SHINGLES

Shingles, an infection sparked by a virus, manifests as a painful rash. The culprit behind this discomfort is the varicella-zoster virus, the same one responsible for chickenpox. Picture it as a repeat encounter with the same troublesome virus. Those who develop shingles have previously experienced chickenpox, often many years prior.

Chickenpox typically starts with itchy blisters appearing on areas like the back, chest, and face before spreading across the body. In contrast, shingles appears on one side of the body, usually concentrated in a specific region.

Initially, the rash manifests as a cluster of small bumps, distinct in appearance from the surrounding skin. These bumps exhibit varied hues depending on one’s skin tone. On darker skin, they might appear pink, grayish, purple, or brown, while on lighter skin, they take on a red hue.

These bumps eventually transform into fluid-filled blisters, which also exhibit diverse colors based on skin tone. They typically dry up and form crusts within 7-10 days. Despite the rash subsiding, the pain associated with shingles can persist even after the skin clears up.

Shingles affects people differently depending on their skin tone, with variations in appearance noted particularly on black or brown skin, where the rash may display as pink, grayish, purple, or brown.

As for its prevalence, approximately 1 million individuals in the U.S. are afflicted with shingles annually. The risk of developing it escalates with age, and about 10% of those who previously battled chickenpox will encounter shingles later in life.

Symptoms of shingles

Enlarged lymph nodes
Cluster of tiny blisters that spontaneously open
Stabbing or shooting pain, which can occur even without a visible rash
Tingling or burning sensation in or under the skin
Fever
Chills
Headache
Fatigue
Sensitivity to light
Upset stomach

It’s crucial to contact your doctor promptly upon experiencing any of these symptoms. While there’s no outright cure for shingles, timely treatment can reduce the risk of complications, such as persistent pain known as postherpetic neuralgia, which can persist after the rash subsides.

When shingles manifests on the face, immediate medical attention is necessary. The virus could potentially harm your eyesight or the nerves within your inner ear.

Shingles affecting the eyes presents additional concerns, including:

Rash on one or both eyelids
Redness and oozing affecting the whites of the eyes (conjunctivitis)
Blurry vision
Pain and swelling within the eye (iritis)
Sensitivity to light
Swelling of the optic nerve (optic neuritis)
Breakdown of the cornea surface (keratitis)

A shingles infection in the eye can lead to subsequent complications such as glaucoma, cataracts, double vision, dry eyes, bacterial infections, corneal scarring, and permanent vision impairment.

While the most common location for shingles is the trunk, it can also occur on the buttocks and spread down the leg.

Causes of shingles

As for its cause, both chickenpox and shingles stem from the varicella-zoster virus. This virus triggers a rash of painful and itchy blisters. Once inside the body, the virus remains dormant and can resurface later as shingles.

Initially causing chickenpox, the virus then settles into the nerve tissues near the spinal cord and brain, where it lies dormant. Periodically, for reasons not entirely understood, the virus reactivates, traveling along nerve fibers to the skin, resulting in shingles, also known as herpes zoster.

Stages of shingles

When dealing with this painful rash. Expect the illness to last anywhere from 2 to 6 weeks. The journey of shingles unfolds in three distinct stages:

Pre-Rash Stage (Preeruptive): This initial phase, often termed “preeruptive,” precedes the appearance of the rash. During this time, you may experience sensitivity or tingling in the skin, accompanied by localized pain. General viral symptoms like headache, fatigue, and overall malaise may also manifest. This stage typically kicks in about 48 hours before the rash emerges.
Eruptive Stage: In this phase, the characteristic painful blisters start to surface on the body. These blisters can rupture and form crusts. This stage is when you’re most contagious, lasting until the blisters have completely dried up. It’s typically the most agonizing period of the outbreak, with over-the-counter pain relievers often providing inadequate relief. Symptoms like headache and fatigue may persist during this stage, which usually spans 2 to 4 weeks.
Chronic Stage: If the shingles infection persists beyond 4 weeks, it enters the chronic stage. Nerve involvement may lead to unusual sensations such as “pins and needles” or shooting pains unrelated to external stimuli.

Risk Factor

Several risk factors may trigger the reactivation of the virus, leading to the painful rash.:

Age 50 or older
High levels of stress
Underlying conditions like cancer, HIV, or other illnesses weakening the immune system
History of severe physical injury
Long-term use of medications like steroids that suppress the immune response
Lack of childhood or adult vaccination against chickenpox
Eligibility for the shingles vaccine but failure to receive it
Perimenopause or menopause, which can impact immune response

It’s worth noting that many individuals develop this painful rash. don’t necessarily fit into these risk categories.

Pregancy and shingles

Experiencing shingles during pregnancy is uncommon, but if you suspect you have it while pregnant, it’s crucial to consult your doctor immediately. Fortunately, antiviral medications are safe to use during pregnancy and can help shorten the duration of the illness. Starting antiviral treatment as soon as possible enhances its effectiveness.

