What Can Cause Shingles To Come Back

Shingles In The Back Of The Eye

Shingles involving the retina or optic nerve structures found at the back of the eye typically is not associated with a skin rash or other symptoms at the eye surface. This type of shingles infection is called viral retinitis and occurs much less commonly than HZO. But it can significantly damage the retina through a combination of infection and inflammation. Viral retinitis can take the form of acute retinal necrosis or progressive outer retinal necrosis .

In contrast to patients with HZO or other forms of shingles that are associated with a skin rash, patients with ARN are often middle-aged and generally healthy. Diagnosis of ARN requires a careful eye exam by an ophthalmologist, and a sample may be collected from the inside of the eye for testing to confirm that the infection is caused by the varicella zoster virus. In mild cases, ARN can be treated with oral antiviral medications, with or without injections of antiviral medications into the eye. In more severe cases, or if there is no improvement with oral medications and intraocular injections, these infections are treated with intravenous antiviral medications until the infection starts to improve.

Prior Chicken Pox And Shingles

Any individual that has had chicken pox or the chicken pox vaccine is at a risk for shingles. Shingles in people over 60 years of age is particularly dangerous, and in response there is now a vaccine against the disease. Shingles, in effect, is latent chicken pox that sits in the bodys nerve endings. Aggravation of the nerve endings and the chicken pox virus causes shingles. The vaccine may prevent shingles, but is not guaranteed.

There is no way to know when or where shingles will appear. When first appearing, shingles looks like a small rash, but the rash causes no pain. Within a few days or even a few hours, the rash will become quite red and painful. Shingles can appear anywhere on a persons body. Shingles can last for a few weeks to several months, but eventually clears up on its own.

What Does Prednisone Do

Prednisone, like other corticosteroids, quickly lowers inflammation, which cuts down on pain, redness, and swelling. It also dials down your immune system. Under normal conditions, this system protects you against things like viruses and bacteria that cause infections and diseases.

Sometimes your immune system overreacts and attacks your bodys tissues. Prednisone stops that attack. Thereâs also proof that low-dose prednisone may slow joint damage in people with rheumatoid arthritis, but not as much as other arthritis medications do. It can also cause unpleasant long-term side effects.

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How To Identify The Source Of Your Foot Pain

With all the possible causes of nerve pain in the foot, it may be difficult to pinpoint the exact underlying cause. Here are a few useful signs to help you identify the source of your foot pain:

• Foot pain that follows recent trauma to the lower back, hip, knee, or ankle may help indicate the site of nerve damage
• Foot pain due to nerve root compression or sciatica may also be associated with other symptoms, such as pain, numbness, and/or weakness in the buttock, thigh, and leg and typically affects one leg at a time
• Foot pain that develops after wearing tight boots or shoes may indicate peroneal or sural nerve compression near the knee or ankle
• Foot pain that develops after a hip injection or hip surgery may indicate sciatic neuropathy

Nerve pain in the foot may also occur due to nerve damage from systemic conditions, such as diabetes or multiple sclerosis.

Twisting, bending, or a direct hit on your ankle and/or foot may injure the foot bones, ankle joint, blood vessels, muscles, and/or tendons, causing foot pain.

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Can You Still Develop Shingles If Youve Been Vaccinated For Chickenpox

Yes. Despite being vaccinated for chickenpox, you can still get shingles. No vaccine is 100% protective, and the effectiveness of vaccines lessens with time. However, people who get the chickenpox vaccine are significantly less likely to develop shingles later in life compared with people who never received the chickenpox vaccine. One recent 12-year study found that the number of shingles cases was 72% lower in children who had received the chickenpox vaccine compared with those who didnt.

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What Is The Most Painful Stage Of Shingles

Typically, the peak pain of shingles is felt within 4 or 5 days after the first symptoms develop, and it comes along with a blistering rash. As the blisters scab over, the pain usually starts to disappear. In some cases, the pain does not go away. This is known as a condition called postherpetic neuralgia.

