Hows Shingles Without A Rash Diagnosed
Shingles without a rash isnt common, but it may be more common than previously thought because it often goes undiagnosed. Shingles without a rash is difficult to diagnose based on your symptoms alone.
Your doctor may test your blood, cerebrospinal fluid, or saliva to identify the presence of VZV antibodies. This will allow them to confirm a diagnosis of shingles without a rash. However, these tests are often inconclusive.
Your medical history may provide clues that suggest you have shingles without a rash. Your doctor may ask if youve had a recent operation or if youre under increased stress.
Once your doctor suspects you have VZV, theyll use antiviral medicines such as acyclovir to treat the shingles. They may also prescribe drugs for the pain.
Other treatment will vary based on the location and severity of symptoms.
Do You Always Get The Typical Rash If You Have Shingles
Occasionally, some people dont get a rash. If you have any of the other symptoms of shingles , see your healthcare provider sooner rather than later. There are effective treatments you can take early for shingles. Even if you dont have shingles, seeing your healthcare provider will help you get your condition diagnosed and treated.
Is Treating Relapse The Same
The approaches to treating shingles and any relapse are the same. In the latter case, healthcare providers may become particularly interested in isolating the cause of the weakened immunity thats causing the recurrence. That said, there is no outright cure for this disease, so treatment focuses on managing symptoms.
These approaches include:
- Antiviral medications, such as Zovirax , Famvir , and Valtrex , can help, especially if given within 72 hours of symptom onset.
- Over-the-counter drugs like Tylenol or Motrin or Advil can also help manage discomfort and pain.
- Compresses and creams are among other approaches that help relieve itching these include applying wet compresses, using calamine lotion, and taking colloidal oatmeal baths.
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What Should You Expect If You Get Shingles
Shingles can be a very painful condition. If you think you have the symptoms of shingles, see your healthcare provider right away. Starting antiviral medications early can ease your discomfort and end symptoms earlier.
A better approach to shingles is to take action and do what you can to lessen your risk of getting it. If you’ve never had shingles in the past, talk to your healthcare provider about getting the shingles vaccine. If youve never had chickenpox, talk with your healthcare provider about getting the chickenpox vaccine.
Does The Vaccine Help Prevent It
The CDC suggests getting the shingles vaccine Shingrix if you’re a healthy adult ages 50 or older, or if you are19 years of age and older and are or will be immunodeficient or immunosuppressed due to disease or therapy.. It was approved in 2017 and has been found to be more than 90% effective in preventing shingles and the complications caused by the disease. Even if you’ve already had shingles, the CDC says the vaccine can help prevent a second round of it. Shingrix is preferred over an earlier vaccine, Zostavax, which was removed from the market in 2020. You should also get it if you previously had the Zostavax vaccine.
Shingrix is also approved for those 18 years or older who may be immunodeficient or immunosuppressedbecause of an illness or treatment.
Talk to your doctor about when to get the vaccine. If you’ve just gotten over shingles, the CDC recommends waiting at least until the shingles rash has disappeared.
You should not get the Shingrix vaccine if you:
- Are pregnant or nursing
- Are allergic to the vaccine
- You tested negative for immunity to chickenpox if so, you should ask about the chickenpox vaccine.
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Can You Get Shingles More Than Once
Shingles is a severe skin rash caused by the herpes zoster virus, which also causes chickenpox. Those affected typically only experience the condition once . However, in rare cases, shingles recurs.
Estimates vary as to how common recurrence is. Some populations, including those that are immunocompromised, are more prone to it. One wide-ranging study found that as many as 5% of those who experience the condition develop it again within eight years.
Clearly, its worth looking at why this happens, what the risk factors are, as well as how to prevent shingles relapse.
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What Triggers Shingles Flare
Most people who get shingles will have a one and done type of experience. In other words, theyll get it and likely never have it again. That said, there are some people who get shingles more than once.
Heres how it happens: the varicella-zoster virus, the same virus that causes chickenpox, lies dormant in nerve cells after you recover from chickenpox or shingles.
For the most part, the virus stays inactive after your shingles symptoms subside and youve healed. But certain risk factors can trigger flare-ups and cause the virus to reactivate. Experts call this recurrent shingles.
A 2021 review looked at the incidences of first and recurrent shingles episodes and found that the average time between infections was 2 years for people ages 45 to 54 and 3 years for those ages 55 and older.
In addition, of the participants who experienced a flare-up, the incidence was higher in those who were immunosuppressed compared with people with healthy immune systems.
In other words, if you have a compromised or weakened immune system, you have a greater chance of getting shingles again. This can happen if you:
- are undergoing chemotherapy
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What Problems Can Happen
Most cases of shingles heal on their own, with or without treatment, and won’t lead to any other problems. In rare cases, shingles can lead to complications, including:
- Ongoing pain : Damaged nerve fibers in the skin send confused messages to the brain, leading to pain. Pain can go on for a long time after the shingles rash is gone. This is the most common shingles complication.
