What are shingles symptoms?
Depending on the nerves involved, shingles can affect many parts of the body. The first symptom is often extreme sensitivity or pain in a broad band on one side of the body. The sensation can be itching, tingling, burning, constant aching, or deep, shooting, or lightning bolt pain. Typically, 1-3 days after the pain starts, a rash with raised, red bumps and blisters erupts on the skin in the same distribution as the pain. They become pus-filled, then scab over by 10-12 days. The rash disappears
as the scabs fall off in the next 2-3 weeks, and scarring may result.
After an attack of chickenpox, the varicella-zoster virus retreats to nerve cells in the body, where it may lie dormant for decades. But under certain conditions, usually related to aging or disease, the virus can reactivate and begin to reproduce. Once activated, the virus travels along the path of a nerve to the skin's surface, where it causes shingles. Shingles' symptoms may be vague and nonspecific at first. People with shingles may experience numbness, tingling, itching, or pain before the classic rash appears. In the pre-eruption stage, diagnosis may be difficult, and the pain can be so severe that it may be mistaken for pleurisy, kidney stones, gallstones, appendicitis, or even a heart attack, depending on the location of the affected nerve.
The first sign of shingles is usually pain, which may be severe, in the areas of one or more sensory nerves, often where they emerge from the spine. The pain may be just in one spot or it may spread out. The patient usually feels quite unwell with fever and headache. The lymph nodes draining the affected area are often enlarged and tender. Within one to three days of the onset of pain, a blistering rash appears in the painful area of skin. Sometimes, especially in children, shingles is painless. It starts as a crop of closely-grouped red bumps in a continuous band on the area of skin supplied by one, occasionally two, and rarely more neighbouring spinal nerves. New lesions continue to appear for several days, each blistering or becoming pustular then crusting over. Shingles occasionally causes blisters inside the mouth or ears, and can also affect the genital area. The pain and general symptoms subside gradually as the eruption disappears. In uncomplicated cases recovery is complete in 2-3 weeks in children and young adults, and 3 to 4 weeks in older patients. Occasionally pain is not followed by the eruption - shingles "sine eruptione". The chest (thoracic), neck (cervical), forehead (ophthalmic) and lumbar/sacral sensory nerve supply regions are most commonly affected at all ages but the frequency of ophthalmic shingles increases with age. Rarely the eruption may affect both sides of the body. In elderly and undernourished patients the blisters are deeper. Healing may take many weeks and be followed by scarring. Muscle weakness arises in about one in twenty patients because the muscle nerves are affected as well as the sensory nerves. Facial nerve palsy is the most common result. There is a 50% chance of complete recovery and in time some improvement can be expected in nearly all cases.
Post-herpetic neuralgia is defined as persistence or recurrence of pain more than a month after the onset of shingles. It becomes increasingly common with age affecting about a third of patients over 40 and is particularly likely if there is facial infection. The pain may be continuous and burning with increased sensitivity in the affected areas, or a spasmodic shooting type, or, rarely, of an itchy, crawling variety. The overlying skin is numb or exquisitely sensitive to touch. Sometimes, instead of pain, the neuralgia results in a persistent itch (neuropathic pruritus).