Infectious diseases specialists diagnose and treat infections from bacteria, viruses, fungi, and parasites, focusing on fevers, antibiotics, and vaccines.
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Shingles, also known as Herpes Zoster, is a localized reactivation of the Varicella-Zoster Virus (VZV), which targets nerve tissue. At Liv Hospital, shingles is seen as more than just a skin rash; it is a disorder involving both the nerves and skin, caused when the immune system can no longer keep the virus inactive. Shingles usually affects only one side of the body and is limited to a single dermatome, which is an area of skin served by one spinal nerve. This condition happens after the initial VZV infection, which is chickenpox.
Shingles develops because the virus stays in the body after a person recovers from chickenpox, usually in childhood. Instead of leaving, the virus moves from the skin to nerve clusters near the spine or in the head, where it remains inactive for years. During this time, the virus is hidden from the immune system. Shingles happens when the balance is disturbed, often many years later, and the virus becomes active again, travels along the nerve, and causes a new infection in the skin.
A key part of understanding shingles is how the virus becomes active again. The immune system, especially T-lymphocytes, keeps the virus trapped in the nerve clusters. As people get older, their immune system weakens, making it harder to control the virus. When the immune system drops below a certain level, the virus can reactivate.
Shingles is common worldwide, with about one in three people developing it at some point. The risk increases sharply after age 50 as the immune system weakens. Unlike chickenpox, which often comes in outbreaks, shingles appears randomly. The disease causes not only short-term illness but also long-term problems, especially Post-Herpetic Neuralgia (PHN), a lasting pain that can continue after the rash is gone.
Doctors also define shingles by its different forms, depending on which nerve area is affected.
How severe shingles becomes depends on the person’s immune system. In healthy people, the virus usually stays in one area. In people with weak immune systems, the virus can spread through the blood to many skin areas or even organs like the lungs, liver, or brain. This widespread infection is much more dangerous and is treated very carefully at Liv Hospital.
A full understanding of shingles must include Post-Herpetic Neuralgia (PHN), which is pain that lasts more than 90 days after the rash starts. This pain changes from being caused by tissue injury to being caused by nerve damage. The virus makes the nerves overly sensitive and changes how pain is felt in the spinal cord. For many older adults, PHN is the most serious part of shingles, often causing poor sleep, less social activity, and a lower quality of life.
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The same virus causes chickenpox and shingles, the Varicella-Zoster Virus (VZV). Chickenpox is the “primary infection” that usually occurs in childhood. After a person recovers from chickenpox, the virus does not leave the body; instead, it goes to sleep (becomes latent) in the nerve roots near the spine. Shingles is the “reactivation” of this sleeping virus, usually decades later, when the immune system weakens.
No, shingles is not caused by a new or different strain of the virus. It is the reactivation of the endogenous virus that has been living inside the patient’s body since they had chickenpox. Molecular analysis confirms that the virus causing a patient’s shingles is identical to the VZV strain acquired during the patient’s initial chickenpox infection.
Shingles appears on only one side of the body because the virus lies dormant in the dorsal root ganglia, which are paired nerve clusters located on either side of the spinal cord. Each ganglion supplies a specific strip of skin (dermatome) on only the left or right side. When the virus reactivates in a particular ganglion, it travels down the corresponding nerve fibers to that side, respecting the body’s midline.
Yes, significant physical or emotional stress can act as a trigger for shingles. Stress causes the body to release cortisol and other hormones that can temporarily suppress the immune system, specifically the T-cell function required to keep the VZV virus in check. This temporary dip in immunity can provide the window of opportunity the virus needs to reactivate and replicate.
A dermatome is a specific area of skin that is supplied by a single spinal nerve. It acts as a “map” on the body. The rash is the visible sign of the infection that appears within that dermatome. In shingles, the rash is the physical manifestation on the surface, while the dermatome defines the boundaries and location of where that rash will appear.
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