Shingles Explained: What Triggers This Painful Rash and What to Do About It?
Did you know that 1 in 3 adults will experience shingles in their lifetime? If you had chickenpox as a kid — and most people in the United States over age 50 did — then you're at risk for shingles. It's a painful reactivation of the chickenpox (varicella-zoster) virus that has been dormant and hiding in your nerve cells. Before the United States started its widespread vaccination program in 1995, there were roughly four million cases of chickenpox every year. Unlike many childhood viruses, the varicella-zoster virus doesn't clear from the body when the illness ends. Instead, it hangs around, taking up residence and lying dormant in the nerves, sometimes for decades, with the immune system holding it in check. In some people, it lives there harmlessly for the rest of their lives. But in others, the virus can move through the nerves to the skin's surface to suddenly emerge and strike again, this time appearing as a different condition known as shingles. It causes painful blisters and potentially long-lasting pain.
What are the symptoms of shingles?
While it can affect people of any age, including children, it's most likely to strike after age 60. Like chickenpox, shingles also cause a blistering rash. It generally appears as a painful band around one side of your ribcage or on one side of your face. The first symptom for many people is pain or a burning sensation in the affected area. You may also have a fever, a headache, and fatigue. Along with the rash and other temporary symptoms, shingles can also bring unpleasant, long-lasting, and sometimes permanent complications, such as skin infections, nerve pain in the area where the rash appeared, or even vision loss.
How long does shingles last?
An episode of shingles usually lasts 2-4 weeks. In some cases there is a rash but no pain. Rarely, there is no rash but just a band of pain.
What triggers shingles in some people and not others?
Experts don't fully understand this. One theory is that shingles occurs when your immune system loses its ability to keep the virus in check. After you get chickenpox, your immune system can recognize the varicella-zoster virus thanks to specialized immune system cells, called B and T cells, that can remember the virus and quickly marshal an attack on it. Factors that weaken the immune system increase your risk of developing shingles. These include
Certain illnesses, such as HIV (the virus that causes AIDS), cancer, or autoimmune conditions.
Medicines that suppress your immune system, such as cancer drugs, steroids, medications to treat autoimmune conditions, and drugs given to patients who undergo an organ transplant to keep their bodies from rejecting it.
Age-related changes: shingles can occur in people of any age, including children, but is most common in people over 60. Your immune system may become weaker as you get older. While it's unclear why this happens, it may be due to a decline in T cells. Some experts also think that the bone marrow produces fewer stem cells, the progenitors of T and B cells, as you age. With fewer white-cell soldiers in the army, the immune system might be unable to mount as robust a response to invaders as it once did.
What is the best way to prevent shingles?
The best way to avoid a painful case of shingles is to get vaccinated. The FDA approved the Shingrix vaccine in October 2017. A few years after Shingrix was approved, an older shingles vaccine called Zostavax was discontinued because it was much less effective. Shingrix is recommended for adults over age 50 and is given in a series of two injections, six months apart. Research shows that Shingrix is 90% effective in preventing an outbreak of shingles. Even if you get shingles after vaccination, Shingrix significantly reduces your risk of developing persistent pain in the affected area, known as postherpetic neuralgia.
In addition to getting vaccinated, it's always a good idea to keep your body healthy, such as choosing nutritious foods, staying active, and getting sufficient sleep. It's not clear if healthy lifestyle habits like these can prevent shingles. Still, even if they don't, they're worthwhile because they will benefit your body in many ways.
Is shingles contagious?
Yes and no. If you come in close contact (of fluid from blisters) with someone with shingles, you can't catch shingles. But you can be infected with the varicella-zoster virus and develop chickenpox if you aren't vaccinated against the virus and haven't had chickenpox.
Can you get shingles more than once?
Unfortunately, you can. Studies have found approximately a 5% risk of getting a second or a third case of shingles within eight years of your first. This is why it is recommended that people get the shingles vaccine even if they have already had shingles in the past.
How common are complications from shingles?
Approximately 10% to 18% of people develop the nerve pain known as postherpetic neuralgia. It can be disabling and life-limiting. About 1% to 4% of people experience other complications that require a hospital stay, such as skin infections or eye-related problems.
Are there any tests for shingles?
No, there is no specific test to diagnose shingles. The rash can be recognised by its typical pattern and symptoms.
Shingles and pregnancy
There's no danger to you or your baby if you develop shingles while pregnant. However, you may need antiviral treatment so you should be referred to a specialist.
Is there a cure for shingles?
No, nothing can cure a shingles attack. However, antiviral medications may help you recover quickly and reduce your chances of developing complications. These medications, including acyclovir, famciclovir, and valacyclovir, do not kill the virus but work by stopping the virus from multiplying. When fewer viruses are present, your immune system can control the reactivation better. So, it may limit the severity of symptoms of the shingles episode. An antiviral medicine is most useful when started in the early stages of shingles (within 72 hours of the rash appearing). However, in some cases your doctor may still advise you have an antiviral medicine even if the rash is more than 72 hours old - particularly elderly people with severe shingles, or if shingles affects an eye. Antiviral medicines are not advised routinely for everybody with shingles. As a general rule, the following groups of people who develop shingles will normally be advised to take an antiviral medicine:
If you are over the age of 50. The older you are, the more risk there is of severe shingles or complications developing and the more likely you are to benefit from treatment.
If you are of any age and have any of the following:
Shingles that affects the eye or ear.
A poorly functioning immune system (immunosuppression).
Shingles that affects any parts of the body apart from the trunk (that is, shingles affecting an arm, leg, neck, or genital area).
Moderate or severe pain.
Moderate or severe rash.
If prescribed, a course of an antiviral medicine normally lasts seven days.
Is there anything I can do to help relieve shingles symptoms?
The most bothersome symptoms associated with shingles are typically itching and pain related to the rash. Several strategies may help under the guidance of your provider. For pain
cool compresses
an over-the-counter pain reliever, such as ibuprofen or acetaminophen
a topical pain-relieving cream containing capsaicin
a topical numbing agent called lidocaine
an injection procedure called a nerve block
a topical numbing agent called lidocaine
For itching
soaking in a colloidal oatmeal or starch bath
applying calamine lotion
taking an oral or topical antihistamine.
Whenever possible, try to keep your shingles rash clean and covered with sterile bandages to prevent infection.
I already had the Zostavax vaccine. Do I need to get vaccinated with Shingrix?
Yes, it is recommended that you get the Shingrix vaccine even if you already have had the older vaccine. The newer vaccine is far more effective.
Who should take Shingrix?
in adults aged 50 years and older.
in adults aged 18 years and older who are or will be at increased risk due to immunodeficiency or immunosuppression caused by known disease or therapy.
Bottomline
Understanding shingles is the first step toward prevention and effective treatment. By staying informed and proactive, we can all reduce the impact of this condition on our lives and the lives of those around us. Remember, knowledge is your best defense against shingles. Get vaccinated for it. If you develop symptoms, please reach out to your health care provider.
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About Us
Dr. Poonam Singh, MD, and Dr. Amar Singh, MD, are board-certified by the American Board of Internal Medicine and the American Board of Obesity Medicine. They specialize in preventing, treating, and reversing chronic diseases using an evidence-based holistic approach. They are specifically interested in weight management, hormone re-balancing, and longevity. The American College of Physicians has recognized them as Fellows, FACP, for their excellence and contributions to medicine and the broader community. They enjoy teaching, volunteering, and advocating for their patients. Their mission is to share simple, effective, proven strategies leading to meaningful, sustainable, and long-lasting well-being.