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Shingles and Chickenpox (Varicella-Zoster Virus)

  • Symptoms

    Symptoms of Chickenpox

    The time between exposure to the virus and eruption of symptoms is called the incubation period. For chickenpox, this period is 10 - 20 days. The patient often develops fever, headache, swollen glands, and other flu-like symptoms before the typical rash appears. While fevers are low grade in most children, some can reach 105 °F.

    These symptoms subside once the rash breaks out. One or more tiny raised red bumps appear first, most often on the face, chest, or abdomen. They become larger within a few hours and spread quickly (sprout), eventually forming small blisters on a red base. The numbers of blisters vary widely. Some patients have only a few spots, others can develop hundreds. Each blister is filled with clear fluid that becomes cloudy in several days.

    It takes about 4 days for each blister to dry out and form a scab. During its course, the rash itches, sometimes severely. Usually separate crops of blisters occur over 4 - 7 days, the entire disease process lasting 7 - 10 days.

    Symptoms of Shingles

    Shingles nearly always occurs in adults. Usually two, and sometimes three, identifiable symptom stages occur:

    Prodrome. In the prodrome phase, a cluster of warning symptoms appear 3 - 4 days before the outbreak of the infection. These symptoms range from general feelings of malaise (chills, fever, nausea, muscle aches) to abnormal sensations such as tingling, itching, burning, or a feeling of “pins and needles” accompanied by deep pain. The skin may be unbearably sensitive to touch.

    Active Infection. After prodrome, a rash appears, usually on the trunk. However, the rash can develop in other areas as well, such as legs, arms, face, or neck. The rash is typically confined to one side of the body and follows the same track of inflamed nerves as the prodrome pain.

    • The rash usually starts as well-defined, small, red clear spots.
    • Within 12 - 24 hours, these pimples develop into small fluid-filled blisters. The blisters grow, merge, and become pus-filled, and are extremely painful.
    • Within about 7 - 10 days (as with chickenpox), the blisters form crusts and heal. In some cases it may take as long as a month before the skin clears completely.

    Sometimes pain develops without a rash, a condition known as zoster sine herpete.

    This is a picture of herpes zoster (shingles) on the neck and cheek. The same virus that causes chickenpox is responsible for outbreaks of shingles. Outbreaks of shingles often follow the distribution of nerves in the skin. This distribution pattern is called a dermatome (see the "dermatomes" picture).

    Postherpetic Neuralgia. Postherpetic neuralgia (PHN) is pain that persists for longer than a month after the onset of herpes zoster. Typical symptoms include:

    • Pain that is described as deep aching, burning, stabbing, or like an electric shock
    • Extreme sensitivity to touch or temperature changes
    • The pain is persistent, but may come and go.