What Can You Do To Help Shingles

Risk Factors For Nerve Pain After Shingles

Researchers have long known that older people are more likely to get PHN, the nerve pain after shingles, but recent studies have found other factors that increase risks.

In one study published in the journal Neurology, researchers — including Dworkin — looked at data from 965 people with shingles. The researchers identified five risk factors for developing PHN in people who had been recently diagnosed with shingles:

• Presence of symptoms before the rash appeared, like numbness, tingling, itching, or pain
• Severe pain during the illness’s initial stages

Importantly, the researchers found the more risk factors you have, the greater the risk of developing PHN.

For instance, 17% of women with shingles and 26% of those who had severe pain went on to get PHN. But 50% of women who were over age 60 and had symptoms before the rash, severe rash, and acute pain went on to get PHN.

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 your 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.

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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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.

When Should You Call For Help

or seek immediate medical care if:

• You have a new or higher fever.
• You have a severe headache and a stiff neck.
• You lose the ability to think clearly.
• The rash spreads to your forehead, nose, eyes, or eyelids.
• You have eye pain, or your vision gets worse.
• You have new pain in your face, or you can’t move the muscles in your face.
• Blisters spread to new parts of your body.
• You have symptoms of infection, such as increased pain, swelling, warmth, or redness.

Watch closely for changes in your health, and be sure to contact your doctor if:

• The rash has not healed after 2 to 4 weeks.
• You still have pain after the rash has healed.

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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

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.

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These Home Remedies Should Provide Relief During A Case Of Shingles

The editors at Health are a dedicated team of experienced health editors, writers, and other media professionals who strive to bring trustworthy and responsible health and medical content to their readers. As a team, we have decades of experience in health journalism and have worked at legacy publishers and some of the biggest news and media companies in the U.S.

Anyone who had chickenpox as a kid remembers the red, painfully itchy blister-like rash, and perhaps the fever and fatigue that came along with it. But even though it’s true you’re now inoculated against chickenpox for life, there’s one pox-related complication you may not have considered: Shingles.

Shingles is a reactivation of the chickenpox virus , and causes a painful, itchy rash in one place on the body. Shingles is most common in adults over 50 years of age in fact, about half of people over age 80 may experience it.

Shingles often begin as pain and itching in the skin before a red rash appears one to two days later, with small, water-filled blisters. These blisters soon rupture and scar over, healing and fading over the course of a few weeks. This process can be extremely uncomfortable and painful, making even the littlest actions difficult.

Here’s how to minimize discomfort and pain with stuff you probably already have at home:

Are There Shingles Home Remedies

People who have shingles symptoms and signs should see their doctor as soon as possible, because antiviral medication is effective only if given early. Individuals with facial, nose, or eye symptoms and signs should seek medical care immediately.

• Do not scratch the skin where the rash is located. This may increase the risk of secondary bacterial infection and scarring. Over-the-counter antihistamines and topical creams can relieve the itching.
• After diagnosis and appropriate treatment, apply cool tap-water compresses to weeping blisters for 20 minutes several times a day to soothe and help dry the blisters. This also aids in removing the scabs and decreases the potential for bacterial infection. Tap-water compresses must be stopped once the blisters have dried, so the surrounding skin does not become too dry and itchy. Remember that weeping blisters contain the virus and are contagious to individuals who are susceptible to the chickenpox virus.
• Keep the area clean with mild soap and water. Application of petroleum jelly can aid in healing. Wear loose clothing to avoid extra pain from clothing rubbing against the rash. Avoid close skin-to-skin contact with others who have not had chickenpox, are ill, or who have a weakened immune system.

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What Can I Do For The Pain

To help with the pain of shingles, your doctor might have you take an over-the-counter pain medicine. This could include acetaminophen or ibuprofen .

Applying a medicated anti-itch lotion to the blisters might reduce the pain and itching. Placing cool compresses soaked in water mixed with white vinegar on the blisters and sores might also help.

If shingles causes severe pain, your doctor might prescribe a stronger pain medicine.

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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Is Shingles Prevention Possible Is There A Shingles Vaccine

Prevention of shingles in people who have contracted chickenpox is difficult, since the factors that trigger reactivation are not yet defined. However, if a person is never infected with the virus, shingles will not develop. Furthermore, there are at least two methods that are currently used to reduce the incidence of shingles.

First, the VZV vaccine, otherwise known as the chickenpox vaccine, may decrease the incidence of shingles by enhancing the immune system’s ability to fight off VZV or keep this virus inactive. This vaccine is usually administered to children, but the immunity may decline in about 15-20 years. The single-dose vaccine dose is given to babies 12-18 months of age. Most vaccine side effects, if they occur, are mild and range from a rash, skin redness, and swelling to small chickenpox lesions, usually at the injection site. Boosters of this vaccine for use in adults are now being investigated and may help prevent shingles in the future.

Shingrix is the vaccine the CDC currently recommends as the preferred shingles vaccine. Two doses about 2-6 months apart are more than 90% effective in preventing shingles and PHN, and it is recommended for use in people 50 and over. Side effects of Shingrix may occur and last about 2-3 days and may include redness and swelling at the inoculation site. Some individuals may experience muscle pain, headache, shivering, fever, stomach pain, and nausea.

Treatment For Shingles On Scalp

Shingles is most commonly diagnosed and treated by a primary-care physician or an emergency-room physician. For certain individuals who develop complications of shingles, a specialist in ophthalmology, neurology, or infectious disease may also be involved.

The treatment for shingles is aimed at diminishing the effects of the virus, as well as pain management. There are several medications that can be used, and your doctor will discuss the best treatment options for your particular situation.

