Shingles Complications: Postherpetic Neuralgia
Postherpetic neuralgia is the most common complication of shingles. This is defined as persistence of the nerve pain associated with shingles beyond one month, even after the rash is gone. It occurs from irritation of the sensory nerves by the virus. The pain of PHN can be severe and debilitating. Up to 15% of people with shingles develop PHN. Typically, this occurs in people over 50 years of age. Treatment of shingles with antiviral drugs can reduce the duration and occurrence of postherpetic neuralgia.
Could It Be Shingles
If youre an older adult and experiencing a blistery rash, the most likely answer is that youve got shingles, a.k.a. herpes zoster, which affects one in three people in their lifetime, according to the CDC. Shingles is whats known as a reactivation virus that usually affects older adults, says Dr. Jones Lopez. Basically, once youve had chickenpox, the varicella zoster virus stays in your body. After the initial infection, the virus goes into dormant state for potentially decades, he says. Much later in life, when your immunity goes down, it can reactivate as shingles.
Unlike a chickenpox rash, the shingles rash is usually confined to a specific area of the body and appears in a single band, rather than spreading indiscriminately. It typically happens somewhere on the chest or back, says Dr. Jones-Lopez, although the head and other parts of the body can sometimes be affected. The key thing that distinguishes the shingles rash is that it doesnt cross the midline. If it spreads across your body, its not shingles. For example, if youve got a rash on left side of your face but another on the right side of your back, you can probably rule out this illness.
In addition to a rash , you may have some pain, itching, or tingling on your skin. You may also have flu-like symptoms . Like chickenpox, shingles rashes may itchbut they are mostly known for causing pain.
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Can You Get Shingles From The Covid
There have been a few reports of shingles happening in people who were vaccinated against COVID-19. The varicella-zoster virus was reactivated in these people.
A note from Cleveland Clinic
If youve had chickenpox, youre at risk of developing shingles later in life. Shingles causes a rash that is contagious and painful. The disease can have serious complications. The best thing you can do to reduce your risk is to get the shingles vaccine. The vaccines are safe and effective.
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Is A Vaccine Available To Prevent Shingles
Two vaccines are available in the United States to reduce your chance of developing shingles and postherpetic neuralgia. One vaccine, Zostavax®, has been available since 2006. The second vaccine, Shingrix®, has been available since 2017. Shingrix is recommended as the preferred vaccine by the Advisory Committee on Immunization Practices, a group of medical and public health experts.
Shingrix® is given as a two-dose shot in the upper arm. You should receive the second dose two to six months after receiving the first. Shingrix has been shown to be more than 90% effective in preventing shingles and postherpetic neuralgia. Its effectiveness remains above 85% for at least four years after receiving the vaccine.
Due to high levels of demand for the Shingrix vaccine and a supply shortage, the vaccine manufacturer is managing the timing and distribution of the vaccine throughout the United States. It plans to continue to manage the availability of the vaccine and hopes to make available the same or increased number of doses and to shorten the wait time for delivery this year .
What Does It Mean To Let Shingles Run Its Course
This refers to the typical course a shingles rash takes, even with antiviral treatment:
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Will Shingles Go Away Without Treatment
Shingles, or herpes zoster, is a painful rash caused by the varicella-zoster virus . This is the same virus that causes chickenpox.
This virus remains dormant in a part of your nervous system called the dorsal root ganglion. It can be reactivated during times of stress or illness, or when the immune system is weakened by an autoimmune disease or cancer.
The risk of developing shingles is relatively low for healthy young adults about 4 out of 1,000 people in the United States, according to the Centers for Disease Control and Prevention . Its much higher for those above age 60. Shingles affects about 1 out of 100 people in this older age group, the CDC says.
Generally, a case of shingles rash resolves within 3 to 4 weeks. It can resolve without treatment, but antiviral treatment can shorten both the duration and severity of the rash.
If I Get The Shingles Vaccine Does This Mean Im 100% Protected From Getting Shingles
No, just like most vaccines, getting vaccinated doesnt provide 100% protection from disease. However, getting the shingles vaccine reduces your risk of developing shingles. Even if you do develop shingles, youll be more likely to have a mild case. Also, youll be much less likely to develop postherpetic neuralgia, the painful condition that can follow a shingles outbreak.
