Onset of Shingles
The person suffering from shingles often complains of intense pain on an area of skin, especially on the trunk or face. This pain can be described as an intense burning pain, stinging pain or in other cases, the person may complain of a tingling sensation in the trunk and the face. This pain may be accompanied by other symptoms such as fever, fatigue and a general feeling of being unwell.
Appearance of rash on the skin
After 2 to 3 days of suffering from this intense pain, there is appearance of a red rash on the skin. The rash is more prominent on the trunk, abdomen and the face of the affected individual. This red rash is very painful. The pain is aggravated by even the slightest touch, such as the touch of bedclothes or in other cases, even a gentle breeze causes severe pain in the affected parts.
The rash begins as a group of small red bumps or small red elevations on the surface of the skin. These red bumps then become filled with a fluid. This gives the appearance of red fluid filled blisters. The fluid in these small blisters then becomes cloudy, and they break open to form a crusty surface. The development of the rash continues for about three to five days after its first appearance. The rash is often distributed in the form of a band across one side of the body or face.
Distribution of the rash on the skin
The blisters follow the path of individual nerves that come out of the spinal cord. As a result of this, the rash appears in a specific “ray-like” distribution. This is called as a dermatomal pattern. Generally only one nerve is involved. The entire path of the affected nerve may be involved. However, there may be development of blisters only in certain areas along the path of the nerve, whereas the other areas remain blister free. In a rare case, more than one nerve will be involved. After about 5 days, no further blisters appear. However, it can take up to 5 weeks for the skin to heal and return to normal.
Post herpetic neuralgia
In younger people, who have a healthy and strong immune system, the rash usually resolves without any further complications. However, in older people whose immune system is weak, there may be development of complications such as post herpetic neuralgia. This is an extremely painful and debilitating condition. The pain associated with post herpetic neuralgia is so severe that it may not respond well to the usual pain medications. The doctor may look into prescribing alternative pain medications such as creams containing an extract of red chilli peppers. In extreme cases, the debilitating fatigue associated with this condition may make it difficult for a person to carry out their usual day to day activities. This condition may also be accompanied by weight loss and depression. The health care professional may also look into prescribing anti-convulsants, antidepressants and local anesthetics.