Complaints & connections · borters.ch
Herpes zoster
A strip on one side, pain before the rash, and a treatment window of three days — the earlier, the less often the nerve pain stays.
Also known as: shingles · herpes zoster · varicella zoster virus · ophthalmic zoster · otic zoster · Ramsay Hunt syndrome · post-herpetic neuralgia
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
The chickenpox virus does not disappear after childhood; it withdraws into the nerve nodes beside the spinal cord and at the brain stem and lies there quietly for life. If the defences weaken — through age, a serious illness, a treatment that damps the immune system, or a longer strain — it can become active again, travel along the nerve and appear in exactly the patch of skin that this nerve supplies. From that the whole course follows: first one to five days of burning, stabbing pain, itching or oversensitive skin in a belt-shaped strip, then redness and grouped blisters in the same place, always on one side of the body only and without crossing the midline. The blisters cloud over, crust after about seven to ten days and heal over two to four weeks. An antiviral works best if it starts within seventy-two hours of the blisters appearing — that is the reason for the hurry. On the trunk the course is usually uncomplicated; involvement of the eye, the ear, the face or a course across several skin areas belongs seen to the same day. The most important late consequence is nerve pain that stays after the healing: burning, shooting, set off by the touch of clothing. It becomes more common with age and has treatments of its own that have nothing to do with ordinary painkillers. As long as the blisters weep, the fluid is catching for people who have never had chickenpox — they then get chickenpox, not shingles. Once everything has crusted, that phase is over.
Apply a cool, damp cloth or rinse with cold water; keep nails short, thin cotton gloves at night.
The antiviral works best if it starts within seventy-two hours of the blisters appearing. That holds especially with involvement of the eye or the ear and with weakened defences.
The nerve pain afterwards is the real burden of this illness. The better the pain is damped in the acute phase, the less often it stays — there are drugs of their own for that, not the ordinary painkillers.
Blisters on the tip of the nose, the lids or in the ear canal, hearing loss, dizziness or a drooping half of the face: that belongs seen to the same day, because eye and hearing nerve can be involved.
The fluid is catching for people who have never had chickenpox — above all pregnant women and people with weakened defences. A dry dressing and hand washing are enough; once everything has crusted, it is over.
Shingles before the age of fifty, more than once or across several skin areas is a reason to look at the state of the defences. That is an investigation, not an alarm.
Wide, soft clothing over the affected strip, no seams and no elastic on it. With oversensitive skin that helps more than anything applied locally.
Drying compresses and a dry dressing are right here; greasy ointments and powders hold the moisture in and favour a bacterial infection.
As long as the blisters weep: keep distance from pregnant women without chickenpox in their history, from newborns and from people with weakened defences. Once crusted, that no longer applies.
A number from zero to ten every evening, with where and what set it off. This curve shows whether the treatment is working, and it is the basis for switching in good time to a drug for nerve pain instead of taking ever more ordinary painkillers.
Blisters on the tip or the bridge of the nose show that the branch also supplying the eye is involved. Then the eye belongs looked at, even if it is not yet red and does not yet hurt.
An outbreak is one of the occasions on which a previously unknown diabetes is found. A single long-term value answers that — and it changes the prospects for healing.
The drugs that work against the lasting nerve pain make one tired and dull at the start. They are increased slowly and started in the evening — that belongs in the planning, not in the surprises.
Then it is no longer the skin but the nerve. That is the moment for a treatment of its own — from drugs against nerve pain through a plaster with local anaesthetic to a pain clinic. Waiting longer achieves nothing here.
Antivirals slow the virus multiplying. They only work if started within the first seventy-two hours after the rash — after that the multiplying is over anyway. On the nerve pain afterwards they act only indirectly, by keeping the damage smaller.
About one person in three has shingles in their lifetime, usually after the age of fifty. The rash heals in two to four weeks; nerve pain stays behind in roughly one in ten and becomes more common with age.