Do I Need To Stay Away From Children Pregnant Women People With Cancer Or Anyone With A Weak Immune System After I Get The Zostavax Vaccine

According to the CDC, it is safe to be around babies and young children, pregnant women or anyone with a weakened immune system after you get the Zostavax vaccine. Even though the Zostavax vaccine contains a weakened live varicella zoster virus, the CDC says there is no documented case of a person getting chickenpox from someone who has received the Zostavax vaccine.

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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

What Increases Your Risk

Things that increase risk for shingles include:

• Having had chickenpox. You must have had chickenpox to get shingles.
• Being older than 50.
• Having a weakened immune system due to another disease, such as diabetes or HIV infection.
• Experiencing stress or trauma.
• Having cancer or receiving treatment for cancer.
• Taking medicines that affect your immune system, such as steroids or medicines that are taken after having an organ transplant.

If a pregnant woman gets chickenpox, her baby has a high risk for shingles during his or her first 2 years of life. And if a baby gets chickenpox in the first year of life, he or she has a higher risk for shingles during childhood.footnote 1

Post-herpetic neuralgia is a common complication of shingles that lasts for at least 30 days and may continue for months or years. You can reduce your risk for getting shingles and developing PHN by getting the shingles vaccine.

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Is The Zostavax Vaccine Still Being Used

Yes. The CDC, however, recommends Zostavax for adults age 60 and older, but not routinely for people aged 50 to 59. Zostavax is given as a single-dose shot versus the two-dose shot for Shingrix. Zostavax is less effective than Shingrix in preventing shingles and postherpetic neuralgia .

You can consider Zostavax if you are allergic to Shingrix or if Shingrix is unavailable because of supply shortage and you want some immediate protection from a possible case of shingles and/or postherpetic neuralgia. Because its a weakened live vaccine, it may be dangerous if you have cancer, HIV, or take steroids, chemotherapy or other medications that suppress your immune system. Ask your healthcare provider if the Zostavax vaccine is an option for you.

How Is Shingles Diagnosed

Your healthcare provider will do a complete physical exam and ask about your medical history, specifically about whether you have ever had chickenpox.

Your healthcare provider will likely know right away that it is shingles based on the unique rash. The rash usually appears one area on one side of the body or face. It appears as red spots, small fluid- or pus-filled vesicles, or scabs.

The healthcare provider may also take skin scrapings for testing.

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How Do Dermatologists Treat Shingles

An antiviral medication can:

• Reduce the amount of time that you have a shingles rash

• Lower your risk of developing long-lasting nerve pain and other health problems

One of three antiviral medications is usually prescribedacyclovir, famciclovir, or valacyclovir.

To treat your symptoms, dermatologists typically recommend the following:

Pain: Medication that you can buy without a prescription can help, such as:

If you have severe pain, your dermatologist may prescribe a medication that reduces inflammation, such as a corticosteroid.

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How Is Shingles Treated

Specific treatment for shingles will be determined by your healthcare provider based on:

• Your age, overall health, and medical history
• How long the shingles have been present
• Extent of the condition
• Your tolerance for specific medicines, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference

There is no cure for shingles. It simply has to run its course. Treatment focuses on pain relief. Painkillers may help relieve some of the pain. Antiviral drugs may help lessen some of the symptoms and reduce nerve damage. Other treatments may include:

• Creams or lotions to help relieve itching
• Cool compresses applied to affected skin areas
• Antiviral medicines
• Anticonvulsants

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How Can You Care For Yourself At Home

• Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. Antiviral medicine helps you get better faster.
• Try not to scratch or pick at the blisters. They will crust over and fall off on their own if you leave them alone.
• Put cool, wet cloths on the area to relieve pain and itching. You can also use calamine lotion. Try not to use so much lotion that it cakes and is hard to get off.
• Put cornstarch or baking soda on the sores to help dry them out so they heal faster.
• Do not use thick ointment, such as petroleum jelly, on the sores. This will keep them from drying and healing.
• To help remove loose crusts, soak them in tap water. This can help decrease oozing, and dry and soothe the skin.
• Take an over-the-counter pain medicine, such as acetaminophen , ibuprofen , or naproxen . Read and follow all instructions on the label.
• Avoid close contact with people until the blisters have healed. It is very important for you to avoid contact with anyone who has never had chickenpox or the chickenpox vaccine. Pregnant women, young babies, and anyone else who has a hard time fighting infection is especially at risk.

