Shingles, also called herpes zoster, is a rash that affects approximately 1 million people in the United States per year. While common, it can potentially cause serious complications, so it’s important to be well-informed. Here’s what you need to know!

What causes shingles?

After someone recovers from chickenpox, the virus may remain dormant (inactive) in certain nerves of the body for years. If the virus reactivates (becomes active again) and travels down the nerves to the skin surface, it will manifest as a characteristic red rash with small, fluid-filled blisters that eventually crust over. The rash may or may not be painful.

Who is at risk?

Only people that have previously had chickenpox can get shingles. While shingles may occur at any age, it most commonly occurs in people older than 50. Shingles is also more likely to show up in people with weakened immune systems (people with cancer, an autoimmune disease, organ transplant history, or HIV/AIDS). Most people who have shingles will not get it again, but on rare occasions it can re-activate and then reappear.

What happens when you have shingles?

A shingles rash is often, though not always, painful, and may be accompanied by a burning, itching, or tingling sensation- sometimes the sensation changes occur even before the rash or skin irritation appears. A characteristic feature of shingles is that the rash will appear on only one side of the body and involve a specific local area of skin, corresponding with the distribution of the nerve that got affected by the virus. Shingles most commonly occurs on the trunk (chest, abdomen, back), but can show up on the face. The affected area will develop smooth, red bumps and fluid-filled blisters that are clustered together over the course of about 1-2 days, and those blisters break open after 5-7 days, leaving sores that turn into scabs. Sometimes people have associated fever, chills, headache, and body aches with the rash. Most people fully recover within 4 weeks of the shingles rash initially showing up.

What complications can occur with shingles?

  • Chronic pain: The most common long term problem that can occur with shingles is long lasting pain that persists even after the rash has healed. This type of pain is called postherpetic neuralgia. Postherpetic neuralgia occurs in close to half of people 60 years old or older. It is also more common in anyone who had more severe symptoms while the rash was present. Postherpetic neuralgia can be intense and debilitating pain and require long term pain management if severe.
  • Vision problems: If shingles occurs on the face, it can affect the eye and possibly cause permanent damage to vision if not treated right away.

Scarring: While most shingles lesions heal without leaving behind a scar, if there are a lot of skin irritation, open wounds, or scabs that aren’t addressed with proper wound care, scarring can end up being a problem.

Is there a treatment for shingles?

Yes, though antiviral medications do not actually cure shingles. Once you have it, you’ve got it. However, certain antiviral drugs that can be prescribed to help promote faster resolution, reduce skin irritation, and encourage healing of the shingles rash, and in some cases can reduce the risk of infection complications. These medications are most effective if started within 3 days of the rash showing up and may not provide much benefit if started later than that. There are some exceptions to this rule, like if the rash has been present more than 3 days but is still forming new blisters, or if someone is elderly and immunocompromised. Your dermatology provider will help weigh the risks and benefits with you when deciding if your case of shingles requires antiviral medication. For that reason, it’s important that if you think you have a shingles rash to seek medical evaluation as soon as possible, either with a dermatology provider or primary care provider. 

Otherwise, your dermatology provider will provide recommendations about wound care, reducing skin irritation through adequate moisturization, pain or itch management, and preventing viral spread to others. Shingles is only contagious to people who never had chickenpox or the vaccine for chickenpox. The virus can be spread to these populations through direct skin-to-skin contact with blister fluid. Once scabs form and blisters resolve, the rash area is no longer considered contagious.

What can I do to prevent shingles?

The shingles vaccine (Shingrix) is a two-dose injection series recommended for all adults ages 50 and older to reduce the risk of developing shingles and its complications. Even if you have had shingles before, it’s recommended that you still get the vaccine. You can get this vaccination from your primary care clinician or a pharmacist.

Shingles, though common, can cause long lasting complications. Take steps toward prevention by getting the shingles vaccine once you turn 50 (or earlier if recommended by your primary care provider). If you suspect you have shingles, contact your primary care provider or dermatology provider right away, as there may be ways to intervene and reduce likelihood of complications, particularly chronic pain. Don’t hesitate to contact us with any questions regarding skin care!

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