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You Cannot Get Shingles From Someone With Chickenpox
You cannot get shingles from someone with shingles or chickenpox.
But you can get chickenpox from someone with shingles if you have not had chickenpox before.
When people get chickenpox, the virus remains in the body. It can be reactivated later and cause shingles if someones immune system is lowered.
This can be because of stress, certain conditions, or treatments like chemotherapy.
Zoster Sine Herpete Is A Rare Form Of Shingles That Doesn’t Cause A Rash
Most people with shingles have a telltale rash on one side of their body, but it is possible to have shingles without a rash. It’s called zoster sine herpete or internal shingles. It’s caused by the same virus, varicella-zoster virus , that causes chickenpox and typical shingles .
Internal shingles still causes pain and itchingjust without the rashalong with other symptoms. Because healthcare providers may not recognize it as a shingles infection, ZSH infections may be more common than previously thought.
This article explores the differences in symptoms, the additional complications ZSH can cause, how it’s diagnosed and treated, and how you can cope with it.
Getty Images / Oscar Wong
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How Long Can Shingles Last Without Medication
Without medication, blisters typically scab over within seven to ten days, clearing completely by two to four weeks later. Symptoms can arrive before an outburst, but also continue to remain after the redness and blistering subside.
Medication is optional for people suffering from shingles, but its often a welcome reprieve from the complications of the condition. Still, some medication can prolong shingles outbreaks if a person is allergic or suffers other side effects from any dosage.
Can Shingles Be Prevented
Shingles can be prevented. Vaccine is available against varicella zoster virus to prevent chickenpox and shingles. According to the CDC , children are routinely recommended to take two doses of the vaccine, the first dose at the age of 12 to 15 months and the second between four and six years. Two doses of the vaccine are recommended in children and adults who have never had chickenpox. One dose of the vaccine prevents 95% of moderate disease and 100% of severe disease. Two doses of the vaccine are more effective. It is not known how long the vaccine is effective, but studies have shown that the vaccine provides protection against the varicella zoster virus for 10 to 20 years following vaccination.
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Which Shingles Vaccine Is Best
Eventually, your doctor will start mentioning the shingles vaccine which can help prevent shingles from developing, as well as reduce its severity if it does still develop. The shingles vaccine can also reduce your risk of postherpetic neuralgia, one of the most common complications of shingles.
“Because shingles becomes increasingly more common as a person ages, the shingles vaccine is currently recommended for people over the age of 50. There are two vaccine options, Shingrix and Zostavax, with Shingrix being the newer of the two vaccines and the preferred choice as it is more effective.”
When it comes to how the shingles vaccine works, Shingrix is a shot that requires two doses administered six months apart. There are temporary side of effects of this shingles vaccine that can be unpleasant, however. Shingles vaccine side effects typically don’t last more than three days, but include:
- Redness or swelling
What Does Early Stages Of Shingles Look Like
Shingles progress through several stages as the virus replicates in your body. Shingles start as a rash with red bumps, known as papules, distributed most frequently over your back and torso.
Within several days, grouped blisters are present. Within seven to ten days, the vesicles dry up and crust.
The early stage of shingles looks like small, red, raised, solid pimples or an inflamed rash. These are tiny, raised bumps on the skin. Eventually, these bumps blister and later crust. The beginning stages of shingles create tingling and localized pain.
The early stages of shingles are also described as itching, burning, or deep pain. People who have had shingles also described the early stages as similar to the beginning of the flu.
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Who Should Not Get The Vaccine
Do not get the shingles vaccine if:
- You have a severe allergic reaction, such as anaphylaxis, to any ingredient of a vaccine or to a previous dose of Shingrix
- You have shingles now.
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You are sick with an illness and a fever of 101°F or higher.
- You should also consider delaying the vaccine if you are pregnant or breastfeeding. Not enough is known about its safety for expectant and lactating women.
- You have had a negative test for varicella this would be uncommon for adults eligible for the vaccine, as most adults worldwide ages 50 and older have been exposed to the virus. You do not have to be tested before getting the vaccine.
You Can Get Chickenpox As An Adult
The majority of cases occur in kidsbut if you never had chickenpox and youre exposed to the varicella zoster virus as an adult, you can certainly still come down with the illness. And unfortunately, youre probably in for a worse ride: Its usually milder in kids, says Dr. Parsons, also a dermatologist in private practice at Dermatology Consultants of Sacramento. In adults, the virus can be severe, potentially even leading to pneumonia or meningitis, she says.
