Shingles, medically termed Herpes zoster are caused by the same virus as chicken pox – Varicella zoster virus. They are characterized by one sided, severe painful lesions that heal in 2 to 4 weeks.

The lesions are often form a belt shape. This actually explains the origin of the term “shingles”– as this word derives from the Latin term for belt. (6)

Progression of symptoms of Shingles

The first symptoms are a severe burning, numbing, itching or tingling pain. It appears before the rash.

The pain is followed by a red patch and then small blisters that cluster over a small area.

The blisters contain clear fluid. They break to form small raw ulcers.

New vesicles continue to form over 3–5 days. These dry and form crusts and the scabs fall off in 2 to 4 weeks.

Rarely there is formation of scars. (1)

Which regions of the body do the symptoms of Shingles affect?

The rash may appear over the side of the torso between the spine around to the front of the abdomen or chest.

It may affect the face, forehead, eyes and ears as well.

When painful rash occurs around ears, the condition is called Ramsay Hunt syndrome.

Other symptoms of Shingles

Other symptoms are (1, 2) –

• Fever with chills
• Headache
• Tiredness
• Belly aches
• Drooping eyes
• Difficulty in moving facial muscles if face is affected
• Some lesions over the genitals
• Loss of hearing
• Loss of eye movements
• Loss of taste
• Swollen glands (lymph nodes)
• Joint pain

Symptoms of Ramsay Hunt syndrome

Ramsay Hunt syndrome is characterized by (3) –

• Painful lesions over and within the ears. This could affect the ear canal, eardrum and earlobe. There may be rash over the tongue and roof of the mouth (palate) as well as paralysis of facial muscles.
• Loss of hearing on one side
• Vertigo or dizziness
• Facial paralysis leading to difficulty in shutting one eye, difficulty in speaking or eating, and single sided facial droopiness, difficulty in forming facial expressions etc.

Possible complications of Shingles

Postherpetic neuralgia is a common complication of shingles. In this the pain persists in the area where the rash was present after the rash has resolved.

The pain may last for more than 30 days or more than 6 months after rash had begun in the area.

The neuralgia may last for weeks, months and even years. The pain can be severe and affects normal living. It affects the elderly more often than the young. (4)

The stages of Shingles symptoms

The stages of shingles thus are (5) –

1. Prodromal stage – this occurs before the rash appears. This is characterized by burning, itching or tingling numbness. This can last several days or weeks before the rash appear. This may accompanied by fever, chills and flu like symptoms and swelling of lymph nodes.
2. Active stage – At this stage the rash and blisters appear. Clear fluid filled clustered blisters appear. The clear fluid may become cloudy after 3 to 4 days. Crops of rash appear for initial 3 to 5 days. These break open and ooze finally forming dried crusts. The rash heals in 2 to 4 weeks.
3. Postherpetic neuralgia – This is a long term condition after shingles much after the rash has disappeared. There may be burning, stabbing or dull pain over the area sometimes persisting for years. The area shows extreme sensitivity to touch.

Shingles and the eyes

If the eyes are involved in the condition there may be consequences and complications.

Sometimes the eye lesions may get a secondary bacterial infection. This is usually caused by Staphylococcus aureus and less commonly due to group A beta hemolytic streptococcus.

There may be paralyses, pneumonitis (affecting the lungs), hepatitis (affecting the liver), acute retinal necrosis (killing the cells of the retina at the back of the eyes destroying vision). (4)