If you’ve had chickenpox, you’re at risk for getting shingles.
Shingles (herpes zoster) is an outbreak of blisters by the same virus that causes chickenpox, the varicella-zoster virus (VZV). After getting over the chickenpox, the virus remains dormant in the body. Doctors don’t know why the virus suddenly reactivates years later.
It is estimated that one out of every three Americans will develop shingles. Half of the shingles cases occur in people 60 and older.
The scientific research suggests that women are more likely to get shingles than men and that blacks are less likely to get shingles, by more than 50%. There is also a higher risk in those with immune system disorders like leukemia and HIV, and in those taking drugs that suppress the immune system, for example, after organ transplants.
Shingles start as an itchy or burning pain, which can be severe. As someone who dealt with multiple outbreaks of shingles, this initial pain for my first episode felt like someone rubbing broken glass over badly sunburned skin. Most often this pain, and the later rash and blisters, occur on one side of the face or body in bands at specific locations:
- On one side of the head, from the eye over the crown to the middle of the head at the back.
- One side of the neck to the top of the shoulder blade, and down to the shoulder joint.
- On one side of the chest, from the middle of the sternum around the torso to the middle of the spine.
- On one side of the abdomen starting about the belly button and around the torso to the middle of the spine.
About 20% of people who get shingles get the rash and blisters on both sides of the body, less commonly, in two or more of the bands.
Several days after the pain starts, the rash and fluid-filled blisters appear. Pain can be mild to severe. Some suffer just an itch. In others, the slightest touch causes extreme pain. One doctor told me that he had a patient who considered suicide because of the intense pain. The rash and blisters can be accompanied by fever, chills, headache, and upset stomach.
Shingles cannot be transmitted to another person, but the varicella-zoster virus can spread and cause chickenpox in someone who has never had chickenpox or has not been vaccinated against chickenpox. Transmission is only possible when blisters occur because the virus is in the fluid. Those with active shingles should avoid pregnant women who have not had chickenpox or the chickenpox vaccine, premature or low birth weight babies, and people with weakened immune systems.
Shingles usually clear up in two to four weeks, though there can be some serious lasting complications:
- If the varicella-zoster virus enters the eye, it can cause blindness.
- Post-herpetic neuralgia (PHN), where severe pain continues in the area of the shingles once the rash is gone. PHN pain can be severe. It usually goes away within a few months, but some people can have the pain for many years. The older a person who gets shingles is, the more likely they are to develop PHN, and the more likely the pain will be severe. PHN is rare in people under 40 but occurs in up to a third of those 60 and older.
Most people have only one outbreak of shingles, though there can be multiple outbreaks at random intervals. In my own bouts with shingles, these subsequent outbreaks become less and less severe.
The antiviral drugs acyclovir, valacyclovir, and famciclovir are used to treat shingles and shorten the duration and severity of the illness. However, these need to be taken early, at the first appearance of the rash and before the blisters develop to be effective. The longer into the shingles outbreak the drugs are started, the less effective they will be.
Analgesic drugs (painkillers) can help with the pain that accompanies shingles. These include acetaminophen, aspirin, ibuprofen, COX2 inhibitors, and opioids. Calamine lotion and oatmeal baths may help with the itching.
The only current way to reduce the risk of shingles and PHN is the zoster vaccine (Zostavax), and the recently approved Shingrix vaccine. The CDC recommends that everyone over age 60 get one dose of the vaccine, even those who have already had shingles since it can lessen the severity of the illness. Clinical trials showed the vaccine reduced the risk of shingles by about 50%. Even if it does not prevent shingles, it still reduces the risk of having long-term pain.