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Who Is At Risk From Shingles
Anyone who has had chickenpox is at risk of getting shingles later in life. About one in three people who have not been immunised against chickenpox or shingles will get shingles in their lifetime.
Shingles usually affects older people. The older you are if you get shingles, the higher your risk of getting serious disease. People who have a weakened immune system are also at risk of getting more severe disease, even if they are young.
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How Long Does Shingles Last
From the time you begin to feel symptoms until the rash has totally disappeared can take three to five weeks.
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Can You Have Shingles Without The Rash
Whether or not shingles can present without a rash is a topic of debate, and for Dr. Gurland, the answer is not simple: Theres a lot of discussion about this because, without the rash, youre left with pain at a single nerve root, and other diseases can cause that. But there are people who present with just pain and while you are confident that they have shingles, they just dont have the typical rash, and they may even respond to some shingles treatments. But its a hard diagnosis to make without the rash. Thats why seeking the care of an infectious disease specialist like those at ID Care is key as experience can play a vital role in the proper diagnosis and treatment of shingles.
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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.
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Is There A Shingles Vaccination
In the UK there is a shingles vaccine immunisation programme for people aged 70 years to protect against herpes zoster. There is also a catch-up programme which offers the vaccine to anyone aged between 70 and 79 years who has previously missed out on immunisation. The vaccine is licensed for people aged over 50 years, and if you are not eligible for the vaccine on the NHS, your pharmacist may be able to provide the vaccine as a private service.
The chickenpox vaccine is not routinely given to children in the UK but is offered to people who are in close contact with someone who is particularly vulnerable to chickenpox or its complications – eg, people with a weakened immune system.
What Specialists Treat Shingles
Primary care physicians, including internal medicine specialists, family medicine specialists and/or specialists in infectious diseases, can appropriately treat some patients. An emergency medicine physician may start the initial care. However, if there is a chance the eye may be involved, an ophthalmologist should be consulted. If a person is pregnant and gets shingles, they should consult with their ob-gyn physician immediately. For long-term or chronic pain involved in postherpetic neuralgia, a neurologist and/or pain specialists may be involved in the care of the patient.
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Should I See A Doctor For Shingles
It is usually worth seeing a doctor to be certain about the diagnosis and to see if you need treatment or not. Ideally you should see a doctor as soon as possible after the rash appears.
The rash of shingles can be very painful. So even if the doctor doesn’t think you need an anti-shingles medicine, they may be able to give you stronger painkillers than those you can buy over the counter from the chemist.
Can You Spread Shingles Over Your Own Body
Shingles cannot be spread over different areas of your body. For example, if you have an active shingles rash on your back, the fluid from the blisters cannot cause a new rash on your arm.
However, the fluid could potentially spread VZV to someone else if theyve never had chickenpox or received the chickenpox vaccine.
One caveat here is that some people can develop disseminated herpes zoster, which is when the shingles virus causes a rash over multiple areas of the body. This can happen in people who have weakened immune systems from autoimmune disease, cancer, or immunosuppressant medications.
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If I Have Disseminated Zoster/shingles What Can I Expect For My Hospital Stay
It is important to note that most people with shingles do not need to be in a hospital, but if you do:
- You will be in an airborne-contact isolation room.
- The door will be kept closed.
- A sign on your door will remind people who have never had chickenpox or the vaccine not to enter.
- The sign will also remind staff to wear gowns and gloves when entering the room.
Systemic Disease Produced By Vzv Reactivation Without Rash
reported a case of fatal hepatic necrosis caused by VZV in a 64-year-old woman. She had undergone splenectomy 14 months before the fatal hepatitis. The postmortem diagnosis was based on characteristic pathological changes in the liver, the detection of herpesvirus virions in liver by electron microscopy, and serologic evidence of recent VZV infection. A report of fulminant fatal disseminated VZV infection without rash occurred in an 8-year girl undergoing chemotherapy for leukemia virus was present in blood, lungs, liver, kidneys, and bone marrow . Although the nervous system was spared in both patients, these cases confirm the existence of disseminated VZV infection of multiple organs in the absence of rash.
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