Varicella-Zoster Virus

Varicella–zoster virus (VZV) is known to cause two diseases: chickenpox (varicella) and shingles (herpes zoster). Chickenpox is a common contagious disease of children that usually has a benign course. However, chickenpox in adults or people with weakened immune systems can have serious complications. Second attacks of chickenpox are very rare. Shingles is caused by a reactivation of the latent VZV. In other words, the virus lies dormant in nerve cells in the spine and can re-emerge in the form of shingles years after you have had chicken pox.

Signs and Symptoms

Chicken Pox
The typical rash of chickenpox is made up of groups of small, itchy blisters surrounded by inflamed skin. The rash usually begins as one or two lesions, quickly spreading throughout the body including the trunk, scalp, face, arms, and legs. The total number of blisters varies greatly from person to person. Over four days, each blister tends to dry out and form a scab, which then falls off between 9 to 13 days later.

The rash is usually preceded by: Shingles
The typical rash of shingles begins as redness (erythema) followed by the appearance of blisters that cover one concentrated area of the body on either the face, trunk, shoulders and neck, or legs (unlike the rash of chicken pox, which is generally diffuse, meaning that it is widespread throughout the body). These eruptions follow the path of an infected nerve. Usually only a single nerve is involved, confining the rash to one side and one section of the body (called a dermatome). The trunk is the area affected in 50% to 60% of cases. The next most common site is one side of the face, which may even involve the tongue, the eye, or the ear.

Before the rash appears, you will have warning symptoms of pain experienced as a sharp, aching, piercing, tearing, or burning sensation limited to the specific part of the body where the rash appears 1 to 5 days later. That area may also feel itchy, numb, and unbearably sensitive to touch, even just from your clothes touching your skin in that section.

Other symptoms that you may experience include:


Anyone who has not had chickenpox or the vaccine, is at risk for contracting the virus if exposed to someone with either chickenpox or shingles. The time between exposure to the virus and appearance of symptoms (called an incubation period) is between 10 and 20 days. The virus is spread through sneezing, coughing, and breathing – in other words, when someone with chickenpox sneezes or coughs, there are respiratory droplets with the VZV virus in the air. Then, you can breathe in those infected droplets and, if you have never had chickenpox or the vaccine, get chickenpox yourself.

Another possible way to get chickenpox, is to come into direct or indirect (like the clothes of someone with shingles) contact with discharge from VZV skin lesions.

The virus is contagious from two days before the rash appears until all of the lesions have crusted over.

While shingles is caused by the same virus that leads to chickenpox, the way that you develop this painful skin lesion is quite different. After you have had chickenpox, the virus lives in a dormant state (like it is hibernating) in nerve cells along the spine. Later in life, when it is reactivated (usually from a weakened immune system, aging, or other risk factor), the virus travels down the tract of the particular nerve where it was "hibernating", first causing the pain and other sensations followed by the rash. The pattern or path that the symptoms follow is called a dermatome, which essentially means the area of the skin that the nerve supplies.

Risk Factors

Chicken Pox


Your health care provider will generally be able to diagnose chickenpox easily because of its characteristic rash. If there is any doubt, however, the doctor may take a scarping from one of your skin lesions to look at under the microscope. This is called a Tzanck test.

Similarly, if you have shingles, it is rare that your provider needs to perform any tests because the history of pain and other symptoms and the rash itself are very typical. If the doctor is not certain, however, a Tzanck test may be performed or some blood tests.

Preventive Care

Treatment Approach

Both chickenpox and shingles generally resolve spontaneously in those not at high risk for complications. The goal, therefore, is to make you as comfortable as possible while you have either condition and to shorten the length of time that you have the pain and itching associated with shingles in particular. Many lifestyle approaches and medications may be helpful for these purposes. Mind/Body techniques for relaxation can also help alleviate pain and reduce stress associated with shingles.


Certain measures, in the list that follows, can reduce itching from chickenpox and its complications. The less you scratch, the less likely it is that you will develop a secondary baterial infection of the skin (see Prognosis and Complications).


