Zone: symptoms, causes & treatment

Zona is a viral skin infection that appears as a characteristic band-shaped rash on one side of your body. The name “zona” comes from the Latin word for belt or band, which perfectly describes the typical distribution of the rash. In Dutch, the condition is also known as shingles because of the red, painful nature of the skin lesions.

The condition is caused by the varicella virus, the same virus that causes chicken pox. After a chickenpox episode, usually in childhood, the virus does not completely disappear from your body. Instead, it retreats into the nerve nodes adjacent to the spinal cord, where it can remain in a dormant state for years or even decades. Under certain circumstances, the virus can become active again and travel via the nerve tracts to the skin, where it causes zona.

It's important to know that zona is contagious, but only for people who have never had chicken pox. The fluid in the blisters contains active viruses and can cause chicken pox in someone without immunity if contacted. This infectious stage lasts about one to two weeks, until all the blisters have dried and crusted. The scabs themselves are no longer contagious. For people who have already had chicken pox or have been vaccinated, contact with someone with zona is not a risk.

The risk of zona increases sharply with age. Although the disorder can occur at any age, it mainly affects people over the age of 60. This is due to the natural decline in immunity against the virus as we age. People with a weakened immune system due to illness or medication also have an increased risk of developing zona, and often in a more severe form.

The development of zona is the direct result of reactivation of the varicella virus in your body. To understand how this happens, it's helpful to know the full story of the virus. When you first contact the varicella virus, usually in childhood, you get chicken pox. Your immune system fights this infection but never manages to completely eradicate the virus. After curing chicken pox, the virus strategically retreats to the dorsal ganglion, the nerve nodes located next to your spine.

In these nerve nodes, the virus remains quietly present for years without causing symptoms. Your immune system controls the virus but cannot eliminate it. However, this balance can be disturbed when your immune system weakens. With age, cellular immunity naturally decreases, which explains why zona mainly occurs in the elderly. However, most people who develop zona have no clearly identifiable cause for the reactivation of the virus.

Several factors can increase the risk of reactivation. Stress, both physical and emotional, can temporarily weaken your immune system. Serious diseases, especially those that affect the immune system, such as HIV or cancer, increase the risk significantly. Treatments that suppress the immune system, such as chemotherapy, high-dose corticosteroids, or immunosuppressive medications after an organ transplant, make you more vulnerable to zona.

When the virus reactivates, it multiplies in the nerve node and then travels via the nerve fibers to the skin area provided by that particular nerve. This explains why zona is always confined to one side of the body and follows a band-shaped pattern that matches the course of one or more nerves. The virus causes inflammation of the affected nerve, which explains the pain and skin lesions.

The anatomical distribution of your nerves determines where zona can appear. Thoracic nerves, which supply the chest and abdomen, are most often involved. Cervical nerves in the neck and facial nerves can also be affected. In rare cases, several neighboring nerves may be involved at the same time, leading to a greater extension of the rash.

The development of zona follows a characteristic pattern that usually takes place in several phases. It is important to recognize this progression because early treatment can reduce the risk of complications.

The first phase, which can take several days before visible skin changes occur, is often characterized by local pain, a burning or tingling sensation, or itching in a specific skin area. These sensations are often confusing because nothing is visible on the skin yet. Some people describe it as a deep, pervasive discomfort that is difficult to localize. During this prodromal phase, general complaints such as tiredness, headache and mild fever can also occur, which makes you feel like the flu.

After this pre-announcement, the characteristic skin lesions appear. First, red spots appear in the affected area, followed by clusters of clear blisters that form on the red surface. These blisters contain clear fluid and are filled with virus particles. The distribution of the lesions is very characteristic because they follow a band-shaped pattern on one side of the body, without crossing the midline. This one-sided, band-shaped aspect is so typical that it often makes the diagnosis clear immediately.

New blisters may be added for about a week, so you can see blisters at different stages of development at the same time. The pain associated with zona can range from mild to very severe. Some people experience constant, burning pain, while others are more likely to suffer from a stabbing, shooting pain. The affected skin is often very sensitive to touch, even contact with clothing can be uncomfortable.