While research on this painful rash during pregnancy remains limited, there’s currently no data indicating whether it increases the risk of miscarriage or complications such as preterm birth. Similarly, studies examining the link between shingles and birth defects are scarce, with no evidence suggesting that a shingles outbreak heightens the likelihood of your baby developing birth defects. Moreover, there’s no research demonstrating whether this painful rash during pregnancy might lead to learning or behavioral issues for the child later in life.

Furthermore, there’s no evidence indicating that this painful rash impacts your ability to conceive.

If you develop this painful rash while breastfeeding, it’s important to prevent your baby from coming into contact with the rash. Although the shingles virus isn’t known to appear in breast milk, infants can contract chickenpox from exposure to the blisters since both chickenpox and shingles stem from the same virus. If you develop a rash on your nipples, it’s advisable to pump and discard the breast milk. Once the blisters have scabbed over, it’s safe to resume nursing. If you’re undergoing antiviral treatment for shingles, consult your doctor regarding breastfeeding compatibility.

Complications of shingles

Shingles isn’t just a brief inconvenience; it can lead to lasting complications even after the rash fades away. Here’s what you need to know:

Persistent Pain and Nerve Damage: The painful rash of small blisters characteristic of shingles can endure for months or even years. This persistent discomfort can result in nerve damage and scarring. Although there’s no cure, a vaccine is available that may help prevent shingles.
Long-Term Complications: Even after the rash disappears, shingles can cause enduring complications, including:
- Brain inflammation or facial paralysis if certain nerves are affected
- Eye problems and potential vision loss if the rash occurred around the eye
- Postherpetic neuralgia, a condition where pain lingers long after the outbreak. This affects up to 1 in 5 individuals who contract shingles and is more prevalent among older individuals.
- Risk of bacterial infection in the rash area
Rare but Serious Complications: While uncommon, shingles can lead to severe complications such as lung infection, hearing loss, and in rare cases, even death.

Is this painful rash contagious?

Regarding its contagiousness, shingles can spread the varicella-zoster virus to individuals who have never had chickenpox or haven’t been vaccinated against it. The contagious period lasts until all the sores have crusted over. During this time, it’s essential to avoid contact with pregnant women who may not have immunity to chickenpox, individuals with weakened immune systems, and newborns. Taking precautions during this contagious period is crucial to preventing the spread of the virus to vulnerable individuals.

Shingles vaccine

To safeguard against this painful rash and its potential complications, the Centers for Disease Control and Prevention (CDC) advocate for the Shingrix vaccine. Here’s what you need to know:

What is the dosage of the vaccine? The CDC recommends two doses of Shingrix for healthy adults aged 50 and above. It’s also advised for individuals aged 19 and older with weakened immune systems due to illness or treatment.
Administration: You can receive the Shingrix vaccine at your pharmacy or doctor’s office, with the injection administered into your upper arm. For healthy adults aged 50 or older, the second dose should be administered 2-6 months after the initial vaccination. If you’re younger and getting vaccinated due to weakened immunity, the second dose can be given 1-2 months following the first.
Who Should Get Vaccinated: It’s recommended to receive the Shingrix vaccine even if you:

Have previously had shingles
Received the earlier vaccine, Zostavax (now off the market)
Received the chickenpox vaccine
Aren’t sure if you’ve had chickenpox, particularly if you were born before 1980 (as most individuals in the U.S. have likely had it)

Who Should Avoid Vaccination? You shouldn’t receive the Shingrix vaccine if you:

Experienced an allergic reaction to any components of the vaccine or to your first dose of Shingrix
Currently have shingles (wait until the virus clears)
Are pregnant

Vaccination Timing: While it’s generally safe to receive the Shingrix vaccine while experiencing minor illnesses like a cold, it’s advisable to postpone vaccination if you’re suffering from a more severe illness, even in the absence of a fever.
Effectiveness and Protection: While the Shingrix vaccine doesn’t guarantee complete immunity, it significantly reduces the risk of shingles. It’s approximately 97% effective in preventing shingles among healthy adults aged 50-69, and 91% effective for older adults. Even if shingles still occurs post-vaccination, the vaccine can help mitigate the risk of postherpetic neuralgia, the most common long-term complication of shingles.
Effectiveness for Those with Compromised Immune Systems: Among individuals with compromised immune systems, such as those with underlying health conditions, the effectiveness rate ranges from 61% to 91%, depending on individual health factors.

Overall, the Shingrix vaccine offers substantial protection against shingles and its potential complications, providing an essential preventive measure for adults, especially those at higher risk.

Side effects of the vaccine

Yes, while Shingrix is generally safe, it can cause some side effects, usually lasting 2-3 days. These side effects might affect your ability to carry out normal activities. Here are some potential side effects:

Tiredness: Feeling fatigued or exhausted.
Headache: Experiencing discomfort or pain in the head.
Muscle Pain: Feeling soreness or discomfort in the muscles.
Shivering: Experiencing episodes of trembling or shivering.
Fever: A mild increase in body temperature.
Upset Stomach and Nausea: Feeling queasy or experiencing digestive discomfort.
Arm Soreness: Your arm might feel sore for a day or two after receiving the vaccine. Some individuals may also experience redness and swelling at the injection site.