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Why Doesnt Having Chickenpox Earlier In Life Provide Immunity Against Having Shingles Later

After having chickenpox, your body doesnt rid your system of the virus. Instead, the virus stays in a portion of the spinal nerve root called the dorsal root ganglion. In most people, the virus simply stays there quietly and doesnt cause problems. Scientists arent always sure why the virus gets active again, but they know stress can be a cause.

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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.

Shingles In The Front Of The Eye

Shingles can affect the cornea, the curved, transparent dome of tissue at the front of the eye. This is called keratitis, and it can occur as a complication of herpes zoster ophthalmicus , which refers to shingles with a rash that typically involves one side of the upper face, forehead, and scalp. More than half of patients with HZO may have keratitis.

If you have shingles involving the upper face, forehead, or scalp area, it is important to see an ophthalmologist for a formal eye examination, whether or not you notice any eye symptoms. Keratitis usually develops within one month of the shingles rash and can lead to numbness of the cornea, scarring, additional infections, and more corneal damage, which can ultimately cause blindness.

HZO, like episodes of shingles on other areas of the body, is typically treated with oral antiviral medications to address the underlying viral infection. Treatment decreases the risk of later eye complications by about 40% to 60%. When started within 72 hours of the onset of symptoms, antiviral treatment also reduces the overall severity of the infection and the risk of post-herpetic neuralgia, a form of long-term pain that can occur after an episode of shingles.

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A Word About The Shingles Vaccine

If you are age 60 or over and have not had shingles, talk to your doctor about getting the shingles vaccine. Not only will it reduce your risk of developing shingles, but if you do develop shingles, youll be more likely to have a mild case. And, just as important, youll be much less likely to develop PHN if youve had the vaccine.

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When To See A Healthcare Provider

• If you suspect shingles
• Within 3 days of getting the rash, to prevent lasting nerve pain
• If the rash and pain are near an eye, which can cause permanent eye damage
• If you’re over age 60 due to an increased risk of complications
• If you have a weakened or suppressed immune system or someone close to you does

Shingles Doctor Discussion Guide

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How Does It Occur

If you have had chickenpox, you are at risk for later developing shingles. After you recover from chickenpox, the chickenpox virus stays in your body. It moves to the roots of your nerve cells and becomes inactive . Later, if the virus becomes active again, shingles is the name given to the symptoms it causes.

What exactly causes the virus to become active is not known. A weakened immune system seems to allow reactivation of the virus. This may occur with normal aging, immune-suppressing medicines, or another illness, or after major surgery. It can also happen as a complication of cancer or AIDS or treatment of these illnesses. Chronic use of steroid drugs may trigger shingles. The virus may also become active again after the skin is injured or sunburned. Emotional stress seems to be a common trigger as well.

Is There A Vaccine Against Shingles

Shingix is currently the only shingles vaccine available in the United States. Its given to people over age 50.

Previously, an additional vaccine, Zostavax, was used, but it was phased out in the United States as of November 2020.

According to the CDC, two doses of Shingrix are over 90 percent effective at preventing shingles. Youll retain at least 85 percent protection for 4 years after being vaccinated.

If you get shingles after being vaccinated, your symptoms will likely be less severe. Youll also have a lower chance of developing postherpetic neuralgia a complication where pain remains even after a shingles rash goes away.

Shingles usually follows a pattern of development. It typically progresses with the following symptoms:

• First, you may notice a tingling or burning sensation in your skin.
• One to 5 days later a rash appears as small red spots.
• Fluid-filled blisters develop a few days later.
• After 7 to 10 days, the lesions crust over.
• The rash disappears over the next 2 to 4 weeks.

In some cases, pain may persist for several months or even years after the rash has disappeared. This complication, known as postherpetic neuralgia , can be severe enough to affect your quality of life.

Certain antiseizure medications can help manage the pain. Gabapentin and pregabalin are two that are commonly used.

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