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Coping With Shingles Pain

If you have shingles, you may be wondering how to cope with the pain:

• Be sure to get plenty of sleep and eat a healthy diet to help boost your immune system.
• Wear comfortable, loose clothing with natural fiber .
• Establish or maintain a regular exercise routine.
• Utilize home remedies to help soothe pain from blisters.
• Engage in activities that help take your mind off of the pain.
• Establish a routine to help manage stress.
• Seek out support when needed from family and friends as well as professional supportive services.

Questions To Ask Your Doctor

• Ive had chickenpox. Am I at risk of developing shingles?
• What is the best treatment for my shingles?
• The pain from shingles isnt going away. What can I do to make myself more comfortable?
• Im on treatment for shingles. When should I call my doctor if things dont get better?
• I have shingles and my children havent had the chickenpox vaccine. Should I get them vaccinated?
• Is the shingles vaccine right for me?
• Are there any risks associated with the shingles vaccine?
• Will my post-herpetic neuralgia ever go away?
• If Ive never had the chickenpox, should I still get the shingles vaccination?

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Consider Using Creams Lotions Or Patches

Shingles can be very painful. If you need help managing pain, your doctor might prescribe a topical pain-relieving cream or patch. These contain lidocaine or other nerve block medication for the skin.

A medicated anti-itch cream that includes an antihistamine, such as diphenhydramine , might also help you find some relief.

After the rash has scabbed over, you can try using creams or lotions to soothe any remaining symptoms. Look for products that contain:

• colloidal oatmeal

Your doctor may also recommend an oral over-the-counter pain reliever such as a nonsteroidal anti-inflammatory drug or acetaminophen . Always follow the dosage instructions on the label or take according to your doctors instructions.

What If I Have Shingles And A Poor Immune System

If you have a poor immune system and develop shingles then see your doctor straightaway. You will normally be given antiviral medication whatever your age and will be monitored for complications. People with a poor immune system include:

• People taking high-dose steroids. per day for more than one week in the previous three months. Or, children who have taken steroids within the previous three months, equivalent to prednisolone 2 mg/kg per day for at least one week, or 1 mg/kg per day for one month.)
• People on lower doses of steroids in combination with other immunosuppressant medicines.
• People taking anti-arthritis medications which can affect the bone marrow.
• People being treated with chemotherapy or generalised radiotherapy, or who have had these treatments within the previous six months.
• People who have had an organ transplant and are on immunosuppressive treatment.
• People who have had a bone marrow transplant and who are still immunosuppressed.
• People with an impaired immune system.
• People who are immunosuppressed with HIV infection.

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Why Does Shingles Appear Mostly On One Side Or In One Area Of Your Body

The virus travels in specific nerves, so you will often see shingles occur in a band on one side of your body. This band corresponds to the area where the nerve transmits signals. The shingles rash stays somewhat localized to an area. It doesnt spread over your whole body. Your torso is a common area, as is your face.

Rebooting The Nervous System

Its like restarting a computer, Dr. Rosenquist says. When its running slowly or acting weird, you restart it. We are trying to turn that nerve off. When it comes back on, hopefully, it will send an appropriate transmission as opposed to a pain transmission.

Treatmentoptions for PHN patients include:

Patientswith refractory PHN rarely need opioid pain medication. However,you should be evaluated by a physician. We cant make a blanket statement abouttreatment. It is individualized, she says.

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Preventing Nerve Pain After Shingles

But if you’re worried about PHN, don’t despair. There are medications that can cut your risks of getting the condition. There are three antiviral drugs used: famciclovir , valacyclovir , and acyclovir . These medications need to be started within two to three days of the onset of shingles.

“If you look at the clinical trials with any of these drugs in people over 50,” says Dworkin, “they cut the rate of pain at six months in half. That’s a very significant improvement.” They are also very safe and have few side effects, he says.

But who needs the drugs? Dworkin says there’s not a clear consensus yet.

There are some obvious cases. “I think everyone would agree that someone who is over 50 and has severe symptoms should get preventative treatment,” he tells WebMD.

But for younger people or those with fewer risk factors, the course is less clear.

“Some people think that everyone who gets shingles should get preventative treatment with antiviral medicines, because the medicines are so safe and have such few side effects,” he says.

Others argue that preventative treatment should only be given to those at greater risk. The main reason for this, Dworkin says, is cost.

“A full course of treatment could cost anywhere between $100 and $160,” he says. “That can add up, and insurance companies might not want to pay if the risks are very, very low.”

What Is The Outcome For Someone Who Has Shingles

Most people get shingles once, but its possible to get it again.

If you have a healthy immune system, the blisters tend to clear in 7 to 10 days. The rash tends to go away completely within 2 to 4 weeks. The pain may last longer, but usually stops in 1 or 2 months.

For some people, the pain will last longer than the rash. When it does, its called postherpetic neuralgia , which can come and go or be constant. PHN can last for months, years, or the rest of your life. Treatment can help reduce the amount of pain you feel.

Be sure to tell your doctor if you continue to have pain. Treatment can help you feel more comfortable.

For anyone who has a shingles rash, the right self-care can help ease your discomfort. Youll find out what dermatologists recommend at, Shingles: Self-care.

ImageGetty Images

ReferencesCenters for Disease Control and Prevention . About shingles. Page last reviewed 10/17/2017. Last accessed 4/1/2019.

Dooling KL, Guo A, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. Morb Mortal Wkly Rep 2018 67:103-8.

Madkan V, Sra K, et al. Human herpes viruses. In: Bolognia JL, et al. Dermatology. . Mosby Elsevier, Spain, 2008: 1204-8.

Straus SE, Oxman MN. Varicella and herpes zoster. In: Wolff K, Goldsmith LA, et al. Fitzpatricks Dermatology in General Medicine . McGraw Hill Medical, New York, 2008: 1885-98.

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