- Vision problems: Shingles near or in an eye can lead to vision loss.
- Skin infections: A shingles rash can become infected with bacteria, leading to impetigo or cellulitis.
- Nervous system problems: Shingles on the face can involve different nerves that connect to the brain. This can lead to nerve-related problems such as facial paralysis, hearing problems, and problems with balance. In very rare cases, shingles can lead to encephalitis .
How Is Shingles Diagnosed And Treated
If you think you might have shingles, talk to your doctor as soon as possible. Its important to see your doctor no later than three days after the rash starts. The doctor will confirm whether you have shingles and can make a treatment plan. Most cases can be diagnosed from a visual examination. If you have a condition that weakens the immune system, your doctor may order a shingles test. Although there is no cure for shingles, early treatment with antiviral medications can help the blisters clear up faster and limit severe pain. Shingles can often be treated at home.
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Focus On Prevention Doctors Say
Prevention is the best way to avoid a shingles episode.
There is a vaccine that prevents the onset of shingles in people exposed to chickenpox. The CDC recommends that people age 60 and older get one dose of the vaccine. Vaccines are readily available at a doctors office and drug stores. In 2011, the Food and Drug Administration extended the vaccine use for people aged 50 to 59.
Wigand-Bolling said the vaccine reduces the incidence of shingles by 51% and the neuralgia associated with shingles by 67%. The doctor said the vaccine is injected and once vaccinated a person is protected for life.
Unless contraindicated because of pregnancy or being an organ transplant recipient or on chemotherapy, everyone over age 50 should be vaccinated, Wigand-Bolling said. I would recommend getting vaccinated to patients who may not have had chicken pox, or those who dont remember having chicken pox.
More than 90% of those identified in the study at increased risk of stroke and heart attack after a shingles episode hadn’t been vaccinated for shingles. The people in the study who had the vaccine still got shingles, it’s worth noting.
When Should I See A Doctor
See your doctor at the first sign of shingles. Getting treated early can help it go away faster and may help you avoid related problems. For instance, shingles on the face can cause hearing or sight problems, including blindness.
If you have a weak immune system and can’t get the vaccine, early treatment is your best defense against shingles.
Sometimes what seems to be shingles is really herpes simplex. Though it usually appears as “cold sores” around the mouth or genitals, this form of herpes can show up elsewhere. A different treatment is used to clear it up. Your doctor can do tests, such as a viral culture, to confirm whether you have shingles and to get you the right treatment.
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Vaccinate To Decrease Your Shingles Risk
Your chances of getting shingles increase as you get older. The U.S. Centers for Disease Control and Prevention recommends that adults age 50 and older get vaccinated against shingles.
Two vaccines, recombinant zoster vaccine and zoster vaccine live are available in the United States to prevent shingles. Shingrix is the preferred vaccine.
The CDC recommends Shingrix for adults 50 years and older, whether or not they have already had shingles or previously received the Zostavaxvaccine, which has been used since 2006. You should get two doses of Shingrix, two to six months apart. Two doses of Shingrix are more than 90% effective at preventing shingles. Shingrix is also 90% effective in helping to prevent PHN in those who get shingles despite being vaccinated.
While Zostavax is still available, studies show it is less effective than Shingrix.Zostavax may be used in some healthy adults 60 years and older, for example, in those who are allergic to Shingrix.
There is no specific time that you must wait after having shingles before receiving the shingles vaccine. But its probably best to hold off until the shingles rash has disappeared before getting vaccinated.
About the Author
Urmila Parlikar, Associate Director, Digital Health Products, Harvard Health Publishing
Shingles Linked To Stroke Heart Attack
Not only do shingles flare-ups hurt, research says they can increase your short-term risk of heart attack and stroke following the virus outbreak.
Shingles was found to raise the risk of stroke by 35% and the risk of heart attack by nearly 60%, according to a study of more than half a million people. The risk of stroke was highest in those under age 40.
Its been known for a while now that zoster causes stroke, said Dr. Gwen Wigand-Bolling, an internist at . The inflammation it creates causes heart attack and stroke, and shingles causes increased blood clotting in the arteries, she added.
The risks of both stroke and heart attack were highest in the first year after the onset of shingles and decreases with time, researchers said.
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How Often Does Shingles Return
Experts don’t know exactly how many people get shingles more than once. They do know it comes back more often in people with weakened immune systems.
If your immune system is healthy:
- In the first several years, your chances of having shingles again are lower than it is for people who have never had shingles.
- Over time, your chances of a second bout go up. One study found that within 7 years, the odds of getting it again may be almost 5%. That’s about the same as the odds of getting shingles the first time.
When To Seek Medical Advice
Shingles is not usually serious, but you should see your GP as soon as possible if you recognise the symptoms. Early treatment may help reduce the severity of your symptoms and the risk of developing complications.
You should also see your GP if you are pregnant or have a weakened immune system and you think you have been exposed to someone with chickenpox or shingles and haven’t had chickenpox before.