Nutrition and Dietary Supplements

Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider. Lysine
Taking lysine supplements may speed recovery time from shingles and reduce the chance of recurrent breakouts of this skin condition. More research is needed.


The use of herbs is a time-honored approach to strengthen the body and treat disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care and only under the supervision of a practitioner knowledgeable in the field of herbal medicine.

In certain parts of the world, herbs are the standard form of medicine for conditions such as shingles. In an observational study in Uganda, for example, people receiving hrebal medicine for this skin condition were compared to people attending a clinic who received typical Western therapy. Those who were treated by the herbal therapists with traditional medicinal herbs suffered from less pain associated with the shingles and were less likely to have post-herpetic neuralgia (see Prognosis and Complications) than those who received Western medical therapy.

Cayenne (Capsicum frutescens/Capsicum spp.)
Capsaicin cream made from cayenne pepper has very powerful pain-relieving properties when applied to the surface of the skin. Capsaicin may help relieve the pain of post-herpetic neuralgia (see description of this potential shingles complication in Prognosis and Complications).

German Chamomile (Matricaria recutita)
Traditionally, this herb has been used to treat skin conditions and childhood illness like chickenpox. Research on how well this herbal remedy alleviates the symptoms of chickenpox is lacking, however. Therefore, specific recommendations regarding effectiveness and safety of chamomile for this condition cannot be made. An herbal specialist would be able to direct you in terms of whether it is appropriate to try this herb and how to do so.

Peppermint Oil (Mentha x piperita)
A case report in the scientific literature suggests that applying peppermint oil to the painful area may help relieve symptoms of postherpetic neuralgia, a potential complicaion of shingles (see Prognosis and Complications).

Although not studied scientifically for VZV specifically, some herbalists may consider one of the following herbs because either it has been used traditionally for skin lesions or because the herb has been used for another virus in the same group as VZV, namely herpes simplex virus. All of the herbs mentioned below would be prescribed to be used topically for shingles or chicken pox.


Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of chicken pox and shingles based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. Chicken Pox:

Mind/Body Medicine

The following relaxation techniques may help reduce the pain and stress associated with shingles and its potential complication of post-herpetic neuralgia: Also, cognitive behavioral therapy can help you restructure your thinking about the pain from feeling completely helpless to feeling like the pain is only one negative aspect of your overall positive life.

Another practice from which people with post-herpatic neuralgia have reported some relief is:

Traditional Chinese Medicine

In a case series (a type of study that observes groups of people) of 56 people with post-herpetic neuralgia (see Prognosis and Complications for description of this post-shingles pain syndrome), the addition of the following traditional Chinese medical techniques to usual Western medical care helped reduce their pain of the participants in the trial: In addition, a traditional Chinese herb called Clinacanthus nutans (Bi Phaya Yaw) is able to kill VZV and other herpes viruses in test tubes. An extract of this herb has been compared to placebo in small numbers of people with shingles. It appears that a topical form of C. nutans extract may shorten the length of time that one has skin lesions from this condition. More research would be helpful. In the interim, it may be worthwhile to work with a certified Traditional Chinese physician in your area. Be sure to discuss this with your regular doctor as well.

Other Considerations


If you acquire chickenpox when you are pregnant, the infection may spread to the fetus.

Special Populations

If you have a compromised immune system, shingles lesions may be widespread rather than localized to one area of the body and it will likely take longer for the symptoms to heal, maybe lasting for months. Conditions that compromise your immune function include:

Warnings and Precautions

Prognosis and Complications

While chickenpox usually goes away on its own with non-serious complications like itching and scarring, severe and sometimes fatal infections may occur, particularly in newborn infants, adults, and people whose immune systems are weakened (see Special Populations just above). Such potential infections include: Shingles usually clears in 2 to 3 weeks and rarely recurs. Your chance of getting another bout of shingles is only 1% to 5% if you have a normal, working immune system. If you are immunocompromised (see Special Populations above), your risk for recurrence is higher.

Potential complications from shingles include:


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