After about a week, the blisters begin to dry up. They become cloudy and begin to collapse, after which scabs form. This scab formation marks the beginning of healing. The scabs gradually fall off over a period of one to two weeks. Once all the scabs have disappeared, the acute phase is over. The skin may remain discolored for some time, often darker or lighter than the surrounding skin, but this usually disappears gradually.

Unfortunately, for some people, zona does not end with the skin lesions disappearing. Postherpetic neuralgia, permanent nerve pain after infection, is a dreaded complication. This pain can last for months to years and is caused by permanent nerve damage caused by the virus infection. The risk of this complication increases with age and is highest in people over 60 years of age.

In principle, Zona can occur anywhere on the body where nerves run to the skin, but there are clear preferred locations associated with the anatomy of your nervous system.

The most common location is the torso, affecting the chest, back, or abdomen. This distribution follows the course of the intercostal nerves that run between the ribs. You then see a horizontal band of skin lesions that starts at the spine and runs forward but always stops at the midline of your body. Sometimes it looks like there's a band around your body, which explains the name “shingles” well.

The neck and neck are also involved relatively often, with the rash ranging from the back of the neck to the side or front. The face is an important location because of the possible involvement of the eye. When zona affects the face, the rash often follows the division of the trigeminal nerve. This may mean that one side of the forehead, cheek or jaw is affected. A specific branch of this nerve runs to the eye, and if it is involved, you speak of zona ophtalmica.

Zona ophtalmica deserves special attention because eye involvement can cause serious complications. Warning signs include blisters at the tip or side of the nose, eye redness, eye pain, blurred vision, or increased photosensitivity. This situation always requires urgent referral to an ophthalmologist because there is a risk of permanent eye damage, including corneal scarring and even partial vision loss.

The limbs are less commonly affected by zona, but it can occur. Then, the rash follows the course of a specific nerve in an arm or leg, resulting in an elongated band of injuries. In very rare cases, zona may occur in more atypical locations such as the hearing, where you may experience ear pain, hearing loss, and even facial palsy.

In people with a highly weakened immune system, zona can spread outside the normal nerve area, a form called disseminated zona. This can indicate a serious immune system problem and always requires medical attention.

The treatment of zona has multiple goals: to shorten the duration of the acute phase, to reduce pain and discomfort, and, above all, to prevent complications such as post-herpetic neuralgia. The approach differs depending on several factors, including your age, the location of the zone, the severity of the symptoms, and your general health condition.

For healthy people under the age of 60 with zona on the torso, symptomatic treatment is often sufficient. The natural course is beneficial and healing usually occurs within two weeks without intervention. Pain relief with acetaminophen may be sufficient to alleviate the discomfort. Anti-inflammatory drugs are generally not recommended because they may delay healing.

Antiviral medications play a central role in specific groups of patients. These drugs inhibit the multiplication of the virus, so that the infection comes under control more quickly. However, they must be started very early, preferably within 72 hours of the appearance of the skin lesions, to be optimally effective. Antiviral treatment is highly indicated for people over 60 years of age because they are at highest risk of post-herpetic neuralgia. Early treatment can reduce this risk by about half.

Antiviral treatment is also essential for facial zona, regardless of age, because of the risk of eye involvement. People with weakened immune systems, such as cancer patients, people with HIV, organ transplant patients, or people taking immunosuppressive medications, should always be treated. In this group, zona may be more severe and spread, and sometimes treatment in hospital with intravenous medication is necessary.

Pain management is an important aspect of treatment. Paracetamol is the first choice for mild to moderate pain. In case of severe pain, stronger pain relievers may be necessary.

Local treatment of skin lesions is mainly aimed at preventing bacterial infection and promoting comfort. Open vesicles can be disinfected with antiseptic solutions. It is important not to intentionally destroy the blisters and not to rub them too hard when drying. Showering and bathing are okay, but swimming is better to avoid as long as there are active blisters due to the risk of infection.

