Shingles: What you should know
So you thought you were through with chicken pox? It may have been decades since you beat back the virus, but it can come back later in life — and, at times, with a vengeance.
Here’s what happens: After you have the chicken pox, the virus that caused the infection (the varicella-zoster virus) sticks around in your nervous system. It lies dormant in the body for decades, but can reactivate (or “re-awaken”) at any time. Doctors aren’t quite sure why this occurs, but stress, a weakened immune system, autoimmune diseases, certain medications and infections are some of the culprits that can cause the virus to reactivate and spread in the body.
Shingles affects the nerves, making the infection very uncomfortable and sometimes debilitating. The rash of blisters, which usually appear in a band around the back and chest, are only part of the unpleasantness. Many patients also experience pain, tingling and burning — which can range from mild to severe. In approximately one fifth of people, this pain can last for weeks or even months after the blisters are gone. This pain — formally known in the medical community as postherpetic neuralgia or PHN — can be difficult to deal with and not everyone responds to treatment.
So what are your chances of getting shingles? It depends on who you ask. Some experts predict that 10 to 20 per cent of people who have had chicken pox will get shingles. Other experts peg this number a little higher, estimating there’s a 28 per cent chance people of getting it during their lifetime. Numbers aside, it’s important to note that the majority of people won’t get shingles at all.
The bad news for baby boomers and their parents: the risk of getting the infection increases with age — thanks in part to our body’s decreasing immune response as we get older. People over the age of 50 have a 40 per cent chance of getting shingles, reported Dr. Jay Keystone, in a presentation at the 2nd annual CARP Conference “A New Vision of Aging” in Toronto. That risk increases to 80 per cent by age 80.
The good news is that shingles isn’t deadly, it rarely makes an encore and complications aren’t common.
The sooner you realize you have it, the sooner you can do something about it. The symptoms can be vague at first, and people may mistake shingles for an allergic reaction or even a flu.
How can you tell if you have it? Watch for:
– Pain, burning, numbness or tingling. Shingles usually starts with pain or burning, not the rash — and can be easy to mistake for other causes. Some patients also describe the pain as throbbing or stabbing, or their skin feels like its been scalded. The rash and blisters usually develop at the site of the pain.
– A red rash that begins a few days after the pain. The rash usually starts as a series of red bumps on the trunk of the body — often as a band that wraps around one side. Bumps can appear elsewhere too, like on the arms or face.
– Blisters. The rash will develop into fluid-filled blisters that break open and crust over (this process often takes about 7-10 days). In some cases, blisters can occur on other parts of the body like the arms and face — and they can cause serious complications if they appear around the eyes. The rash and blisters will be accompanied by itching.
– Flu-like symptoms. Many patients experience fatigue, fever, general aches, nausea, headache and chills.
If you have these symptoms, see your doctor as soon as possible. Treatments for shingles are most effective when started within 72 hours of the symptoms appearing. While not for the squeamish, many reliable medical sources online include pictures or diagrams that can be helpful in identifying the signs.
When your doctor says, “It’s shingles”, what’s next? Unfortunately, there’s no cure. Instead, your doctor will suggest treatment to try and limit the duration of the illness and the severity of the symptoms. Your doctor may prescribe:
– Strong anti-viral medications to fight the virus so you’ll feel better sooner.
– Over-the-counter painkillers like acetaminophen or ibuprofen to treat the pain.
– Steroids for pain and inflammation (if over-the-counter medications don’t do the job).
– Topical antibiotics (if needed, to prevent infection).
In addition, people who experience lingering or severe postherpetic pain may require corticosteroids, anti-depressants, prescription painkillers or topical medications (like a lidocaine patch).
At home, there are some things you can do to make the infection more bearable:
– Avoid scratching the skin.
– Keep the skin and blisters as clean as possible to prevent a bacterial infection.
– Apply topical treatments like calamine lotion to minimize itching.
– Soak in an oatmeal bath to sooth the skin.
– Avoid clothing or fabrics that irritate the area such as scratchy sweaters or bras. Lightweight clothing (turned inside-out to avoid the seams) is often most comfortable.
If you see an alternative health care provider, he or she may have some additional recommendations. Some supplements like zinc, vitamin C or colloidal silver are thought to help with shingles, but there isn’t any scientific proof of their effectiveness so it’s “buyer beware”. Foods and vitamins that help boost immunity can be beneficial for all viruses.
Expect to “take it easy” for a few weeks. After all, shingles is a virus so it’s important to get plenty of rest, keep your stress levels down and take care of yourself until it passes. It could take a month or more for shingles to fully run its course.
Complications are rare, but if you experience severe pain, the rash spreads or you experience other symptoms like muscle weakness or paralysis, it’s important to seek medical attention right away. While frightening, the symptoms are often temporary but could lead to permanent problems without further medical attention.
Is shingles contagious? Yes… and no. The virus itself is contagious, and people can come into contact with it through the blisters. However, the virus will cause chicken pox first, and potentially shingles later on if it reactivates. In other words, you can give someone chicken pox if they haven’t already had the virus, but you can’t pass along shingles. If you’re caring for someone with shingles, you won’t get it yourself.
Still, if you have it doctors recommend staying away from people who are vulnerable to infection, such as pregnant women, infants and people with compromised immune systems.
Can you prevent shingles altogether? A healthy diet, exercise and a strong immune system are beneficial, but there may be another way to stop it: vaccines. If you haven’t had chicken pox or the chicken pox (varicella) vaccine, you can still get the vaccine as an adult. Recent research shows promise for this vaccine for preventing shingles later in life.
If you’ve already had chicken pox, there is a vaccine that can boost your immune system and help prevent shingles. This past fall, Health Canada approved the shingles vaccines (Zostavax), but don’t expect a miracle preventative. The vaccine isn’t 100 per cent effective — based on clinical trials and current information, it can prevent shingles about 50 per cent of the time in people over 50. People who were 60-69 years of age saw the most benefit with about two thirds of people in this age group being protected compared to the placebo group. However, effectiveness declines as age increases, and by age 80 only 18 per cent of cases were prevented.
For people who still get shingles despite getting the vaccine, two thirds will experience a shorter duration and less severe symptoms. The vaccine is still fairly new, so there isn’t a lot of hard data on its effectiveness yet. (For full details, see the U.S. Food and Drug Administration Zostavax Questions and Answer webpage.)
So should you get the shot? It’s a conversation to have with your doctor — especially in light of recent research suggesting that shingles raises the risk for stroke and glaucoma. The vaccine requires a single dose and costs about $150 — which isn’t covered by most health plans because shingles isn’t considered to be a public health issue. If you ask around, many sources recommend the vaccine for people over the age of 60, though some say people as young as 50 can consider it too. The vaccine hasn’t been around long enough to determine if or when booster shots will be required.
Unfortunately, there’s no fool-proof, quick or easy way to prevent or treat shingles. Many people won’t get it at all, but for those who do recognizing it and taking care of themselves can make a big difference.
Where to find more information
For more information, news and links, try the sources we used for this article:
The Mayoclinic.com: Shingles
National Institute of Neurological Disorders and Stroke: Shingles Information Page
WebMD: Shingles – Topic Overview