One to five days before the rash: burning, stabbing pain or an oversensitive patch of skin in a belt-shaped strip. During that time it is often taken for back or heart trouble.
Grouped blisters on a reddened base that do not cross the midline — trunk, face or one leg. That sharp limit to one half of the body is the identifying mark.
In some the nerve pain continues after the skin has healed: burning, shooting, set off by the touch of clothing. With age this becomes more common — and it has treatments of its own.
Blisters on the tip of the nose or the lid, a red painful eye, a visual disturbance — or blisters in the ear canal with hearing loss, dizziness and a drooping half of the face. Both belong treated the same day.
In the days before the rash the pain is taken, depending on where it sits, for a heart attack, a kidney colic, appendicitis, a slipped disc or toothache. Knowing that the skin only joins in later saves detours.
Rarely the skin stays completely silent and only the strip-shaped nerve pain appears. That is hard to recognise and is usually only placed in hindsight — but it happens, and it is no reason to take the pain less seriously.
A touch that should not hurt is felt as pain: the duvet, a shirt, the shower jet, the wind. This sign is the real burden of the late consequence — and the reason loose clothing helps more than any ointment.
People over fifty, on a treatment that damps the immune system, after a transplant, with a blood illness, under chemotherapy or with diabetes. For them the three-day window counts most.
Lymphocytes clearly below normal point to weakened defences — the most common reason the virus becomes active again at all.
An unrecognised or poorly controlled diabetes favours the outbreak, delays healing and raises the risk of lasting nerve pain. A value worth checking here.
Normal or only slightly raised in shingles itself. A clear rise speaks for the scratched skin having become additionally infected with bacteria.
The antiviral drugs are cleared through the kidney and the dose has to be adjusted when kidney function is reduced. That is the practically most important value before the prescription.
With shingles before the age of fifty, with repeated episodes or with involvement across several skin areas, this test is standard — not out of suspicion, but because the answer can be treated.
A low level is common in older people and with weakened defences. Correcting it is simple and is among the things worth doing independently of the shingles.
Low levels are common in older people and with weakened defences. Correcting it is simple, cheap and worthwhile independently of the current outbreak.
Zinc is needed for the defences and for wound healing. A lack is common in older people, with little meat and pulses, and with chronic diarrhoea.
For the nerves themselves. A lack causes sensations of its own and can overlie the nerve pain after shingles — above all under acid blockers, with metformin and with a plant-based diet.
Wound healing and the defences need building material. Anyone eating little during the painful phase loses exactly that — enough protein spread across the day belongs to the treatment.
The antiviral drugs are cleared through the kidney. Drinking enough protects it — especially in older people, in whom the feeling of thirst declines.
Often mentioned with herpes pictures. For shingles the evidence is thin; anyone wanting to try it should not do so instead of the antiviral drug, at most alongside it.
The pungent substance of chilli is used against the lasting nerve pain and is recognised for it. It burns markedly on application and never belongs on open or freshly crusted skin.
Described, including as an infusion. The available studies are small and inconsistent. Anyone considering it should discuss it as an addition and not as a replacement — and be cautious with kidney stones in the history.
Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
A lastingly raised cortisol — through longer strain or through cortisone treatment — damps exactly that part of the defences which keeps the virus in check. That is the understandable road from a hard time to an outbreak.
A high blood sugar weakens the defence cells and wound healing. That is why outbreaks are more common in diabetes, run more widely and more often leave the lasting nerve pain behind.
The idea of avoiding arginine-rich foods such as nuts and chocolate comes from laboratory work. In humans it is not established for shingles — treatment is antiviral and the first 72 hours count.
If the nerve pain lasts months appetite often suffers. Regular meals with protein keep strength up — weight loss worsens the course.
With lasting nerve pain after shingles, pain-coping methods are studied and effective. They do not change the nerve but the way the pain is handled.
Offered for shingles. There is no proof of effect against viruses in the body, and the first 72 hours are decisive for the antiviral — time counts here more than the choice of remedy.