Side effects can occur after the first dose, the second dose, or both. Over-the-counter pain relievers like acetaminophen or ibuprofen can help alleviate these symptoms.

It’s important to note that, while rare, some individuals may develop Guillain-Barré syndrome, a nervous system illness, after receiving the shingles vaccine.

Diagnosis

Diagnosing this painful rash involves a combination of medical history, symptom assessment, and physical examination by your doctor. Additionally, your doctor may collect a small sample of fluid from your blisters for further testing to confirm the diagnosis.

Treatments

Treating shingles involves a combination of antiviral medications to combat the virus and various pain management strategies to alleviate discomfort. Here’s what you need to know about shingles treatment:

Antiviral Drugs: These medications help accelerate healing and reduce the risk of complications associated with shingles. They are most effective when taken within 3 days of the rash appearing, so it’s crucial to seek medical attention promptly. Common antiviral drugs prescribed for shingles include:

Acyclovir (Zovirax)
Famciclovir (Famvir)
Valacyclovir (Valtrex)

Pain Management: Managing the pain associated with shingles is essential for comfort and recovery. Various medications and treatments can help alleviate discomfort, including:

Anticonvulsant medicines like gabapentin (Neurontin)
Medicated lotions
Numbing medications such as lidocaine
Over-the-counter drugs like acetaminophen or ibuprofen
Prescription painkillers such as codeine
Tricyclic antidepressants like amitriptyline
Topical patches containing capsaicin, the active component in cayenne pepper
Injections of steroids and local anesthetics

Home Remedies

Home and over-the-counter remedies can also provide relief from shingles symptoms. These include:

Cold compresses
Calamine lotion
Oatmeal baths to soothe itching caused by the rash

Duration of Shingles

In most cases, shingles typically last between 2 and 6 weeks. However, it’s essential to complete the prescribed course of antiviral medication and follow your doctor’s recommendations for pain management to ensure a smoother recovery.

It’s worth noting that while most individuals experience shingles only once, it can recur, especially in individuals with weakened immune systems. Therefore, maintaining overall health and immunity is crucial for preventing recurrent episodes of shingles.

Prevention

Preventing shingles is crucial for avoiding the painful rash and potential complications. Here’s what you can do to protect yourself:

Shingrix Vaccine: The most effective method for preventing shingles is the Shingrix vaccine. It’s recommended for adults aged 50 and older, as well as individuals with weakened immune systems. Getting two doses of the vaccine significantly reduces the risk of developing shingles and its associated complications.
Avoiding Exposure: If you’ve never had chickenpox or haven’t been vaccinated against it, steer clear of individuals with active cases of chickenpox or shingles. Direct contact with fluid from the blisters or particles emitted by the blisters can transmit the varicella-zoster virus, potentially leading to chickenpox and increasing the risk of shingles later in life.
Preventing Spread: If you have shingles or chickenpox, take measures to prevent spreading the virus:

Cover the rash to avoid direct contact.
Refrain from scratching or touching the rash, as this can exacerbate symptoms and facilitate virus transmission.
Practice frequent handwashing for at least 20 seconds to reduce the risk of spreading the virus.
Avoid contact with individuals who may be more vulnerable to complications, such as pregnant women, newborns, and those with weakened immune systems.

Remember these key points:

Shingles and chickenpox stem from the same virus.
After having chickenpox, the virus can lie dormant in your body and resurface later as shingles.
Risk factors for shingles include age (over 50), weakened immune system, and high stress levels. Perimenopause and menopause also increase risk.
Antiviral drugs can help shorten the duration of shingles outbreaks and provide relief from symptoms.
If you’ve had shingles before, you can still benefit from the shingles vaccine to prevent future outbreaks.

Shingles FAQs:

Is shingles caused by stress?: While shingles is caused by the varicella-zoster virus, stress can trigger an outbreak.
Do I need the shingles vaccine if I’ve already had shingles?: Yes, previous shingles episodes don’t guarantee immunity from future outbreaks. The vaccine is the most effective preventive measure.
Is it OK to leave shingles untreated?: It’s advisable to seek medical attention if you have shingles. While most cases resolve within 2-6 weeks, untreated shingles can lead to complications such as vision loss, brain inflammation, and even death. Antiviral drugs can help alleviate symptoms and shorten the duration of the illness.

Sources

National Institutes of Health
American Academy of Family Physicians
National Institute of Neurologic Disorders and Stroke
The New England Journal of Medicine
American Academy of Dermatology
Johns Hopkins Medicine
Center for Disease Control (CDC)
Mayo Clinic
Drug Safety
Detroit Medical Center
Mother to Baby Fact Sheets: Herpes Zoster, National Library of Medicine publishing, 2023.
Cleveland Clinic
Brigham and Women’s Hospital
American Academy of Ophthalmology
Montana Department of Public Health and Human Services
Nair, P., Patel, B. Herpes Zoster, StatPearls Publishing, 2023.