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Shingles, A Painful Rash Lying In Wait

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Sam Altstein, DO
Medical Director, Mount Sinai Doctors
Assistant Professor of Family Medicine and Community Health
Icahn School of Medicine at Mount Sinai

Shingles, a Painful Rash Lying in Wait

Red bumps, blisters, and pain: These are the symptoms that about one million Americans will suffer this year when they develop the viral infection commonly known as shingles. The Centers for Disease Control and Prevention (CDC) estimates that 30 percent of people in this country will experience shingles during their lifetime. But what exactly is shingles, and what can you do to protect yourself?

What is shingles?

Shingles is an infection caused by the reactivation of the varicella-zoster virus, the same virus that causes chicken pox. It can occur in people who had chicken pox when they were younger, and in those who have received the chicken pox vaccine. (The vaccine, which contains a weakened version of the virus, has been part of the childhood immunization schedule since 1995.)

After a chicken pox infection or vaccination, the virus sometimes retreats to the body's nervous system, hibernating inside small sensory nerves that come off the base of the spine. These nerves relay sensation from the skin's surface to the brain. The virus can lie dormant there for years, often decades. If it reactivates and begins to replicate, you will get shingles on the area of the body served by the nerves in which the virus was residing.

Who gets shingles?

You can get shingles only if you have been exposed to the varicella-zoster virus; people who have never had chicken pox or gotten the vaccine will not develop shingles. Shingles can occur at any age among people at risk, but those over 50 are much more likely to get it because the level of antibodies that protect them against the virus declines with age. This decrease in defenses can allow the virus to reactivate. That's why people whose immune systems are weakened due to cancer, certain medications, or HIV infection are also more likely to develop shingles.

What are the signs and symptoms of shingles?

Commonly found on one side of the body and lasting two to four weeks, a shingles rash starts with red bumps that evolve into vesicles, or blisters. It usually appears on the trunk (between your shoulders and waist). It occurs less often on the face, but infection near the eye can cause vision changes or permanent vision loss on the affected side, and shingles inside the ear can lead to hearing loss. Unlike chicken pox, which may be irritating or itchy, a hallmark of shingles is burning or stabbing pain that ranges from mild to excruciating.

Can shingles be prevented?

Yes. The single thing you can do to prevent shingles is get a shingles vaccine, which a large study has shown to significantly reduce one's risk for this disease. The vaccine was found most effective in individuals age 60 to 69. That's why CDC guidelines recommend that people receive this one-time shot at age 60 or older (unless you have a condition for which it is contraindicated, as specified in the guidelines). You should get it even if you think you've never had chicken pox, as most people over 40 have had this childhood disease, even those who don't recall it.

If you do get shingles despite being vaccinated, the vaccine will protect you against postherpetic neuralgia, a complication characterized by pain that lingers in the rash area longer than 90 days after the rash first appeared.

Should you be vaccinated if you've already had shingles?

Getting shingles more than once is rare but not unheard of, so even if you have already had shingles and are unvaccinated, you should still get the vaccine to help prevent future episodes. Talk to your health care provider about the best time for vaccination--it's best not to get it during an active shingles infection.

When should you see a doctor for shingles?

You should see a primary care doctor or dermatologist as soon as possible after noticing signs of shingles because effective treatment depends on beginning antiviral therapy within 72 hours of rash development. Sometimes people feel shingles-related pain days or even weeks before the rash appears, so if you have unusual skin pain on one side of your body, make an appointment; sometimes astute doctors can pick up on a shingles syndrome before the rash occurs.

How is shingles treated?

Primary treatment consists of oral antiviral therapy. Being diagnosed early and starting valacyclovir, acyclovir, or famciclovir within 72 hours of the onset of symptoms can speed healing, reduce acute pain, and lessen your chances of developing postherpetic neuralgia.

During an episode of shingles, it's important to keep the affected area clean and dry, and applying a drying agent like calamine lotion may help alleviate discomfort. Mild pain can be managed with over-the-counter pain relievers like acetaminophen or ibuprofen, but patients with extreme pain may need a short course of prescription opioid painkillers. If the rash looks infected, your doctor may also prescribe a topical or oral antibiotic.

Is shingles contagious?

The rash is infectious only in its blister phase. It should be covered during this stage to reduce the risk of transmitting the varicella virus to people who have never been exposed to it. If these people catch the virus, they will get chicken pox and be at risk for shingles later in life. It is especially important to avoid contact with pregnant women and people with compromised immune systems who have never had a chicken pox infection or vaccination, as they are at risk for serious complications.

The blisters usually last about 7 to 10 days from onset to resolution. Once they are crusty and dry, you are no longer contagious.

While shingles is rarely life-threatening, it can be very painful, and, if contracted around the eyes or ears, can cause permanent damage. That's why it is important to be vigilant for symptoms and seek immediate treatment. And people age 60 or older should be sure to get the shingles vaccine, either at their doctor's office or pharmacy.