Shingles: How to prevent a painful rite of passage

Shingles hurts. It is largely preventable.

It hurts. It hurts a lot.

That's what patients have always said when describing their shingles.

Sometimes it starts hurting before the telltale rash appears - a painful stripe of purplish bubbling blisters. It usually is found on just one side of their bodies. I've known patients who've been to emergency departments for presumed heart attacks. The pain across their chest seemed like it couldn't be anything else. It hurts that badly.

Over their lifetimes, 1 in 3 in the US will develop shingles. 1 million will this year.

Anyone who has had chickenpox can develop shingles. The virus that causes chickenpox (Varicella Zoster Virus (VZV)) causes shingles, also called herpes zoster or zona. VZV lies dormant, sleeping in nerve cell bodies.

Who develops Shingles?

The simple answer is anyone who has had chickenpox.

Those at most risk for shingles are immunosuppressed (a "weak" immune system). This may be a medical condition: leukemia, lymphoma, HIV. It may be from medications: steroids (prednisone), drugs for organ transplants, immunosuppressive drugs for immunologic, rheumatologic, or arthritic conditions (including Rheumatoid Arthritis, Lupus) or inflammatory bowel disease (Crohns or Ulcerative Colitis). Infections in immunocompromised individuals may be unusual, more severe, and not diagnosed as quickly.

The disease is associated with an aging immune system.

The elderly develop more shingles.

Reduced immune system protection against shingles is also thought to be associated with stress and depression. However, recent research has shown shingles may not be more likely when people are stressed.

Children and young adults can develop shingles - even without any immunosuppressive drugs or conditions.

Very few have shingles more than once. 

Shingles after chickenpox vaccination alone is quite rare.

What is Shingles like?

Shingles causes a painful rash on one side of the face or body that looks like a stripe (representing one dermatome, or the region of skin supplied by one spinal nerve). The rash, usually red or purple, forms blisters. These scab in 7-10 days and clear in 2-4 weeks. 1-5 days before the rash develops, some have pain or itching where the rash will develop.

If the rash develops near the eye, it can cause vision loss (herpes zoster ophthalmicus) and should be evaluated immediately by a doctor.

Likewise, zoster can develop near the ear (in the facial nerve there) and can cause Ramsay Hunt Syndrome (herpes zoster oticus). Symptoms include one-sided hearing loss, nearby facial paralysis, difficulty closing an eye, ear pain and/or ringing, loss of taste in front of the tongue, and rash.

How to avoid all of this?

The shingles vaccine can help prevent shingles. CDC recommends those 60 years and older to have one dose of the shingles vaccine. The FDA approves use for anyone 50 years and older. The vaccine is a high dose chickenpox vaccine, a live-attenuated virus. It has been used in the US since 1995, was developed in the 1970s in Japan and used there since the 1980s.

There are some who should not be vaccinated for shingles: pregnant women, those allergic to the vaccine, and the very ill. Those who have cancer, are immunocompromised or taking drugs that affect their immune system should discuss the vaccine with their doctor.

Is there a treatment?

It's best to get the vaccine and not get the illness.

Shingles can be treated with antiviral medications that treat herpes, a closely related virus. These include acyclovir, valacyclovir, famciclovir. These drugs need to be started as soon as symptoms begin so it is important to discuss with a health care provider without delay.

These drugs, though, don't work miracles and the infection can, at times, remain quite painful even if taking the drugs.

Others may try calamine, oatmeal baths, and wet compresses for itching.

Some develop chronic burning pain, called PHN (post-herpetic neuralgia), at the shingles site. This usually occurs in those who are older. It rarely occurs in those under 40, but 1 in 3 over 60, who develop shingles and are not treated, can develop PHN. It may lasts weeks to months, or for some, years. Those affected should discuss further pain regimens with their doctors.

How does it spread?

Shingles is transmissible, but not as shingles. Someone with active shingles can spread the causative virus (Varicella Zoster Virus) to someone who never had chickenpox; that person would develop chickenpox.

To avoid transmission, the shingles lesions should be covered with gauze. If shingles spreads to a wider area of skin, it may be more transmissible. Avoid contact with pregnant women who have not had chickenpox (or the vaccine), premature or small infants, those who are immunosuppressed.

Chickenpox (Varicella) cases have dropped after vaccination started in 1995. It is very infectious and airborne - spread through respiratory droplets. 


The diagnosis is often made by examination of the classic rash (see photo). Others rely on PCR testing of the blisters or even blood antibody testing. 

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