An Expert's Perspective on Preventing and Treating Shingles
As an internal medicine physician who has had shingles myself, I urge my patients to do what they can to prevent it. If they’ve already developed shingles, it’s important to recognize the symptoms and see a doctor as soon as possible, because early diagnosis and treatment can make a big difference. Here’s what I want people to know about preventing and managing shingles.
A: Shingles is caused by the same virus that causes chickenpox, so anyone who has had chickenpox can develop shingles. After your chickenpox goes away, the virus lies dormant in your body until one day, it can pop back up in the form of shingles.
It’s a painful experience that can last from 2-6 weeks. It typically manifests as a rash that occurs on one side of your body. Many people feel a numbing, burning, or tingling sensation before the shingles rash appears. When I developed the condition, I felt a numbing sensation down my leg, and as I thought about it more, I began to wonder if I had shingles. Sure enough, the next day I developed a rash.
The rash is usually red on lighter skin and can show up as red or hyperpigmented on darker skin. It also consists of fluid-filled bumps called vesicles – they are the telltale signs of shingles. The rash can be painful, burning, tingly, and itchy. You might also experience nerve pain. Some people have headaches, fevers, chills, or an upset stomach. The earlier you recognize it, the better, because starting treatment early can help you avoid more severe symptoms.
People who develop shingles are also at risk of a condition called postherpetic neuralgia (PHN), which is continued pain after a shingles infection due to peripheral nerve damage. This condition is really painful, so it’s best to do what you can to avoid getting shingles in the first place.
A: Shingles is treated with antiviral medications like acyclovir, valacyclovir, or famciclovir. Also, your physician may suggest a pain reliever such as ibuprofen, acetaminophen, codeine, or numbing agents such as lidocaine. They may also prescribe capsaicin ointment to help with the rash pain after blisters have crusted over, and gabapentin or amitriptyline to help with the nerve pain.
At home, you can take an oatmeal bath to find relief. A cold compress can help with pain and itchiness. After your blisters have crusted over, you can try calamine lotion to relieve the itching, as well.
If your shingles rash or pain spreads to your face, go to an emergency department as soon as possible. When shingles affects the face, especially the eyes, this is a medical emergency; there can be serious complications, including blindness or encephalitis, which is brain inflammation. The emergency doctors can administer antiviral medications through an IV so they work faster and more effectively.
A: By getting the shingles vaccine, you can significantly improve your chances of avoiding shingles. The shingles vaccine is 97% effective at preventing shingles in adults 50-69 years old with healthy immune systems. It’s 91% effective at preventing shingles in adults 70 years or older. And it’s between 68 and 91% effective in preventing shingles in adults with weakened immune systems, depending on their underlying health condition.
Anyone who is over the age of 50 or who is immunocompromised should get the shingles vaccine, except for people who are allergic to its ingredients or those who are pregnant. It’s not a live vaccine; it contains components of the virus, which your immune system uses to build your immunity against shingles. If you’ve had shingles before, you should still get the vaccine, because it is possible to develop it again. It consists of two doses 2-6 months apart. People with weakened immune systems can get their second dose 1-2 months after their first shot.
Side effects of the vaccine are minimal; some people may experience pain at the injection site, or redness and swelling in their arm. You might feel tired or develop headaches, stomach pain, or nausea, but these symptoms usually go away after 2-3 days. As with any vaccine, there are rare, more serious complications, like an allergic reaction or Guillain-Barré syndrome (GBS), but it’s important to note that having shingles also raises your risk of GBS.
A: If you had chickenpox, you’re at risk of shingles. Even if you didn’t have chickenpox, you can get shingles if you’re exposed to it by someone with an active case. It’s important to note that some people have a higher risk than others. The dormant virus can become activated again when you have a weakened immune system. It usually affects older adults because their immune systems aren’t as strong as they once were, but stress can also weaken the immune system and allow shingles to develop. I was in my 30s when I had shingles, and it was triggered by stress. Also, people who are immunocompromised due to a medication or a health condition like cancer or HIV are also at a higher risk of developing the virus.
A: Typically, in an annual physical, I’ll talk to patients about screenings like mammograms and colonoscopies, as well as their vaccines. Adults don’t need many vaccines; the big three are the TDAP vaccine to prevent tetanus, diphtheria, and pertussis, as well as the pneumonia vaccine and the shingles vaccine. I also recommend that people get their annual flu shot as well as stay current with COVID-19 vaccines and boosters. If your doctor hasn’t mentioned any of these vaccines to you, don’t be afraid to bring them up yourself.
If you’re immunocompromised, it’s especially important to discuss the shingles vaccine with your doctor; you don’t want to just go to the pharmacy and get it without a discussion. Tell your doctor you’ve learned you’re at high risk of shingles due to your health condition or medication, and see what their recommendation is. There may be certain factors to consider, but for the most part, it’s a good idea to do whatever you can to prevent shingles.