Shingles is very common. Fifty percent of all Americans will have had shingles by the time they are 80. While shingles occurs in people of all ages, it is most common in 60- to 80-year-olds.

Shingles is a painful skin disease caused by a reactivation of the chickenpox virus. It is distinctive because it affects only one side of the body. The early signs of shingles usually develop in three stages: severe pain or tingling, possibly itchy rash, and blisters that look like chickenpox.

The name shingles comes from the Latin word cingulum, which means "belt" or "girdle." The scientific name for the virus that causes shingles is varicella-zoster, combining the Latin word for "little pox" with the Greek word for "girdle." Another name for shingles is herpes zoster.

The virus that causes shingles is a herpes virus. Once you are infected with this kind of virus, it remains in your body for life. It stays inactive until a period when your immunity is down.

If you have had chickenpox, shingles is not contagious. Nothing will happen to you if you are exposed to someone who has shingles. If you have never had chickenpox, however, avoid contact with anyone who has shingles; the fluid from their open blisters is infectious. You will not get shingles, but you could get chickenpox if exposed.

If you have not had chickenpox and you come into contact with someone who has shingles, ask your healthcare provider whether you should get a chickenpox vaccination.

Unlike chickenpox, with shingles, the virus is NOT transmitted by someone breathing or coughing on you. You have to come in contact with the blister fluid itself. Once the blisters scab over, the contagious period is ended.

The pain of shingles can be debilitating. If it is severe and persists for months or years, it is called postherpetic neuralgia. And unfortunately, persistent pain is a common symptom in people over 60.

Outbreaks that start on the face or eyes can cause vision or hearing problems. Even permanent blindness can result if the cornea of the eye is affected.

Bacterial infection of the open sores can lead to scarring. In a very small number of cases, bacteria can cause more serious conditions, including toxic shock syndrome and necrotizing fasciitis, a severe infection that destroys the soft tissue under the skin.

The burning waves of pain, loss of sleep, and interference with even basic life activities can cause serious depression.

In patients with immune deficiency, the rash can be much more extensive than usual and the illness can be complicated by pneumonia. These cases are more serious, but they are rarely fatal.

If you are basically healthy, shingles usually goes away without complications. You are not likely to ever get it again!

More importantly, the shingles vaccine may one day make shingles a rare disease.

1. Shingles is a rare disease.

2. Shingles is sometimes called herpes zoster.

3. You can get shingles from somebody who has shingles.

4. Vision problems can be a complication of shingles.

Shingles is caused by a germ called varicella-zoster virus -- the one that gave you chickenpox when you were a child. As you recovered from chickenpox, the sores healed and the other symptoms went away, but the virus remained. It is with you for life.

The virus hides out in nerve cells, usually in the spine. But it can become active again. Somehow, the virus gets a signal that your immunity has become weakened. This triggers the reactivation.

When the virus becomes active again, it follows a nerve path called a dermatome. The nerve path begins at specific points in the spine, continues around one side of the body, and surfaces at the nerve endings in the skin. The pattern of the rash reflects the location of that nerve path.

The leading risk factor for shingles is a history of having had chickenpox. One out of every five people who have had chickenpox is likely to get shingles.

Another risk factor is aging. As we age, our natural immunity gradually loses its ability to protect against infection. The shingles virus can take advantage of this and become active again.

Conditions that weaken the immune system can also put people at risk for shingles. Shingles is especially dangerous for anyone who has had cancer, radiation treatments for cancer, HIV/AIDS, or a transplant operation.

Most cases of shingles occur in adults. Only about 5 percent of cases occur in children. With children, immune deficiency is the primary risk factor, but children who had chickenpox before they were one year old may also get shingles before they become adults.

There have been studies of adults who had chickenpox as children and were later exposed to children who had chickenpox. Interestingly, that exposure apparently boosted the adult's immunity, which actually helped them avoid getting shingles later in life.

Stress is another factor that may contribute to outbreaks. While stress alone does not cause the outbreaks, shingles often occurs in people who have recently had a stressful event in their lives.

1. What kind of germ, or microbe, causes shingles?

2. Where does the virus hide out while it is inactive?

3. Who is most at risk for getting shingles?

4. What is one of the questions healthcare providers might ask if they suspect a patient has shingles?

An outbreak of shingles usually begins with a burning, itching, or tingling sensation on the back, chest, or around the rib cage or waist. It is also common for the face or eye area to be affected.

Some people report feeling feverish and weak during the early stages. Usually within 48 to 72 hours, a red, blotchy rash develops on the affected area. The rash erupts into small blisters that look like chickenpox. The blisters seem to arrive in waves over a period of three to five days.

The blisters tend to be clustered in one specific area, rather than being scattered all over the body like chickenpox. The torso or face are the parts most likely to be affected, but on occasion, shingles breaks out in the lower body. The burning sensation in the rash area is often accompanied by shooting pains.

