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If you have shingles, it’s important to talk to your doctor about your risk for developing PHN. Ask whether preventative treatment with antiviral drugs makes sense. If your doctor says it’s not necessary, ask why.
The full implications of the psychological risk factors for PHN aren’t clear yet, says Dworkin. But he suggests that people with shingles should try to stay active and connected.
“If psychological distress is a risk factor for PHN,” he says, “then we think that people who have shingles might benefit from getting out and not being isolated and homebound.”
You might make an effort to stay connected to family and friends and not to dwell on your symptoms. Also, keep in mind that even if you do develop PHN, there are treatments that can help.
“We have about a half dozen types of drugs that are used as first-line treatments for PHN,” says Dworkin. They include lidocaine patch , pregabalin , gabapentin , capsaicin , carbamazepine , tricyclic antidepressants, and painkillers.
The most important thing is to get prompt medical attention if you think you might have shingles.
“If you have a one-sided rash — especially if you’re over 50 — see your doctor right away,” says Dworkin. “It could be shingles. And we know that prompt treatment can dramatically reduce the likelihood of developing long-term pain.”
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Where A Shingles Rash Forms
A shingles rash typically occurs on the face, neck, or chest, on just one side of the body.
The affected area of skin is called a dermatome, a region supplied by the sensory fibers of a specific spinal nerve. Outbreaks can involve two adjacent dermatomes, but rarely two non-adjacent dermatomes.
The exception may be in people whose immune systems are severely comprised, such as those with advanced HIV infection. They’re often at risk of disseminated shingles , shingles of the eyes or internal organs, and a recurrence of shingles within six months.
Dont Shrug Off Shingles
- By Matthew Solan, Executive Editor, Harvard Men’s Health Watch
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If you had chickenpox as a kid, there is a good chance you may develop shingles later in life. In fact, one in three is predicted to get shingles during their lifetime, says Dr. Anne Louise Oaklander, director of the Nerve Unit at Harvard-affiliated Massachusetts General Hospital.
The same varicella-zoster virus that causes chickenpox also causes shingles. After the telltale spots of chickenpox vanish, the virus lies dormant in your nerve cells near the spinal cord and brain. When your immunity weakens from normal aging or from illnesses or medications, the virus can re-emerge. It then travels along a nerve to trigger a rash in the skin connected to that nerve. The rash often appears on only one side of your body. The most common locations are the chest, back, or stomach, or above one eye.
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How Long Does It Take For Shingles To Progress
Shingles progresses into blisters over three to five days and begins to crust over after seven to ten days. The rash is preceded by a prodromal phase lasting 48-72 hours or longer, consisting of throbbing pain and numbness in the area affecting the nerve. Once the rash blisters, it can last another three to five days before the lesions scab over.
After the lesions crust over, it may take two to four weeks to heal completely. At this time, pain may still be present. The most painful stage of shingles is when you have fluid-filled blisters. This usually occurs three to five days after the rash first appears.
What Increases The Risk Of Long
The risk of developing post-herpetic neuralgia increases with age. Four weeks after getting shingles,
- 27% of 55- to 59-year-olds and
- 73% of over 70-year-olds had nerve pain.
Women seem to be more likely to have longer-lasting nerve pain than men. Post-herpetic neuralgia is also more likely to develop if your eyes were affected by shingles.
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Key Points About Shingles
- Shingles is a common viral infection of the nerves. It causes a painful rash or small blisters on an area of skin.
- Shingles is caused when the chickenpox virus is reactivated.
- It is more common in people with weakened immune systems, and in people over the age of 50.
- Shingles starts with skin sensitivity, tingling, itching, and/or pain followed by rash that looks like small, red spots that turn into blisters.
- The rash is typically affects just one area on one side of the body or face.
- Treatment that is started as soon as possible helps reduce the severity of the disease.
What Are Shingles Symptoms
Common symptoms of shingles are pain and a rash in a belt-like form that stops at the midline of the body affecting only one side. Symptoms of shingles progress from burning and itching sensations to severe pain at the location of the rash. Early shingles symptoms may include burning, tingling, or a numb sensation on the skin accompanied by headache, upset stomach, and chills.
Later stages include painful fluid-filled blisters that cause severe pain, fever, and severe itching.
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How Do Dermatologists Diagnose Shingles
A dermatologist can often diagnose shingles by looking at the rash on your skin.
If there is any question about whether you have shingles, your dermatologist will scrape a bit of fluid from a blister. This will be sent to a lab where a doctor will look at the fluid under a high-powered microscope.
When you have shingles, the fluid contains the virus that causes shingles. Seeing the virus confirms that you have shingles.
Your dermatologist will also ask about your symptoms. Shingles tends to be painful.
When the shingles rash spreads to an eye, it can affect your eyesight
You can reduce this risk by seeing an ophthalmologist immediately.
