Many people are familiar with chicken pox from a young age, but did you know the same virus can lie dormant and reappear years later? This condition, known as shingles, is a common viral infection often accompanied by a painful rash. While the shingles vaccine and early treatment can help prevent or shorten an infection, one out of every three people in the United States will develop shingles in their lifetime. Despite some pain and discomfort, shingles symptoms are rarely life-threatening, though it’s important to be mindful of potential serious complications and to know when to get help.
What Is Shingles?
Shingles is a viral infection caused when the dormant varicella zoster virus, the chicken pox virus, reactivates, causing blistering skin and painful rashes. Shingles is a common condition that affects about 1,000,000 people in the United States each year. Although the varicella zoster virus belongs to a group known as herpes viruses, shingles and its symptoms are not the same as cold sores or genital herpes.
Causes of Shingles
Shingles can affect anyone who has previously had chicken pox, even decades later. After recovering from chicken pox, the varicella zoster virus (VZV) lies inactive in your nerve tissue, remaining harmless and non-contagious in most adults. Shingles can develop when the virus becomes active again.
We aren’t sure exactly what causes the shingles virus to become active again, although a weakened immune system, such as during periods of stress or illness, is a major risk factor. When reactivated, the varicella zoster virus irritates a specific sensory nerve ganglion and the area of skin that it supplies, resulting in painful symptoms that usually resolve within four to six weeks.
Is shingles contagious?
Yes and no. If you have shingles, you can pass the varicella zoster virus to people who are not immune to chicken pox if they have direct contact with your shingles rash. However, if you do pass the virus to someone else, they’re only at risk of catching chicken pox—not shingles. According to the CDC, once your shingles rash passes the blister phase and begins to scab, you’re no longer contagious.
Shingles and stress
While stress doesn’t cause shingles, it can make you more susceptible. During periods of stress, your body’s immune system weakens, in turn putting you at higher risk for developing shingles. If you also have an underlying immune condition or a chronic illness, periods of intense stress, such as the death of a loved one, difficulty at work, or other high-stress situations, can trigger the dormant varicella zoster virus to reactivate.
Symptoms of Shingles
Early symptoms of shingles include:
- Nerve pain: Often described as burning, numbness, or tingling. This pain sometimes appears several days before the rash starts.
- A red, painful rash: Typically appearing as fluid-filled blisters on one side or section of the face or body.
- Fever, headache, or chills
As with many viral infections, some people can experience more serious shingles symptoms:
- Loss of vision: Caused by shingles on the face or in and around the eyes.
- Long-term nerve pain: A condition that can last months or years after the rash subsides.
- Painful, widespread rash: People with weakened immune systems often see their shingles rash spread beyond one part of the body.
Shingles can often be diagnosed based on the location and appearance of common symptoms. Your doctor will examine the rash and may also take a sample or culture from your blisters for further testing if the diagnosis is uncertain. Once the diagnosis of shingles is confirmed, your doctor will prescribe the appropriate treatment.
Risk Factors and Complications
If you’ve had chicken pox, you are at risk of getting shingles someday. Although anyone who has had chicken pox can get shingles, people with the highest risk include:
- Individuals over the age of 50
- Those taking steroids or other immunosuppressive medications
- Those with compromised immune systems or existing autoimmune conditions
If you’re in this high-risk category, you’re also more likely to experience postherpetic neuralgia—a form of long-term nerve pain affecting 10-18% of people who develop shingles—as well as subsequent pneumonia, meningitis, and neurological problems.
A shingles rash can also lead to bacterial skin infections, scars, and even depression due to pain. As with any illness, it’s important to be observant and vocal about your symptoms in order to stay on top of any possible complications.
How to Treat Shingles
In order to treat shingles, your doctor will likely prescribe antiviral medication—such as acyclovir (Zovirax) or valacyclovir (Valtrex)—to shorten the duration of the illness. Your doctor will also likely prescribe steroids, which, when taken early on in the illness, can help prevent long-term nerve pain. Additional medications can be taken for pain relief, including:
- A capsaicin topical patch or cream
- Topical numbing agents such as lidocaine
- Antiepileptics such as gabapentin (which also relieve pain)
- Codeine and other narcotics
What you can do at home
Along with your doctor’s recommendations, there are a few things you can try to soothe shingles symptoms and reduce pain or itchiness, including:
- Over-the-counter pain medications such as ibuprofen or acetaminophen
- Applying a cool, wet compress to the affected area
- Applying calamine lotion directly on the rash
- Taking an oatmeal bath
- Wearing comfortable, loose-fitting clothing
The best way to prevent shingles is to get the shingles vaccine. The vaccine can reduce your chances of getting shingles by 90%. These shots can occasionally cause temporary, sometimes painful, side effects, but they’re unlikely to be as severe as a case of shingles.
If you’re a healthy adult over the age of 50, you should strongly consider getting the shingles vaccine. The most common form of the vaccination, Shingrix, is a two-dose injection. You receive one dose, typically injected into your upper arm, and then a second dose 2-6 months later.
Luckily, those who do develop shingles typically only experience it once. However, it is possible to develop shingles two or more times. Even if you’ve had shingles before, you can get the shingles vaccine in order to significantly reduce your risk for getting shingles again.
When to See a Doctor
Antiviral medications work best if you start taking them right after your symptoms appear, so I recommend chatting with a doctor as quickly as possible. The sooner you’re treated, the lower your risk for long-term pain—plus, your doctor can help you get vaccinated to prevent the varicella zoster virus from reactivating again in the future.
You should also contact your doctor if:
- You’re over the age of 60, because you may be more likely to experience shingles-related complications
- Your shingles rash is near your eyes, putting you at a higher risk of eye infection and potentially permanent eye damage
- You have a compromised or weakened immune system, or an underlying chronic illness
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