Prevention through vaccination is possible for older adults and risk groups. There is a vaccine that significantly reduces the risk of developing zona and post-herpetic neuralgia. This vaccine is recommended for people aged 50 or 60, depending on local guidelines. Talk to your doctor about whether this vaccine is useful for you.

There are several misunderstandings about the treatment of zona, and it is important to know what is not effective to save time and money and prevent possible damage.

Creams and ointments are generally of little use in treating zona. Antiviral creams, which are effective for cold sores, cannot affect zona rashes because they do not penetrate deep enough into the skin to reach the viral infection in the nerve. The only thing that local treatments can do is provide symptom relief and prevent secondary infection, but they cannot change the course of the disease itself.

Creams containing cortisone are sometimes used incorrectly because people believe they reduce inflammation and pain. However, the use of cortisone on zona skin lesions is not recommended because it may delay healing and increase the risk of complications. Cortisone suppresses the immune response locally, while you need that immune response to fight the virus.

Many people look for natural remedies or alternative treatments for zona, such as vitamins, homeopathy, or herbs. While these generally do no harm, there is no scientific evidence that they are effective in treating zona. Supplements containing vitamin C, E or zinc have no proven effect on the course of the infection or the prevention of complications.

The idea that you can “blow away” zona by blowing it hot or cold, or that you have to prick open the blisters, is a dangerous misconception. This can lead to additional skin damage and increases the risk of bacterial infection and scarring. Using alcohol, iodine or other aggressive disinfectants directly on the blisters can also cause more damage than good.

Finally, waiting to seek medical attention is a missed opportunity. Some people think that zona “will go away on its own” and that treatment is not necessary. While this is technically true for the acute phase, early treatment with antiviral medications can significantly reduce the risk of long-term nerve pain. Waiting until the blisters are already a week old makes antiviral treatment virtually useless.

Can you get zona multiple times?

Yes, it is possible to get zona multiple times, although it is not very common. Around 20% to 30% of people who have had zona get it again. In people with a weakened immune system, the risk of recurrence is higher. Each new episode can occur at a different location because it depends on which nerve node the virus reactivates.

Is zona contagious?

Zona itself is not contagious in the sense that you can't get a zona from someone with zona. However, the fluid in the blisters can cause chicken pox in people who have never had chicken pox or have not been vaccinated. This risk only exists as long as there are active blisters. Once all blisters have dried and scabs have formed, there is no longer any risk of infection.

How long does zona take?

The acute phase of zona usually lasts one to two weeks from the time the skin lesions appear until all the scabs have fallen off. However, the pain may last longer. In some people, especially the elderly, nerve pain can last for months to years, a condition called post-herpetic neuralgia. Early treatment with antiviral medications can help reduce the duration.

Do I have to stay home with zona?

There is no medical need to stay home if you feel well enough to work, provided you can cover the affected area properly. However, avoid contact with pregnant women who have not had chicken pox, newborns, people with weakened immune systems, and people who have never had chicken pox. If you have a sore face or if you feel very ill, staying home is wise.

Why does zona hurt so much?

The pain in zona is caused by inflammation of the nerve itself. The virus multiplies in nerve cells and causes damage and inflammation along the entire nerve path. This direct nerve damage explains why the pain is often so intense and has a burning or shooting character. In post-herpetic neuralgia, the nerve remains damaged, which explains the persistent pain.

Can zona be dangerous?

For healthy people under the age of 60, zona is rarely dangerous and usually heals without permanent problems. However, serious complications can occur with facial zones with eye involvement, which can lead to permanent eye damage. In people with a highly weakened immune system, zona can expand and become serious. Postherpetic neuralgia is not dangerous but can be very stressful and significantly affect quality of life.

1. Gezondheidenwetenschap.be - Zona, shingles, herpes zoster
2. Ebpnet.be - Evidence-based guidelines
3. Thuisarts.nl - Shingles
4. BCFI - Zona Transparency Sheet
5. Intego database - Belgian GP data