Treating The Pain Of Phn
Exactly how best to deal with the pain is a difficult question. Rice led a research team that looked at 35 clinical trials of various treatments. The findings appear in the July issue of the free-access online journal PloS Medicine.
“The most important thing to realize is these are painkillers,” Rice says. “You are treating the pain, not the disease itself. And this is due to permanent nerve damage. It is like a stroke. We can’t make the nerve damage better, but we can treat the disability. And for PHN, pain is one of those disabilities.”
What helps? Rice’s team found good evidence supporting:
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Am I At Risk For Shingles
Everyone who has had chickenpox is at risk for developing shingles. Researchers do not fully understand what makes the virus become active and cause shingles. But some things make it more likely:
- Older age. The risk of developing shingles increases as you age. About half of all shingles cases are in adults age 60 or older. The chance of getting shingles becomes much greater by age 70.
- Trouble fighting infections. Your immune system is the part of your body that responds to infections. Age can affect your immune system. So can HIV, cancer, cancer treatments, too much sun, and organ transplant drugs. Even stress or a cold can weaken your immune system for a short time. These all can put you at risk for shingles.
Most people only have shingles one time. However, it is possible to have it more than once.
What Are The Complications Of Shingles
Symptoms of shingles usually dont last longer than 3 to 5 weeks. However, complications can happen. The main complications that can result from shingles include:
- Postherpetic neuralgia . The most common complication of shingles is called postherpetic neuralgia . This continuous, chronic pain lasts even after the skin lesions have healed. The pain may be severe in the area where the blisters were present. The affected skin may be very sensitive to heat and cold. If you had severe pain during the active rash or have impaired senses, you are at increased risk for PHN. The elderly are also at greater risk. Early treatment of shingles may prevent PHN. Pain relievers and steroid treatment may be used to treat the pain and inflammation. Other treatments include antiviral drugs, antidepressants, anticonvulsants, and topical agents.
- Bacterial infection. A bacterial infection of the skin where the rash happens is another complication. Rarely, infections can lead to more problems, such as tissue death and scarring. When an infection happens near or on the eyes, a corneal infection can happen. This can lead to temporary or permanent blindness.
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Skin Care And Itch Relief For Shingles
To relieve itching and discomfort, try:
- A cool, wet compresses on the affected skin
- Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or calamine lotion
- Zostrix, a cream that contains capsaicin
- Antihistamines to reduce itching
Keep your skin clean. Throw away bandages you use to cover your skin sores. Throw away or wash in hot water clothing that has contact with your skin sores. Wash your sheets and towels in hot water.
While your skin sores are still open and oozing, avoid all contact with anyone who has never had chickenpox, especially pregnant women.
What Are The Symptoms Of Postherpetic Neuralgia
Common postherpetic neuralgia symptoms include:
- Burning, sharp, jagging or aching pain in the area where the shingles rash appeared.
- Itchiness or numbness at or near the area of the former rash.
- Pain that is constant or comes and goes. Pain typically lasts, on average, for three months after the rash has healed, but can last for more than a year or longer.
- Pain at affected skin area can be brought on even with a light touch .
- Pain gets worse at night or in heat or cold temperatures.
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Is Shingles Contagious
Shingles is not contagious but is the reactivation of a virus already present in the body.
However, a person with shingles can give chickenpox to someone who has never had the VZV infection before.
Therefore, people with shingles should avoid contact with those who have never had chickenpox until their rash has completely healed. To catch the virus, someone must have direct contact with the rash.
To avoid spreading VZV, people with shingles should:
- Avoid close contact with people who have never had chickenpox or been vaccinated for chickenpox.
- Avoid close contact with low birth-weight infants and people with a compromised immune system, such as those on HIV medication or who have had an organ transplant.
- Keep the rash covered with loose, natural clothing to avoid others coming into contact with it.
- Wash their hands frequently, especially after touching the rash or applying lotions to the skin.
There is a vaccination available to reduce the risk of developing shingles and experiencing long-term complications, such as PHN.
The recommends that adults aged 50 years and older have two doses of the Shingrex vaccination over a 2-6 month period. It is believed to be more than 90% effective at preventing shingles and PHN.
People who have already had shingles can have the vaccine to prevent future occurrences.
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How Is It Treated
It is best to start treatment as soon as possible after you notice the rash. See your healthcare provider to discuss treatment with antiviral medicine, such as acyclovir. This medicine is most effective if you start taking it within the first 3 days of the rash. Antiviral medicine may speed your recovery and lessen the chance that the pain will last for a long time.