After the blisters erupt, the open sores take a week or two to crust over. The sores are usually gone within another two weeks. The pain may diminish somewhat, but it often continues for months -- and can go on for years.

Shingles can be quite painful. Many shingles patients say that it was the intense pain that ultimately sent them to their healthcare provider. They often report that the sensation of anything brushing across the inflamed nerve endings on the skin is almost unbearable.

A typical shingles case is easy to diagnose. A healthcare provider might suspect shingles if

• the rash is only on one side of the body
  
  
• the rash erupts along one of the many nerve paths, called dermatomes, that stem from the spine

A healthcare provider usually confirms a diagnosis of shingles if the person also

• reports a sharp, burning pain
  
  
• has had chickenpox
  
  
• has blisters that look like chickenpox
  
  
• is elderly.

Some people go to their healthcare provider because of burning, painful, itchy sensations on one area of skin, but they don't get a rash. If there is no rash, the symptoms can be difficult to diagnose because they can be mistaken for numerous other diseases.

In cases where there is no rash or the diagnosis is questionable, healthcare providers can do a blood test. If there is a rash, but it does not resemble the usual shingles outbreak, a healthcare provider can examine skin scrapings from the sores.

1. The most common symptom of shingles is a sore throat.

2. Most people get the rash on the rib cage, chest, back, or face.

3. The pain usually disappears within 48 to 72 hours.

4. A rash that appears on only one side of the body is the most distinctive symptom of shingles.

Treatment with an antiviral can reduce the severity of the nerve damage and speed healing. If you suspect you have shingles, see your healthcare provider within 72 hours of the first sign of the rash.

A healthcare provider can confirm the diagnosis, prescribe the antiviral pills, and may also prescribe other drugs such as pain relievers. Patients with long-term pain may also be treated with numbing patches, tricyclic antidepressants, and gabapentin, an anti-seizure medication.

While these treatments can reduce the symptoms of shingles, they are not a cure. The antivirals do weaken the virus and its effects, but the outbreak still tends to run its course.

Good hygiene, including daily bathing, can help prevent bacterial infections. It is a good idea to keep fingernails clean and well trimmed to reduce scratching.

In May 2006, the U.S. Food and Drug Administration approved a vaccine to prevent shingles in people age 60 and older, even if they have had shingles. The vaccine is designed to boost the immune system and protect older adults from getting shingles later on.

The vaccine is basically a stronger version of the chickenpox vaccine, which became available in 1995. The chickenpox shot prevents chickenpox in 70 to 90 percent of those vaccinated, and 95 percent of the rest have only mild symptoms. Millions of children and adults have already received the chickenpox shot.

Interestingly, the chickenpox vaccine may reduce the shingles problem. Widespread use of the chickenpox vaccine means that fewer people will get chickenpox in the future. And if people do not get chickenpox, they cannot get shingles. Use of the shingles and chickenpox vaccines may one day make shingles a rare disease.

1. If you get to a healthcare provider within 72 hours of a shingles outbreak, the healthcare provider may give you

2. What kinds of treatments are used for the pain?

3. Why do researchers expect that shingles may become a rare disease in the future?

Shingles -- also called varicella-zoster -- is a painful skin disease caused by a reactivation of the chickenpox virus. It is distinctive because it affects only one side of the body. The early signs of shingles usually develop in three stages: severe pain or tingling, possibly itchy rash, and blisters that look like chickenpox.

Shingles is very common. Fifty percent of all Americans will have had shingles by the time they are 80. While shingles occurs in people of all ages, it is most common in 60- to 80-year-olds.

The first symptoms usually include burning, itching, or tingling sensations on the back, chest, or around the rib cage or waist. In other cases, it can be the face or eye area that is involved. The affected area can become extremely painful. This is when most people go to a healthcare provider to find out what is causing the pain.

In two or three days, a telltale rash develops in a single area on one side of the body. The rash erupts into small blisters. With all these symptoms, it is extremely likely that you have shingles.

Shingles is caused by a germ called the varicella-zoster virus -- the one that gave you chickenpox when you were a child. As you recovered from chickenpox, the sores and other symptoms healed, but the virus remained. You carry it in the nerve cells around your spine for the rest of your life.

The virus can become active again, especially in the later years of your life when your immune system doesn't protect you as well from infections. The virus travels from the spinal nerve cells and follows a nerve path out to the skin. Nerve endings in the skin become inflamed and erupt in a very painful rash.

Stress, by itself, does not cause shingles outbreaks. But many shingles patients report they have recently had a stressful event in their lives.

Unlike chickenpox, with shingles, the virus is NOT transmitted by someone breathing or coughing on you. You have to come in contact with the blister fluid itself. Once the blisters scab over, the contagious period is ended.

