Shingles, a red, painful, often blister-filled rash that can last for weeks or months, is a unique illness you don’t contract, but can develop. Tens of millions of people in the U.S. are at risk of developing shingles.
What causes shingles?
Shingles is the reactivation of the chickenpox virus in the body. After contracting chickenpox, the varicella-zoster virus may lie dormant in nerves. It reappears as shingles when the body experiences reduced immunity.
Simply put, you do not catch shingles.
“Some people may experience such mild cases of chickenpox in childhood that they don’t realize they’ve had the virus,” said Luis Z. Ostrosky, MD, an infectious disease specialist with UT Physicians. “But if you develop shingles, it’s because you have the chickenpox virus that was hiding in your nervous system.”
Symptoms of shingles at any age
A defining feature of shingles is that pain will often occur first, and a rash second, and because it is distributed through the nerves, symptoms almost always stay on one side of the body:
- Pain, burning, or tingling
- Red rash
- Sensitivity to touch
- Fluid-filled blisters that break open or crust over
- Itching
“Going through shingles can be one of the most disabling and painful conditions you can develop,” said Ostrosky, a professor and the Memorial Hermann Chair in the Department of Internal Medicine and vice chair of health care quality at McGovern Medical School at UTHealth Houston. “Aside from severe and prolonged pain, if shingles develops on your face, the virus can inflame the nerves connected to your eye or ear, which could lead to vision or hearing loss.”
Shingles risk factors
Only those who have previously had chickenpox are susceptible to developing shingles, and in America, that’s a huge number of people.
“Millions of Americans contracted chickenpox as children before the chickenpox vaccine was made widely available in the 1990s. Now, as adults, they have the potential to develop shingles,” said Stephen K. Tyring, MD, MBA, a researcher with UTHealth Houston.
Not everyone who had chickenpox will develop shingles. The illness typically develops in adults 50 and older with weakened immune systems due to aging or medical conditions. However, anyone with the virus can develop shingles at any age. Certain medicines or medical conditions can reduce immunity, along with stress.
“Stress is the most common factor for younger adults to develop shingles,” explained Tyring, an adjunct professor in the Department of Dermatology at McGovern Medical School. “When you’re highly stressed, your immune system wanes, and the virus takes advantage of that.”
Complications
It’s important to seek medical attention at the first sign of shingles because it can produce serious complications:
- Postherpetic neuralgia (PHN): long-term nerve pain after the blisters have cleared and which is difficult to treat
- Vision and hearing loss: a risk if shingles develops on the face
- Skin infections: a possibility of bacterial infections if blisters aren’t adequately treated
Treatment for shingles
There are several antiviral medications that can shorten the length and severity of the illness. They are available by prescription to treat shingles.
The medicine works best if used as soon as the rash appears. Over-the-counter or prescription medications like acetaminophen and ibuprofen can relieve pain. Some people will require steroids and prescription pain medication.
Is shingles contagious?
Someone with shingles does not spread shingles to others. However, until their shingles blisters scab over, they can spread the varicella-zoster virus to someone who isn’t vaccinated against chickenpox or has never contracted chickenpox through direct contact with the fluid from shingles blisters.
Prevention
Receiving the chickenpox vaccine as a child will reduce the risk of developing shingles as an adult.
“Shingles is a vaccine-preventable disease,” said Ostrosky. “We strongly recommend chickenpox vaccination in childhood, which is lifelong protection.”
For adults, the shingles vaccine is the only way to prevent shingles and its associated complications. It is recommended for adults 50 and older and adults 19 and older with weakened immune systems. Those who have had shingles in the past can still get the shingles vaccine after the skin has completely healed to prevent future outbreaks.
The shingles vaccine is a two-dose course given six months apart.
The shingles vaccine is 99% effective.
Shingles vaccine and reduced risk of dementia
Recently published research in the journal Nature shows a connection between the shingles vaccine and reduced risk of developing dementia.
Research found that people who received the original shingles vaccine are 20% less likely to develop dementia than those who were not vaccinated.
The original vaccine was discontinued in the U.S. in 2020 and replaced by the current Shingrix shingles vaccine, which may yield similar protection against dementia.
“There is increasing evidence that this virus that infects the nerves also affects the brain,” said Ostrosky. “What an incredible thought, that we may have a vaccine that protects you against dementia!”
