Prevent the Pain of Shingles

If you’ve had shingles, or you know someone who has, then you know what a painful condition it can be. It’s also surprisingly common: One in three people will develop shingles (medical name: herpes zoster) in their lifetime. Fortunately, there are very effective ways to prevent getting shingles, and effective ways to treat it if you are unlucky enough to get it.

What It Is

Shingles is caused by the varicella-zoster virus (VZV)—the same virus that causes chickenpox. When you’re exposed for the first time, you develop chickenpox. But when you recover, the virus doesn’t leave your body. It lies dormant in nerves that emerge from the spinal cord and causes no problems until something reactivates it. Then you get shingles. Things that make reactivation more likely: getting older, being immuno-compromised, feeling generally run down or dealing with a lot of stress.

“It’s almost like the body’s way of kicking you when you’re already down,” says Esther Freeman, MD, director of Global Health Dermatology at Massachusetts General Hospital.

While shingles is usually associated with a rash, most people develop skin sensitivity—tingling, itching, or a burning, shooting pain—in a specific area of their body first. Then, one to five days later, small red spots appear, which turn into fluid-filled blisters.

In the early stages, people may mistake the rash for something else. “People think it’s poison ivy or an allergic contact dermatitis caused by something they touched,” says Dr. Freeman.

While the rash can appear anywhere on the body and may look like a random red patch or cluster of blisters, it actually follows a distinct pattern. “What’s unique about shingles is that the rash will appear only on one side and on one part of the body in what we call a ­dermatome,” says Dr. Freeman. She explains that the rash follows the line of the nerve where the virus lay dormant. That’s why the rash often looks like a stripe winding around the torso. The face is another common location.

Other symptoms can include fever, headache, fatigue or upset stomach. It generally takes three to five weeks for symptoms to disappear completely.

How to Treat It

It’s important to see a doctor, preferably a dermatologist, as quickly as possible after you experience symptoms. “Doctors can prescribe antiviral medications, which are effective if started within 48 to 72 hours,” says Sonya Kenkare, MD, a board-certified dermatologist in Chicago. The medication can reduce and shorten symptoms, and also lessen the chance of complications. Pain medications can help manage the discomfort.Home treatments include petroleum jelly and dressings over the area. “You want to keep the blisters covered, because open blisters are most contagious,” says Dr. Kenkare. “Keep the area well covered until the lesions are crusted over.”

The period of being contagious can last as long as 7 to 10 days, and people with shingles blisters should avoid direct contact with other people, especially pregnant women and people with compromised immune systems. Interestingly, you can’t get shingles by being in contact with someone who has it. But you can get chickenpox if you’ve never had it and never had the chicken­pox vaccine.

How to Prevent It

While shingles isn’t life-threatening, it can be extremely painful. And one of the most common complications, called postherpetic neuralgia (PHN), can make that pain last long after the rash has healed. “It can be similar to the pain associated with acute shingles, but it can last for months or even years,” says Dr. Freeman. About 1 in 5 people who get shingles develop PHN.

“In a younger person the risk of the complication might be 10 per cent, but in an older person it can be as high as 30 per cent,” she adds. Another complication, though less common, is lasting eye damage or vision loss from blisters on the face.

The newest herpes zoster vaccine, called Shingrix, has been available since 2017. It’s recommended for everyone age 50 and older, plus people who are immunocompromised.

According to the Centers for Disease Control and Prevention, the vaccine is more than 90 per cent effective at preventing shingles and PHN in adults age 50 and over with healthy immune systems. And for those who do get shingles after getting the vaccine, the disease will be much milder than if they hadn’t, with a much lower chance of developing complications like PHN. In fact, the new vaccine is so much more effective than the previous one (which has been discontinued) that the CDC recommends that people who received the previous vaccine now get revaccinated with Shingrix.