If you never had chickenpox and were exposed to someone with shingles, you could get chickenpox -- not shingles. Ask your healthcare provider whether the chickenpox vaccine would be advisable to prevent your getting chickenpox.

For people who have had chickenpox, shingles is not contagious. However, if you have never had chickenpox, contact with someone who has shingles could give you chickenpox. The fluid from their open blisters is infectious. Your healthcare provider may suggest giving you the chickenpox vaccine if you are exposed to someone with shingles.

"A burning, tingly feeling is what I noticed first," said an elderly woman describing her symptoms. "I looked in the mirror, and there was a rash on just one side of my back. Then the shooting pains started. Days later, I could hardly stand to have my clothes touching me. I thought maybe I had hives or poison ivy," she said, "until I went to the doctor."

When the shingles virus reactivates, it travels through nerve fibers, from the spine out to the skin. Inflammation along the nerve path causes the rash. And because the inflammation is in a nerve, it causes pain.

Shingles blisters tend to cluster in one specific area, rather than being scattered all over the body, like chickenpox. The rash erupts along a single nerve path that the virus follows outward from the spine.

Some people get the pain but never develop the rash. These cases are much more difficult to diagnose and can be mistaken for other diseases. Your healthcare provider would need to do a blood test to confirm the diagnosis. If there is a rash, but the diagnosis is questionable, your healthcare provider may examine skin scrapings from the sores.

A week or two after the blisters erupt, the oozing sores will begin to crust over. The sores are usually gone after another two weeks. The pain usually decreases over the next few weeks, but some patients may have pain for months -- sometimes, for years.

You are not likely to ever get it again. In healthy people, a second outbreak happens very rarely.

Yes. First, it is helpful to have your healthcare provider confirm that shingles is the actual cause of the pain. Next, if the healthcare provider can start you on antiviral medication within 72 hours of the outbreak, it reduces the pain and speeds healing.

Yes. In May 2006, the U.S. Food and Drug Administration approved a vaccine to prevent shingles in people age 60 and older, even if they have had shingles. The vaccine is designed to boost the immune system and protect older adults from getting shingles later on.

You get shingles when the chickenpox virus reactivates in your nerve cells, which causes nerve damage. Antiviral medication weakens the virus and may reduce the severity of the nerve damage. At the early stage of shingles, a healthcare provider will usually prescribe antiviral pills along with painkillers.

Sometimes the pain continues after the sores have healed. This persistent pain may be treated with an anti-seizure drug called gabapentin, pain-numbing patches, and tricyclic antidepressants.

The treatments we have now are a huge improvement over what was available 25 years ago. However, they are not a cure. The antivirals weaken the virus and its effects, but the disease still tends to run its course.

Bacterial infections can be a problem, so it is very important to keep the affected area clean. Keeping the fingernails well trimmed makes it easier to keep them clean and reduces scratching.

If the pain is severe and persists for months or years, it is called postherpetic neuralgia. It can be truly debilitating, and unfortunately, it is common in people over 60.

Outbreaks that start on the face or eyes can cause vision or hearing problems. Even permanent blindness can result if the cornea of the eye is affected.

Bacterial infection of the open sores can lead to scarring. In a small number of cases, bacteria can cause more serious conditions, including toxic shock syndrome or necrotizing fasciitis, a severe infection that destroys the soft tissue under the skin.

The constant pain, loss of sleep, and interference with even basic life activities can cause serious depression.

In patients with immune deficiency, the rash can be much more extensive and the illness can be complicated by pneumonia. These cases are more serious, but they are rarely fatal.

Until relatively recently, shingles got little attention because no effective treatments were available, and nothing was known about prevention. Research is changing all that.

The scientific name for the virus that causes chickenpox and shingles is varicella-zoster virus. "Varicella" is the Latin word for "little pox." The term "zoster" comes from the Greek word for "girdle," which relates to the most common area for a shingles outbreak.

Many herpes viruses share two main characteristics: they stay with you for life, and they cause spreading skin eruptions. The virus that causes chickenpox and shingles fits that description perfectly.

The virus seems to need a combination of risk factors in order for a reactivation to be triggered. The usual factors are an aging immune system combined with illness, stress, or even sunburn.

Healthcare providers cannot always be sure what the trigger is in each case. They don't know why the virus reactivates in one person with these risk factors, while in another person with the same risk factors, it does not.

Researchers know that the varicella-zoster virus behaves differently from other viruses, such as the flu virus. Our immune system usually kills off invading germs, but it cannot completely knock out this type of virus. The virus just becomes inactive.

Years later, this virus reactivates if your aging immune system is further weakened by any of the other risk factors. If a person has a particularly severe immune deficiency, the shingles can even recur.

Researchers would really like to understand why some people are NOT susceptible to shingles.