After a child recovers from chickenpox, the varicella-zoster virus is not eliminated from the body like other viruses. Instead, the virus remains alive in an inactive, dormant state, making itself a home in some of the body’s nerve cells. Years later, for unclear reasons, the virus reactivates and starts reproducing. When it does, it begins to infect the surrounding nerve fibers. What prompts the virus to "awaken" in normal, healthy children and adults is still not clear but what is certain is that "Act II" of the varicella-zoster play has now started.

Shingles begins differently in adults than in children. In "grown-ups" the illness starts with symptoms suggestive of the flu-- mild muscle aches, chills, and fever. The virus then causes several days of burning or severe pain in the skin as it migrates along the nerve. In children, there is usually no fever or pain and the child does not feel all that sick. In all age groups, once the virus reaches the skin a rash that is characterized by crops of blisters on a red base, appears on the area shared by the involved nerve. The pattern of the rash is fairly characteristic, almost always stopping at the body’s midline due to its infiltration of only a single nerve group. New blisters continue to appear for about up to seven to ten days, gradually getting larger, clouding up, and forming crusts that will fall off with little or no scarring. The back, chest, and abdomen are the most common areas affected, and the whole episode of pain, rash and healing is generally over in three to five weeks. Complications rarely occur unless the area around the eye and nose are involved. The appearance of lesions in this area usually require treatment by an ophthalmologist or dermatologist to protect the child’s vision.

The shingles virus is contagious by direct contact during the blister stage, but exposed individuals will, interestingly, develop chickenpox, not shingles. Therefore, the child with shingles should be kept away from other children (or adults) who have not had chickenpox. Because shingles results from reactivation of the virus already in the patient's nervous system, one cannot "catch" shingles from another person with the disease. Furthermore, shingles is much less contagious than chicken pox because shingles can be transmitted only if the blisters are broken and touched by a susceptible person. In contrast, chickenpox is spread by both direct contact and through airborne droplets containing the virus in the air. The attack of shingles finally gives the child immunity from subsequent attacks from the varicella-zoster virus. Children recover without any side effects except for occasional scarring of the skin from scratching. The pain infrequently lasts for months but this usually occurs only in affected adults.

There are no antibiotics effective against the zoster-varicella virus. Treatment is aimed at making the child comfortable until nature does the healing. Pain relievers such as acetaminophen are usually effective. Antihistamines may be useful in reducing itching and discomfort, especially when sleep is disrupted. It is important not to open the blisters. Cool compresses will help aid in drying the lesions. Secondary infection of the blisters by bacteria can also occur, resulting in delayed healing of skin lesions, and it is only then that antibiotic treatment may be necessary. Severe cases of shingles, especially if the eye is involved, may be treated with the new antiviral drug, acyclovar.

You may have thought your child has seen the last of the chickenpox virus after the last blister scabbed over. But the tricky varicella-zoster virus remains dormant in some of the body’s nerve cells, and years later, for reasons still to be explained, reemerges to cause the uncomfortable but self-limited self-limited, illness known as shingles.