Can Stress Cause Shingles?

Current research challenges conventional wisdom

Stressed woman sitting at her desk
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Shingles, also known as herpes zoster, is a common viral condition characterized by a painful skin rash with blisters that appears along a band or stripe (called a dermatome) on either side of the body.

The condition is caused by the reactivation of the varicella zoster virus (VZV) in persons who have previously had chickenpox. While 90 percent of chickenpox cases occur in children aged 14 years or younger, the vast majority of shingles cases develop during later adulthood.

Current research, in fact, has shown that a person’s risk of developing shingles increases dramatically over the age of 50. Thereafter, the risk only continues to rise, climbing some 40 percent for each decade that follows.

All told, nearly one in three people will get shingles during the course of a lifetime. While most will only have one episode, it is not uncommon to experience one or even several reoccurrences.

Stress as a Factor for Shingles

While the causes for the reactivation of VZV are not entirely known, it is clear that the outbreaks are most commonly associated with a weakened immune system. It is why we tend to see shingles more in older adults (who have a natural decline in their cell-mediated immunity) and in those with immune suppressive disorders such as HIV and cancer.

One popularly held belief is that shingles can be triggered by stress or, in some cases, a single episode of emotional distress.

On the surface of things, it would seem a fair assumption given that stress is often linked to any number of changes in health, including gastrointestinal problems, migraines, and eczema.

But the question is this: Can stress, in and of itself, reactivate a dormant virus like VZV? And, if so, might stress reduction conversely lessen the risk of a shingles outbreak?

What the Current Research Tells Us

It has only been in recent decades that the field of psychoneuroimmunology (PNI) has begun to shed light on how emotions can translate to physiological changes, often improving or impairing a person’s health. While the results of the research are often mixed, there is some evidence to suggest that stress can contribute to, rather than cause, a shingles outbreak.

One of the most commonly cited studies was conducted in 1998 among a matched set of otherwise healthy adults over the age of 60. In comparing participants who had herpes zoster against those who didn’t, the researchers were able to conclude that those who had experienced shingles were more than twice as likely to have had a negative life event within six months of the outbreak.

However, when queried about events within the past two to three months, the same group was not able to report any more or less negative events than their unaffected counterparts. According to the investigators, this suggested that the perception of a recent event as stressful—rather than the event itself—was linked to the increased rate of shingles.

A study conducted in 2014 largely supported those results, wherein the rate of shingles among 39,000 individuals who had experienced the death or catastrophic illness of a spouse was no greater than the general population.

Some have taken this to mean that an individual’s overall perception of stress—including whether he or she is able to cope—only adds to the underlying factors that create the "perfect storm" for a shingles outbreak.

On the flip side, a study conducted in 2003 aimed to determine whether Tai Chi, when used as a stress reduction tool, had any bearing on the incidence of shingles in older adults. While small, the researchers were able to report that a 15-week course of Tai Chi, practiced for 45 minutes thrice weekly, was associated with an increase in the cell-mediated immunity specific to VZV.

While the investigators were unable to correlate this to a reduction in shingles risk, the study suggested that the very practice of stress reduction can yield beneficial physiological changes to adults at risk of stress-related illnesses.

But does this mean that a person can avoid shingles by alleviating the emotional stresses in one’s daily life? Or that stress and shingles are even as closely interlinked as some might have you believe?

Measuring Stress as a Biological Trigger

In recent years, researchers have looked into the impact of stress on the herpes simplex virus (HSV), a herpesvirus similar to VZV which is associated with both cold sores and genital herpes.

As with VZV, HSV attaches itself to the lining of nerve cells, where it can lie dormant for years. It is typically during periods of diminished immunity that the virus can suddenly re-emerge, often preceded by emotional stresses in the form of anxiety, exhaustion, and depression.

But is it the stress per se that causes the drop in immune function, or the other way around?

It’s a question that scientists at the National Institutes of Health decided to explore. In their research, the investigators measured whether the activation of the hypothalamic-pituitary-adrenal axis (the organ system which controls reactions to stress and other body processes) could trigger the reactivation of HSV in mice.

Corticosteroids are a type of hormone produced by the body in response to stress. During an HSV outbreak, the levels of hormone increase dramatically. By creating social stresses—ones that could be measured by the monitoring of corticosteroid levels—the scientists aimed to determine whether stress, as an independent factor, could spur the outbreak of herpes.

It didn’t. Despite dramatic increases in corticosteroids response, the scientists concluded that there was absolutely no correlation between HPA activation and HSV reactivation.

What the Research Tells Us

None of this means to suggest that stress is not an important player in the reactivation of herpesviruses such as HSV or VZV.  There is, in fact, enough compelling evidence to suggest that psychological stress does significantly alter the common biochemical language that regulates the endocrine, immune, and nervous systems. How they work together is simply unknown.

To this end, it’s important to highlight the factors we can control in order to better maintain both a healthy immune system and an overall sense of well-being. This is particularly true for older adults at risk of shingles, as well as individuals with immune suppressive disorders such as HIV or cancer.

Stress alleviation is key the strategy. This includes a reduction in alcohol intake, the use of which can exacerbate feelings of anxiety or depression. Alcohol abuse is further associated with social isolation, as well as a reduction in the number of interaction with healthcare providers, adding the already long list of ill effects of alcohol use.

Similarly, cigarette cessation should be explored as part of a wellness strategy. Despite their use as "stress relievers,” the negative impact of cigarettes on every organ system vastly outweighs any perceived benefit that smoking might have.

By contrast, common sense choices such as a good diet, exercise, and ample sleep every night will not improve health outcomes but increase a person’s ability to cope with the daily stresses of life.

A Word From Verywell

To prevent a shingles outbreak, a vaccine (Zostavax) is currently available for use in adults aged 50 years or older. The vaccine, delivered in a single injection, has been shown to reduce the risk of shingles by 70 percent in persons between the ages of 50 and 59. The efficacy of the vaccine tends to wane as a person gets older, emphasizing the need for early intervention.

Vaccination for people with HIV can also be explored under certain conditions. Persons on chemo or radiation therapy should avoid Zostavax, along with anyone on immune suppressive drugs. Consult with a doctor before considering a Zostavax injection.

For persons living with HIV, antiretroviral therapy is also strongly recommended in order to restore immune function, alleviating not only the risk of herpes zoster but other opportunistic infections.

Source:

Harpaz, R.; Leung, J.; Brown, C.; et al. "Psychological Stress as a Trigger for Herpes Zoster: Might the Conventional Wisdom Be Wrong?" Clinical Infectious Diseases. November 10, 2014; 60(5):781-785.

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