What to Know About Shingles

Symptoms of Shingles

Pain is typically the first symptom of shingles. A red rash may appear several days after the pain begins, but not everyone will experience a rash. Without the rash, some people may mistake the pain for heart, lung or kidney problems.

Shingles symptoms usually affect a small area on a single side of the face or body and last two to six weeks. Common symptoms include:

• Fluid-filled blisters that break open and crust over
• Intense pain, itching and burning
• Sensitivity to touch

You may also experience:

• Fatigue
• Fever and chills
• Headache
• Sensitivity to light
• Upset stomach

Causes of Shingles

Dr. Parikh explained that after chickenpox, the varicella-zoster virus remains inactive in the body. Sometimes, the virus reactivates, and you can develop shingles. The virus does not reactivate in everyone who has had chickenpox. Physicians do not fully understand why some people develop shingles while others do not.

Shingles Treatment

“Medication can help reduce the length and severity of shingles if started early,” said Dr. Parikh. “Talk to your primary care physician as soon as you notice symptoms.”

Antiviral medications that treat shingles include:

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

Calamine lotion or an oatmeal bath can soothe the itch and irritation from the shingles rash. Over-the-counter medication such as acetaminophen or ibuprofen can help relieve pain. If you have severe pain, your physician may prescribe medication that reduces inflammation, such as a corticosteroid.

For most people, the rash will start to scab within 7 to 10 days. It usually takes two to four weeks for the rash to subside. 

Until the rash clears, the following tips can help to ease some of the symptoms and prevent infection:

• Wash the rash with a fragrance-free cleanser and make sure it is completely dry
• Apply a thin layer of petroleum jelly to the rash
• Cover the rash with a nonstick dressing to protect it from bacteria and prevent others from coming in contact with it
• Wash your hands after touching the rash

Avoid scratching the rash to prevent infection or scarring. If the rash causes discomfort, you can apply a cool towel to the area to soothe the itch. Wear loose-fitting clothing to avoid irritation. Until the rash has gone away completely, keep it covered and avoid being around people, so you don't spread the virus. 

Risk Factors for Shingles

Anyone who has had chickenpox is at risk of developing shingles. However, your risk increases as you age and your immune system becomes less effective. It is rare to get shingles before age 40. Shingles typically occurs in adults 50 and older. Children can have shingles, but it is uncommon.

You also have a higher risk of developing shingles if you:

• Are undergoing chemotherapy or radiation for cancer treatment
• Have medical conditions that keep your immune system from working correctly, such as certain cancers or HIV
• Take drugs or medication that keep your immune system working, such as steroids or drugs to prevent rejection of transplanted organs

Is Shingles Contagious?

“You cannot get shingles from someone who has shingles,” said Dr. Parikh.  If you have shingles, however, you can infect someone with chickenpox if they never had the virus.  

He noted that people with chickenpox are more likely to spread VZV than those with shingles. If you have shingles, you can spread the virus to others until your rash scabs over. Avoid physical contact with others and keep the rash covered.

Exposure to shingles is especially dangerous for:

• Pregnant women who have not had chickenpox or the vaccine
• Newborns or low birth-weight babies
• Anyone with a compromised immune system, including:
  • Organ transplant recipients
  • People undergoing treatment for cancer
  • People with HIV

Complications of Shingles

Shingles affects the nervous system and can cause serious complications including:

• Encephalitis (brain inflammation)
• Facial paralysis
• Hearing and balance problems

The most common complication of shingles is long-term nerve pain. One in five people experience postherpetic neuralgia, a condition that causes damaged nerves to send incorrect pain messages from your skin to your brain. Nerve damage can cause issues for months or even years after the shingles rash heals. Medication can decrease the pain associated with postherpetic neuralgia.

Vision loss can also occur if you contract shingles in or around your eye. You can develop a bacterial skin infection if you do not take an antiviral medication to treat shingles blisters.

When should I see my physician?

“Call your physician or a dermatologist immediately if you think you have shingles,” said Dr. Parikh.

Starting treatment within three days of developing a rash can help prevent possible complications. Receiving treatment after three days can still be beneficial, so you should see a physician if you have had a rash for more than three days. Before taking any medication, make sure you have a diagnosis of shingles.

The following situations can lead to a serious case of shingles if left untreated:

• The rash is near your eye. If you do not treat the rash, it can cause permanent eye damage
• The rash is widespread and painful
• You are older than 50 (the risk of complications increases with age)
• You or someone you live with has a weak immune system

Can I get shingles more than once?

Although uncommon, it is possible to get shingles more than once. VZV remains in the body even after someone recovers from chickenpox. It can lie dormant before reactivating as shingles years or decades later.

Recurrent shingles—shingles that returns more than once—is more common among people with weakened immune systems.

Risk factors for recurrent shingles include:

• Cancer
• HIV
• Medication that suppresses the immune system
• Re-exposure to VZV
• Stress
• Underlying health conditions

Should I get the shingles vaccine?

The best way to prevent shingles is to get vaccinated.

The CDC recommends two doses of recombinant zoster vaccine (RZV, Shingrix) to prevent shingles and related complications in adults 50 and older. The two doses are commonly scheduled two to six months apart.  The Shingrix vaccine is also recommended for adults age 18 and older with weakened immune systems due to disease or therapy.

Speak with your physician to determine if the vaccine is right for you. You should not get the Shingrix vaccine if you:

• Are pregnant
• Currently have shingles
• Have had a severe allergic reaction to any component of the vaccine in the past

In addition to getting a shingles vaccine, you can keep your immune system strong by staying active and eating a healthy diet.