Miami VA Healthcare System
Shingles: More Than A Bad Rash
Burning, aching, stabbing, gnawing. Even the feel of a bedsheet or a light breeze can be horrible, excruciating and unbearable. In the most severe cases, some people describe the pain of shingles as a skin rash gone pyscho.
What Is Shingles?
Shingles--herpes zoster--is a painful skin rash caused by the varicella-zoster virus. It’s the same virus (germ) that causes chickenpox. After you have chickenpox, the virus remains in your body, lying asleep in your nerve cells. However, it can activate again, traveling up the nerves and causing painful blisters on your skin. This often happens decades later, as you age or when your immune system weakens.
Anyone who’s had chickenpox – or who has been exposed to someone who has chickenpox (like a child) – can develop shingles. And the risk increases with age. About half of all shingles cases occur in people older than 60.
Here are the risk factors:
- Age 60 or older
- Weak immune system from diseases or illnesses, like HIV/AIDs
- Cancer, especially Hodgkin disease or lymphoma
- Taking medications that suppress your immune system, including steroids
The first signals of shingles are usually pain, burning, tingling or itching on one part of the body or face. You might also feel like you have the flu, with chills and fever. In a few days, a red rash with small blisters appears, usually on only one side of the body, spreading along the nerve path that held the virus. Blisters are most common on the back, chest or stomach area. However, a rash can also form around eyes; on one side of the neck or face; and even in the mouth.
For most people, the rash comes and goes within two to four weeks, according to Dr. John Toney, director of Healthcare Epidemiology, Antimicrobial Stewardship, and Infectious Disease Clinical Research Programs at the James A. Haley Veterans' Hospital and clinics in Tampa, Fla., and Professor of Medicine in the Division of Infectious Disease and International Medicine at the University of South Florida Morsani College of Medicine, also in Tampa.
At-home shingles treatment may include applying cool compresses to the skin or soaking in a cool bath. Or you can use calamine lotion to calm itchy skin and take over-the-counter pain relievers.
For a suspect rash, however, the best of course of action is to be seen by a health care professional right away to see if the rash is shingles.
“If you catch it early and are seen and treated within 72 hours of the rash first appearing--you’ll have the best outcome,” Dr. Toney said. “Your doctor will likely put you on antiviral medication.”
Dr. Toney explained that antiviral medication shortens the timeframe of the rash and reduces both the pain during the illness’s active stage, and reduces the chance of getting complications of shingles, known as postherpetic neuralgia or PHN.
Dr. Toney, 61, knows all about shingles—in fact, he’s a national expert on the subject. He was a principal investigator and co-author of the landmark 2004 Shingles Prevention Study, the largest study to investigate the disease.
The Zostavax Vaccine: Reducing the Pain of Shingles
More than 38,500 older adults were enrolled in the study—1,200 Veterans and others at the Tampa VA Hospital alone. The data that resulted introduced the first ever shingles vaccine—Zostavax—which was approved in 2006 by the Federal Drug Administration for people older than 60.
During the study, Zostavax was shown to reduce the risk of getting shingles by about half. Dr. Toney and the other researchers also found that administering the vaccine led to a 61 percent reduction in the amount of shingles pain and a 66 percent reduced risk of patients getting long-term pain, three months after the disease first appeared.
The Real Danger: Postherpetic Neuralgia (PHN)
The rash and the pain of shingles aren’t the real problem, according to Dr. Toney, who said those will go away. The real danger, he explained, is PHN, the serious, persistent nerve condition that continues long after the shingles blisters have healed. It can last weeks, months, even years after the virus is no longer active.
Complications can include vision loss, neurological problems, skin infections, permanent scarring and a debilitating type of pain that is beyond description.
Most people will have one episode of shingles, another 20 percent will get it again, and it’s rare to have it a third time, according to Dr. Toney. “But one in every five people who get shingles will get the most painful kind--and you have no way of knowing who will get it,” he said.
Talk to Your Doctor
Not every rash is shingles, but if yours is, it’s important to be seen by a health care professional as quickly as possible. And if you’ve had chickenpox and are age 60 or older, get vaccinated, Dr. Toney advised. He cautioned that not everyone is a candidate for the shingles vaccine.
“If you’re on medications that suppress your immune system, you should wait. And if you have HIV disease or other conditions that affect your immune system, you shouldn’t get it,” he said. He added that a discussion with your primary care provider is the best course of action.
For more information on shingles, visit www.veteranshealthlibrary.org/Encyclopedia/142,89203_VA or talk to a member of your VA care team. For more health and wellness articles specifically focused on Veterans, visit www.visn8.va.gov/VISN8/news/publications.asp.