Many of us have heard the term “shingles.” Some people think it is chickenpox, while others may think it is herpes. Some people remember a parent or a grandparent having a very painful rash. Shingles is a term I use often in my practice where diagnose and treat shingles.
So What Is Shingles?
Shingles is a localized painful blister rash that is described as needles, pins and sharp or shooting pain caused by a germ called varicella-zoster virus which is the same virus that causes chickenpox. Virus is a type of a germ that we cannot cure but your body has to suppress or resolve it using your immune system. So once you have chickenpox, the virus stays dormant (quiet) in your nerve tissues and REactivate when your immune system gets weakened. So you never really get cured of the varicella-zoster virus.
Who Is At Risk of Getting Shingles?
If you had chickenpox at some point in your life, you are at risk as the virus is dormant in your body and may reactivate when your immune system is weakened like when you are older, sick, stressed, or tired. Also, having medical conditions such as diabetes, cancer, HIV, pregnancy, or taking medications for autoimmune diseases that lower your immunity, can decrease your ability to fight infections and increase your risk of developing shingles.
How Do I Know If I Have Shingles?
- If you have a new numbness, tingling or burning pain on your skin, it may be shingles. So you may have normal appearing skin but just the pain.
- If you have painful blisters or rash on your skin, it may be shingles. Sometimes the rash does not look blister-like until it is more advanced. See below two pictures to compare the differences but they can both be shingles.
- Some people may have change in their vision, swelling of the eye, redness of the eye, sensitivity to light, hearing change or ear pain if the shingles develop near the nerve cells of your eyes or ears. Early treatment can help save your vision and your hearing.
Very rarely, shingles can also cause lung infection and brain infection but it is best to seek for medical care immediately if you feel change in your breathing or mentation.
What Should I Do If I Get Shingles?
- Seek medical care immediately.
- Avoid direct contact.
The varicella-zoster virus is commonly spread through direct contact with the fluid from shingles blisters. Although rare, it can also be transmitted by breathing in virus particles that become airborne from the blisters. If you are in contact with someone who already had chicken pox, you are not going to transmit chicken pox or shingles rash. However, if you are in contact with someone who never had chicken pox or have lower immunity, then you can transmit the virus to that person which can cause chicken pox infection. Infants (less than 12 months of age) are at higher risk, especially if they are premature, have a low birth weight, or are newborns.
- Remember, there is treatment for shingles.
What Can Be Done For Shingles?
There are effective treatments your doctor can provide if you seek for help right away.
The prescription medication can be started within 2-3 days of shingles rash can really help to decrease the pain level, amount of rash you may get and decrease your risk of developing a chronic nerve pain condition called postherpetic neuralgia. For this reason, your doctor may prescribe you a temporary nerve pain medication to take while you recover from shingles.
If you have symptoms on your eyes, or have other alarming symptoms like confusion, change in your mentation, difficulty breathing, your doctor may send you to a specialist or send you to the emergency room. So, seek for medical attention immediately if you think you have shingles.
Most of my patients with shingles remember their first episodes. It is painful and alarming. They have fears of giving it to their family. Remember, they are not at higher risk of getting shingles from you but they are only risk of developing chickenpox if they are not immune or never had chicken pox. But covering the blister and washing hands effectively can help. Avoid direct contact with pregnant women who have never had chickenpox or the vaccine, newborn infants, and people with weakened immune systems because they are at higher risk of developing chickenpox and complications if exposed to the virus from your shingles rash. Having well-ventilated home (like opening window) can help decrease aerated virus contact. Once the blister rash scabs in 2-5 weeks, your risk of transmitting to others is very low.
How Do You Prevent Shingles?
Not getting chickenpox is unrealistic. Most of the older people had natural chickenpox infection when they were at a children’s age. In the United States of America today, many children receive the weakened live chickenpox vaccine, which provides protection without having to experience the actual infection.
So most people may end up getting shingles infection as they get older or have lower immunity. However, keeping your immune health at the optimal level with healthy lifestyle, rest, stress management and regular health check-up are helpful ways to prevent shingles. When you are stressed, tired or not balanced in your overall wellbeing, your immune system can be low putting you at risk for shingles. So as you see yourself as a whole person, objectively review where you are in your health. If you have been eating unhealthy, it’s an opportunity to make a healthy meal. If you have been stressed about your work, it’s an opportunity to sit back and prioritize your time and efforts. If you have been a busy mom with long days, it’s time to get some alone time or sleep to recharge. If you have been feeling low, nervous or lonely, it’s an opportunity reach out to your community or seek for a professional help. Please allow your family, friends, community, and healthcare team the opportunity to support you when you need it.
Additional way to prevent shingles is a recombinant zoster vaccine. If you are over 50 or younger with certain medical conditions that cause you to have lower immunity, you qualify for the vaccine. One may say, “I already have immunity to chickenpox but why should I?” The reason is because your immune cells need a reminder that they need to have immune cells against varicella-zoster virus after so many years of “not fighting against” it. So the vaccine is a booster to your immune system to make more defensive and offensive soldiers against the varicella-zoster virus when it reactivates. Many children in America are vaccinated for chickenpox vs. getting the actual infection, so getting a booster when they are older is another important ways to prevent future shingles.
Current shingles vaccine available in the United States is called Shingrix, which does NOT have live virus so many people can receive it without fearing for actual infection happening from the vaccine. It is more effective when you are vaccinated younger than older but it is > 90% effective even when you are older than age 70 (MMWR, 2018;67:103-8). 2 doses are given about 2-6 months apart. The vaccine is well tolerated but local side effects are real. Many of my patients get noticeable swelling and pain at the injection site but still able to do daily activities. So be mindful of your plans prior to the shingles vaccine. Another tip I would like to share is that you can get shingles vaccine at local pharmacies. Please bring your vaccine records to your doctor after you received it. The vaccine boosts your immune system’s memory against the virus, making it much better prepared to prevent shingles or reduce its severity. So, I would encourage you to speak to you doctor about your risk for shingles and if you would benefit to get the shingles vaccine.
Final Thought
Shingles is common. Many people had chickenpox in the world and are at risk of shingles. Keep your immune system healthy by regular check-up with your doctor and through healthy lifestyle. Good hand hygiene is a great and effective practice to keep your body healthy. Available shingles vaccine would also decrease your risk of shingles. However, if shingles happen, please get medical care as soon as possible. Effective treatments are available. Discuss with your doctor about shingles. Learn your risks, and opportunities to prevent and decrease your risk of getting shingles. And always remember that shingles can be diagnosed, treated and prevented.
