Dear Alice,

What are shingles?

— CW

Dear CW,

Shingles, also known as herpes zoster, is a viral infection that affects approximately one third of Americans. The virus typically causes an itchy or painful skin rash of small, fluid-filled blisters. Eventually, the blisters dry out, form a crust, and sometimes leave behind scars. Interestingly, shingles is caused by a re-activation (or “awakening”) of the varicella-zoster virus in the body, the same virus that causes the chickenpox (more on that later). The condition is very contagious and can spread through direct physical contact with open sores or blisters, not just to other parts of the affected person’s body, but to those around them who’ve never been vaccinated or have never been exposed to the virus. It’s highly recommended that anyone who suspects they may have shingles to seek medical attention as soon as possible, as the condition can result in serious health issues if left untreated. Thankfully, only one out of three people with shingles might experience complications or severe symptoms, including nerve pain. 

So, what’s the difference between shingles and chickenpox if they’re caused by the same virus? Usually, most varicella-zoster viral particles are destroyed by a person’s immune system following a chickenpox infection. For most people in the U.S. this happens in childhood. However, some of these particles can remain dormant (or inactive) in the body for years, re-activating later on in life to cause a shingles outbreak during a time of weakened immunity. This is why shingles outbreaks are more likely to occur among individuals with chronic illnesses or compromised immune systems, people taking immunosuppressive drugs, and those over the age of 50. In fact, half of all shingles cases occur in people 60 years of age or older as age is the most relevant risk factor for developing shingles. While multiple outbreaks of shingles are fairly rare, the risk of recurrence is higher in immunocompromised individuals.

Knowing what to look out for can not only help folks seek treatment early, but it can also prevent transmission to others. Symptoms of shingles may include:

  • Red, itchy rash with fluid-filled blisters, often on one side of the abdomen or near an eye
  • Pain, tingling, burning, and itchiness at infected sites of the skin, sometimes one to five days before the appearance of a rash
  • Fever or chills
  • General achiness, fatigue, headache, and upset stomach

A shingles outbreak typically lasts about seven to ten days then blisters start to scab over. It may take another two to four weeks for the skin to clear completely — at this point, the person is no longer actively contagious. It’s worth noting that symptoms and the degree to which they’re experienced may vary between individuals. For example, some folks with shingles might experience pain without the rash, or vice versa. Left untreated, however, shingles can lead to severe complications, including serious nerve damage and pain that can last for months to years, as well as vision loss, neurological problems, and additional skin infections. Thus, if there’s a suspicion that shingles may be the culprit for a given set of symptoms, getting it checked out is wise. With this in mind, it has been noted that getting medical attention is especially critical for those people over the age of 70 concerned that they may have shingles or those who have characteristic symptoms that appear to be affecting the eye or areas of the face near the eye. Confirmation of a shingles diagnosis is only possible by assessing a person’s symptoms and ordering laboratory testing. Treatment started as soon as possible is recommended for best results and may include pain relievers (analgesics) and medicated creams to reduce the pain or itching. A prescription for an antiviral drug that can shorten the duration and severity of the outbreak and also reduce the risk of complications.

Although shingles is less contagious than chickenpox, there are steps individuals can take towards prevention. There have been reports of airborne transmission — so it’s highly recommended that those with an active outbreak also avoid direct contact with newborn babies, pregnant women, and anyone with a weakened immune system. Frequent hand-washing, covering a shingles rash, and avoiding the urge to scratch are ways to prevent spreading the virus to others during an active outbreak. At-home remedies that might help with discomfort include wet compresses, calamine lotion, and oatmeal baths, pain relievers and fever reducers (though avoiding aspirin is a critical recommendation for young children, as it can lead to Reye’s syndrome).

Fortunately, there are also effective preventative strategies for avoiding a shingles infection all together. First, there’s the chickenpox vaccine, which most children receive as part of routine pediatric immunization in the United States. For individuals age 50 and over, the Food and Drug Administration (FDA) has also approved the use of the shingles vaccine. While neither of these vaccines guarantees immunity, they can both help to reduce the onset, duration, and severity of outbreaks if they do occur.

To learn more about the condition, the Centers for Disease Control and Prevention (CDC) has additional information. If you’re experiencing concerning symptoms or are interested in being vaccinated, it may be a good idea to talk with your health care provider for more advice.


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