Shingles: Prevention and Treatment

Shingles, or herpes zoster, is a viral infection that causes a painful rash and can occur in anyone that has had chickenpox. They're caused by the same virus, the varicella zoster virus (VZV), which remains inactive in the body for life after recovery from chickenpox. It can reactivate years or even decades later in anyone who has had chickenpox, causing shingles. Medical professionals are still uncertain why this happens.

The Facts About Shingles

Shingles is rarely talked about, but surprisingly common:

• Nearly 1 out of 3 Americans will develop shingles in their lifetime.
• 1 million cases of shingles occur each year in America.
• About half of all patients diagnosed with shingles are 60 or older.
• 98% of American adults have had chickenpox.

Even children can get shingles if they've had chickenpox previously, but the risk of getting it increases as you age. Other risk factors include:

• Medical conditions that compromise the immune system: HIV, certain cancers like lymphoma or leukemia.
• Taking immunosuppressive drugs: steroids, chemotherapy, drugs given after organ transplants.

Most people who have an episode of shingles only have one in their lifetime, but second or even third episodes are possible.

Shingles Symptoms

Shingles is characterized by a painful rash that develops on one side of the face or body, most commonly in a single stripe on the left or right side of the body. It can also occur on one side of the face, where it can affect the eye and cause temporary loss of vision.

Shingles usually occurs in distinct stages:

1. Non-visible symptoms can start 1-5 days before the characteristic rash. These may include fever, headache, chills, nausea, uneasiness, light sensitivity, and unusual skin sensations or pain (preherpetic neuralgia).
2. The rash develops, going from clear vesicles to postulation, ulceration, and blistering over 2-3 days. This rash is typically painful.
3. The blistering scabs over after 7-10 days.
4. The rash disappears after 2-4 weeks, although scarring and pigmentation may remain.

Complications may occur as a result of shingles, largely dependent on where the virus has spread. The most common complication is postherpetic neuralgia (PHN), which is severe pain in the rash's area long after the rash has cleared up. This usually resolves after weeks or months but can sometimes last for years. It occurs in 10-13% of shingles patients and almost always in patients above 40 years old, with incidence rates increasing with age.

Prevention and Treatment

You cannot catch shingles from someone who has it, but a shingles patient can transfer chickenpox to someone who has never been infected with it or received the chickenpox vaccine. To prevent spreading the virus:

• Cover the shingles rash.
• Avoid touching or scratching the rash.
• Practice regular, proper hand washing.
• Avoid contact with pregnant women who have never had chickenpox or its vaccine, premature or low weight infants, and immunocompromised people.

Prevention is possible through the shingles vaccine Shingrix, which the CDC recommends to adults over 50.

Treatment is about reducing the severity and length of the disease, as well as managing its effects. Options include:

• Antiviral medicines to manage the disease itself, which should be taken as soon as shingles is diagnosed: these can lessen the intensity of pain as well as the development of the rash and blistering.
• Gabapentin or other nerve pain medications to manage the pain of postherpetic neuralgia.
• Analgesics or numbing agents to relieve pain.
• Topical creams and lotions to alleviate pain and itching.