spread to the internal organs and affect the lungs, central nervous system and the brain, possibly leading to death.
Although viral diseases can't be cured, doctors can prescribe oral antiviral medications, such as Zovirax® (acyclovir), Famvir® (famciclovir) and Valtrex® (valacyclovir), that help control the infection by hindering reproduction of the virus in the nerve cells. Antiviral drugs may also help prevent the painful after-effects of shingles known as postherpetic neuralgia or PHN. Other treatments for PHN include steroids, antidepressants, anticonvulsants, and topical agents.
To relieve pain, the doctor may recommend over-the-counter analgesics (pain-relieving drugs), such as ibuprofen and naproxen, or prescription drugs, such as indomethacin, all members of a class of medications known as nonsteroidal anti-inflammatory drugs. Acetaminophen is also commonly used to relieve the pain. If pain is severe, doctors may add stronger analgesics, such as codeine or oxycodone. If any of the blisters become infected it may take longer for the site to heal. Infections may be treated with antibiotics, in the form of a cream, or taken by mouth.
In the case of ophthalmic herpes zoster, treatment is likely to involve specific anti-viral eye drops, and possibly treatment by mouth as well. In the event of long-lasting pain (PHN), a pain specialist could be consulted.
In the Shingles Prevention Study, half of the participants were assigned a single injection of the zoster vaccine and the other half a placebo vaccine. Neither the researchers nor the participants knew who received vaccine and who received placebo until after the study was over. During an average of more than three years of follow-up, the vaccine reduced the incidence of shingles by 51 percent: 642 cases of shingles occurred among those in the placebo group compared with only 315 in the vaccinated group. Among all vaccine recipients, the total burden of pain and discomfort due to shingles was 61 percent lower than in placebo recipients.
Zoster vaccine reduced the incidence of shingles by 63.9% in subjects aged 60 - 69 years of age and 37.9% in people aged 70 years or older.
Refer the service member to a health care provider for evaluation for special consideration of the chickenpox vaccine (not shingles vaccine).
Remember Shingles cannot be passed from one person to another. However, the virus that causes shingles (VZV) can be spread from a person with active shingles to a person who has never had chickenpox through direct contact with the rash. The person exposed would develop chickenpox, not shingles. The virus is not spread through sneezing, coughing or casual contact. A person with shingles can spread the disease when the rash is in the blister-phase. Once the rash has developed crusts, the person is no longer contagious. A person is not infectious before blisters appear or with PHN (pain after the rash is gone).
The Immunization Action Coalition http://www.vaccineinformation.org
Immunization Healthcare Branch http://www.vaccines.mil