Your provider may also recommend or prescribe:
- medicine for pain
- antibacterial salves or lotions to help prevent bacterial infection of the blisters
- corticosteroids
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Is There A Way To Prevent Shingles
Fortunately, a vaccine is available for older adults that can prevent shingles and reduce the incidence of postherpetic neuralgia. The Zostavaxshingles vaccine was approved in 2006. In 2017, the U.S. Food and Drug Administration approved a newer vaccine, Shingrix, as the preferred vaccine. The older Zostavax is a live vaccine given as a single injection, and the newer Shingrix is a nonliving vaccine. The newer Shingrix vaccine is given in two doses two to six months apart. Shingles vaccination is recommended for use in people over 60 years of age.
Antiviral medications, including acyclovir and valacyclovir , when administered early enough in the course of the disease, can decrease the severity and duration of the outbreak, reduce the risk of eye damage if the eyes are involved, and reduce the likelihood of developing postherpetic neuralgia. It is recommended that antiviral drugs be given within 72 hours of the onset of symptoms for the best outcome.
Pain medications can also be effective in controlling shingles pain. These may be applied to the skin, like the capsaicin topical patch or lidocaine . Oral medications that can help with pain control in people with shingles include tricyclic antidepressants such as amitriptyline and certain antiseizure medications such as gabapentin .
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Appearance Of The Shingles Rash
The eruptive stage of shingles begins a few days later. This is when a rash appears.
The skin in the area of the prodromal pain caused by shingles will often be sensitive to the touch and reddish in appearance. As these symptoms get worse, it may begin to feel like a sunburn.
Within three to five days of the initial pain, a few tiny pimple-like spots appear and quickly multiply into clusters, forming a rash that feels prickly to the touch.
From there, sometimes within hours, the pimples develop into water-filled blisters, or vesicles, that then consolidate into larger blisters. Often, redness and swelling accompany the rash.
The shingles rash looks very much like the chickenpox rash, with a key difference: Chickenpox blisters are widely scattered over the entire body. With shingles, the rash almost always occupies a finite strip of skin.
Ultimately, the pain of shingles may get so excruciating that simply grazing the skin with clothing can set off what feels like an electric shock.
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What Outcome Can I Expect If I Have Postherpetic Pain
Theres no standard treatment for the symptoms of postherpetic pain . Depending on the severity of your pain, you may start with over-the-counter products. If your pain is more severe, one or more prescription medications may be tried. PHN is difficult to treat. Achieving a complete symptom-free state was achieved in less than half the patients with PHN, according to one study.
PHN tends to happen in older individuals who may have other health conditions, which can complicate treatment and results. Pain can last weeks, months and even longer than a year. In some people, the pain can be debilitating. In most people, PHN lessens with time.
A note from Cleveland ClinicThe best way to not get postherpetic neuralgia is to prevent it from happening in the first place. Varicella-zoster virus causes both chickenpox and shingles. Vaccines are available to protect against developing both of these viral infections.
Once you develop chickenpox, the varicella-zoster virus remains in your body for life. If the virus reactivates and causes shingles, you have a few days around the rash outbreak to see your provider and get an antiviral medication, which can significantly lessen your symptoms. Still, if you develop PHN, your provider has many medications available to manage your symptoms.
Can I Prevent It
The FDA has approved two shingles vaccines, Zostavax and Shingrix. A vaccine is now recommended for everyone 60 and older. People from 50 to 59 may want to talk to their doctor about it if they have ongoing pain or skin issues or have a weakened immune system.
The vaccines cut the chance of shingles by at least 50%. Even if you still get shingles, the painful period is shortened and you reduce your risk of postherpetic neuralgia.
Early treatment for shingles can also lower your chances of getting this complication. So if you think you have it, call your doctor right away. The main treatment is with antiviral drugs during the early stages of shingles, within 2 to 3 days of symptoms coming on. Medications used include:
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If You Have Shingles Symptoms Get Treatment Now And You May Avoid Permanent Nerve Pain
Shingles, a viral infection of the nerve roots, affects 1 million people in the U.S each year. Most people recover from their bout, but for as many as 50% of those over age 60 who have not been treated, the pain doesn’t go away. It can last for months, years, or even the rest of their lives.
These people have what’s called postherpetic neuralgia , the result of the shingles virus damaging the nerves of the skin. In some cases, the pain is mild. In others, even the slightest touch — from clothing or even a breeze — can be excruciating.
“PHN causes a great deal of suffering and high social costs,” says Robert H. Dworkin, PhD, a professor in the department of anesthesiology at the University of Rochester Medical Center in Rochester, N.Y. “It can severely disrupt people’s lives.”
But the good news is that there are drugs that can help treat and even prevent PHN, and doctors are learning more about who is at greatest risk of developing this debilitating condition.
Are There Other Ways To Ease The Pain
Most people with postherpetic neuralgia use medication to control their symptoms. But there are other ways to control the pain, too. They include:
TENS : You use a device that shoots tiny electrical currents into the area of pain on the skin. This helps block the pain.
Cold packs: Try a gel-filled one to numb the area unless cooler objects make your neuralgia worse.
Comfortable clothes: Go for looser fits and fabrics such as cotton and silk.
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