Could it Be Shingles?

The problem started with “tiny electric zaps” traveling through her nerves. “When it progressed to full force, the zaps hurt so badly that it would take my breath away,” says Julie Stoner, a 59-year-old Indiana resident. “Once, it even took me to my knees.”

Although she didn’t know it at the time, Stoner was experiencing the beginning stages of shingles, a viral infection that causes a painful rash. Because she saw her doctor right away, the majority of her pain subsided within two weeks, though she continued to feel “zaps” along the nerve from her chin to ear and then her forehead for weeks after.

According to the Centers for Disease Control and Prevention (CDC), Stoner’s shingles diagnosis was just one of approximately one million cases that occurred in the U.S. last year. But despite estimates that about 50 percent of people 80 and older will develop shingles, many are still confused about why it happens and how to prevent it. And shingles isn’t just a condition that affects older adults–stress, injury, and compromised immunity can increase your risk of developing it at a younger age. Knowing how to spot the signs and get help fast can mean the difference between prolonged pain and a speedy recovery.

Shingles is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox, a highly contagious disease that begins with an itchy rash made of small bumps that progress to blisters (otherwise known as vesicles) all over the body. “The fluids in these vesicles are chock full of replicating VZV,” says Brian Secemsky, a San Francisco doctor. “From these vesicles, the virus makes its way to the skin’s nerve endings, travels down deep, and settles into the body’s nervous system.” While you may have contracted and recovered from the itchy illness as a kid, the virus has likely lain dormant in your body ever since.

Marie President, a doctor in Redwood City who says she diagnoses the illness “constantly,” notes that many patients have a hard time understanding how a childhood illness can reappear so many years later in a new form.

“I recently saw a 47-year-old man with shingles on his forehead,” President says. “Although I explained and even showed him some educational handouts, he kept asking me, ‘how did I get this?’ For many patients, it’s a weird concept to think that there is a virus living in them that can become reactivated. My main thing is to quell fears: the condition is not likely to worsen after a week, they are not going to die, and they don’t have some alien-like infestation.”

It’s not known exactly what reactivates the virus in people who develop shingles, but experts speculate the reappearance could be due to the lowered immunity associated with aging (shingles is more common in both older adults and anyone with a weak immune system), but stress can also play a role. But regardless of what triggers the recurrence, if you’ve ever had chickenpox in your life, you’re at risk for shingles.

The good news is, the FDA has approved a vaccine called Zostavax for adults 50 and older that can help reduce the risk of developing shingles. It’s not intended as a treatment and it contains live virus, so it shouldn’t be given to anyone with a weakened immune system. It’s also not a 100 percent guarantee against shingles, but it’s likely to reduce the severity and risk of some complications.

And while it’s now a routine childhood immunization, adults who have never had chickenpox are also advised to get the chickenpox vaccine (Varicella). It’s not guaranteed to prevent shingles, but according to the CDC, a double dose is about 90 percent effective at preventing chickenpox.

“Once fully expressed, the clinical characteristics of a classic case of shingles are so identifiable that often no lab test is needed to make the diagnosis,” Secemsky says. The symptoms can occur anywhere, but usually affect one small section on one side of the body — most often a single strip of blisters that wraps around the left or right side of the torso. The symptoms can also crop up on one side of the neck or face, or even around one eye, but are most common on the chest, back, and abdomen. That’s why it’s important to know what to look for:

• The first symptom is usually pain, burning, numbness, sensitivity or tingling. Depending on the location, it might even feel like a problem in the heart, lungs or kidneys.
• A red rash composed of painful blisters usually appears a few days after the initial pain hits.
• Some people may also develop fever, itching, headache, fatigue, sensitivity to light or an upset stomach.

If you have shingles, you can’t directly pass the rash to someone else, but you can pass VZV to anyone who hasn’t had chickenpox. While the infected person will then likely develop chickenpox, not shingles, they’ll have VZV in their system for life. The blisters are contagious until they scab over, so if you develop shingles, it’s best to keep your distance from children, pregnant women, or anyone with a weak immune system (such as anyone with HIV/AIDs or cancer) because these groups are at increased risk of complications from the virus.

If you experience any of the symptoms above, make an appointment with your provider. The risk of complications like skin infections and neurological problems increases with age, so if you’re 70 or older, see your provider immediately. You’ll also want to seek quick medical attention if you’re having symptoms and you have a weakened immune system, or if the pain or rash is near your eye (left untreated, this can lead to permanent eye damage). While there’s no cure for shingles, antiviral drugs like acyclovir or valacyclovir can speed healing and reduce the risk for complications like skin infections and neurological problems.

“Most often people don’t recognize it and let it linger for several days or often weeks,” President says. “But the faster you get antiviral medications the better — treatment should be started within 72 hours of onset if at all possible.”

President says this quick action is not only important to resolve the shingles itself, but to prevent postherpetic neuralgia (PHN), a painful, chronic condition that results from damage to the nerve fibers during the shingles infection. “Once PHN begins, treatment is much more difficult and often unsuccessful.” President also advises patients to avoid scratching shingles lesions during treatment, which can create the right conditions for a secondary bacterial infections.

In addition to antivirals, your provider may also prescribe a medication like capsaicin cream or lidocaine to treat the pain, and you may consider taking a cool bath or using a cool compress to relieve itching.

Stoner’s only regret is that she didn’t seek medical attention sooner, but she’s grateful she took action when she did. “I wish I hadn’t thought the first mark was a pimple because I picked at it and that made a scar develop,” she says. “Getting on antivirals quickly is the key to a quick recovery.”