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Shingles Recurs More Often Than Thought
Recurrences Are More Likely in Those Who Have More Than 2 Months of Shingles Pain
“The risk of getting shingles again, once you already have it, is about one in three,” says Barbara Yawn, MD, director of research at Olmsted Medical Center in Rochester, Minn. “That’s about the same chance of getting shingles once in your lifetime.”
People who suffer pain for 60 or more days after their shingles attack are nearly five times more likely to suffer a recurrence, Moore says.
The research was presented at the annual meeting of the Infectious Diseases Society of America .
Also known as herpes zoster, shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox.
In many people, the virus remains dormant in the nerves. But in some, especially older people and those with compromised immune systems, it can reactivate as shingles.
“We don’t know what causes reactivation of the dormant virus,” Moore says.
The reawakened virus initially causes numbness, itching, severe pain, and even fever, headaches, and chills, followed by the blistering rash characteristic of shingles. The skin rash usually occurs within three to five days after symptoms begin.
Shingles can result in persistent pain lasting for months and even years after the rash has gone away.
“But unless someone has a compromised immune system, we didn’t think they would actually have a recurrent attack,” Moore says.
Who Should Be Vaccinated With Shingrix
The Shingrix vaccine is recommended for those 50 years of age and older who are in good health.
You should get the Shingrix vaccine even if:
- Youve had shingles already.
- Youve been previously vaccinated with Zostavax . If youve been vaccinated with Zostavax, wait at least eight weeks before getting vaccinated with Shingrix.
- You dont know for sure if youve ever had chickenpox.
Ask your healthcare provider, who knows your entire health history if getting this vaccine is right for you.
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How Is Shingles Diagnosed
Doctor usually can diagnose shingles by looking at the rash. Rarely, a doctor may send a small sample of infected skin to be checked in a laboratory.
If you think your child might have shingles, call your doctor. If your child might have shingles on the face, it’s important to get a doctor’s help right away to keep the infection from spreading to the eyes.
A Viral Journey: From Chickenpox To Shingles
Most adults had chickenpox some time in their childhood. If they remember anything at all about it, they remember itchy spotsand maybe a little extra care from mom.
But our bodies never forget.
Thats because the virus that causes chickenpox, the Varicella Zoster virus, lives on for years after the spotsheal up, lying dormant in the nerves along the back. In many people, the virus flares up again years later as anasty case of shingles.
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Avoid Intense Or Irritating Movement
According to the American Academy of Family Physicians, shingles rashes most often appear on the trunk of the body, which includes your:
Shingles rashes can also occur on the:
With that in mind, its best to avoid activities that require you to lay on these areas, like exercising on the floor or a workout bench. For instance, if youre doing gentle yoga, skip any poses that have you lying in the prone or supine position, where your belly or back are touching the floor, respectively.
Additionally, intense cardiovascular exercise like running or cycling may irritate a shingles rash, especially in the early stages.
As you heal, consider switching to lower-intensity workouts like walking until the blisters dry up and crust over. According to the National Institute on Aging , this generally takes around 7 to 10 days after a rash appears.
If possible, hold off on high intensity exercise until the scabs are completely cleared up, which may take 2 to 5 weeks.
Treatments For Other Problems Caused By Shingles
In some cases, shingles causes long-term problems. Treatment depends on what the problem is.
- Disseminated zoster. This is a blistery rash over a large portion of the body. It may affect the heart, lungs, liver, pancreas, joints, and intestinal tract. Treatment is done in the hospital. It may include antiviral medicines to prevent the virus from multiplying and antibiotics to stop infection.
- Herpes zoster ophthalmicus. This is a rash on the forehead, cheek, nose, and around one eye. It could threaten your sight. Get treatment from an ophthalmologist right away. Treatment may include antiviral medicines and steroid eye drops.
- If the shingles virus affects the nerves that begin in the brain , serious problems involving the face, eyes, nose, and brain can occur. Treatment depends on what the problem is and where it is.
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How Is Postherpetic Neuralgia Treated
Treatments include lotions or creams and/or other medications not specifically used for pain, such as antidepressants or drugs for epilepsy. Regular pain relievers are not usually effective for this type of pain.
If your pain doesnt lessen, you might try therapies like nerve blocks or steroid injections near the area where the nerves exit the spine. Your provider might suggest an implantable nerve stimulator device for severe, ongoing pain that hasnt responded to other treatments.
When To Call A Doctor
- Have a rash or blisters on your face, especially near an eye or on the tip of your nose. This can be a warning of eye problems. Treatment can help prevent permanent eye damage.
- Think you have shingles. Early treatment with antiviral medicines may help reduce pain and prevent complications of shingles, such as disseminated zoster or postherpetic neuralgia .
If you still feel intense pain for more than 1 month after the skin heals, see your doctor to find out if you have PHN. Getting your pain under control right away may prevent nerve damage that may cause pain that lasts for months or years.
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