Shingles: A Useful Guide

Shingles is a painful skin condition which is caused by the same varicella-zoster virus which causes chickenpox. It is quite common, with around one in every four people expected to have at least one episode during their life.

It is especially common in old age, particularly in those over the age of 70, as your immunity can often decrease. Fortunately, there is a vaccination available for free on the NHS to those aged between 70 and 78-years-old, which we will look at in more detail later in this blog post.

In today’s post we will also look at the causes, symptoms and treatments available for shingles, alongside any further complications that it can cause.

What is Shingles?

Shingles is an infection of a nerve and the skin around it. It is caused by the same virus which causes chickenpox and only those who have had chickenpox can develop shingles. This is because the varicella-zoster virus remains inactive in the nervous system once the chickenpox has gone.

The infection commonly leads to a rash or blisters forming on your skin, which can become quite painful.

Causes

As we already know, shingles is triggered by the same virus which causes chickenpox and in common in older people. It is not completely known why the virus is reactivated during later life, but most cases are thought to have been caused by the body having lowered protection against infections and diseases.

A lower immune system can be caused by:

• Chemotherapy.
• Physical and emotional stress.
• HIV and AIDS.
• Recently having a bone marrow transplant.
• Recently having an organ transplant.

Despite being more common in older people, young people who are otherwise healthy can also develop shingles.

It is not possibly to catch shingles from someone with the condition, or from somebody who has chickenpox. However, you may catch chickenpox from someone with shingles if you haven’t had chickenpox before, although this is quite rare. The NHS explain how this may happen:

The blisters of shingles contain live virus. If a person who has never had chickenpox makes direct contact with an open blister or something with the fluid on it, they can contract the virus and develop chickenpox.”

You can help to prevent the virus from being passed on by avoiding any contact sports and the sharing of any towels or flannels. You should also avoid swimming and work if your rash is oozing fluid and cannot be covered.

As chickenpox can be dangerous to certain groups of people, you should avoid women who are pregnant who haven’t had chickenpox, those which a weak a immune system and babies who are less than one month old – unless it’s your own baby, in which case your baby should have proteins that fight infection (antibodies) to protect them from the virus.

Symptoms

The main symptom of shingles is pain, followed by a rash which then develops into itchy blisters which are like those caused by chickenpox. New blisters may continue to appear for up to a week, before turning yellow in colour, flattening out and becoming dry.

Scabs will then appear where the blisters were, some of which may cause slight scarring and a loss of skin pigment. The pain that you feel may be a constant, dull or burning sensation and the intensity can vary from mild to severe.

The affected skin area will also be quite tender, and you may experience sharp stabbing pains every now and then. Alongside the main signs, you may also experience some early symptoms of shingles, such as:

• A high temperature.
• A headache.
• A general feeling of being unwell.
• Burning, tingling, numbness or itchiness of the skin in the affected area.

Any part of your body can be affected by shingles, with the chest and abdomen being the most commonly affected. Commonly, the virus will only affect a specific area on one side of your body and won’t cross the ‘mid-line’ of the body – an imaginary line running from between your eyes down past the belly button.

Diagnosis

Although it isn’t usually serious, if you experience any symptoms of shingles you should see your doctor as soon as possible. Your doctor should be able to diagnose the condition based on your symptoms and the appearance of your rash.

It is quite rare for you to be referred to hospital, however this may be the case if:

• Your doctor suspects any complications such as meningitis.
• The condition if affecting your eyes, as this could cause permanent vision problems.
• You have an unusually persistent case of shingles which hasn’t been responding to any treatment.
• You have been diagnosed with shingles twice.
• You’re pregnant.
• You have a weakened immune system.

Treatment

Currently there is no treatment for shingles, however there are treatments available to help relieve the symptoms until the condition resolves itself. Commonly, most cases of the condition will last between two to four weeks.

The earlier the diagnosis, the earlier treatment can begin – which can help to reduce the severity of your condition and reduce the risk of any complications. There are many self-care treatment tips that you can follow to help keep your shingles under control. These include:

• Keeping your rash as clean and dry as possible to reduce infection.
• Wearing loose-fitting clothes.
• Not using any rub-on antibiotics or adhesive dressings such as plasters as this can slow down the healing process.
• Using a dressing that won’t stick to your rash – Non-adherent.

The NHS suggest using Calamine Lotion as this has a cool, soothing effect on the skin and can relieve the itchy feeling. If your blisters are weeping, you can use a cloth or flannel which has been cooled with tap water. You can do this several times throughout the day, but only compress them for around 20 minutes at a time.

Alongside your own self-care treatment, there are forms of medication which can be prescribed to help control your condition. Your doctor may give you a course of antiviral tablets which last seven days, which help to prevent shingles virus from multiplying.

These tablets can also reduce the severity of your shingles, reduce how long the condition lasts and prevent any further complications. These tablets are most effective when taken within 72 hours of the rash first appearing.

Painkilling medication may also be given to help relieve the pain associated with the condition. The most common type of painkiller used is paracetamol, although another alternative is ibuprofen. this isn’t suitable if you suffer from any stomach, liver or kidney problems, or if you have asthma. You should also avoid these if you’re pregnant.

Other medication may include:

• Opioids – Used if you’re in severe pain.
• Antidepressants – Have been proven to relieve nerve pain.
• Anticonvulsants – Also commonly used to control fits caused by epilepsy, these tablets are also useful in relieving nerve pain.

Complications

As we have mentioned throughout this post, there can be some complication of shingles. These are more likely if you have a weakened immune system or are an older person. Here are a few complications of shingles:

• Posterpetic Neuralgia – This is the most common complication of shingles, affecting as many as one in five people over the age of 50. This can cause severe nerve pain and intense itching even after the rash and other symptoms have gone. This can last between three or six months, years or in some cases, for life.
• Eye Problems – If one of your eyes is affected by shingles, further problems may develop. This includes glaucoma, inflammation of the eye and optic nerve and ulceration and permanent scarring of the surface of your eye.
• Ramsay Hunt Syndrome – This can occur if shingles affects certain nerves in your head. Symptoms include earache, hearing loss, dizziness, vertigo, a rash around the ear and a loss of taste. Early treatment can lead to recovery if started within 72 hours of the symptoms occurring.
• Inflammation of your lungs (pneumonia), liver (hepatitis), brain (encephalitis), spinal cord (transverse myelitis) or protective membranes that surround your brain and spinal cord (meningitis). Fortunately these complications are quite rare.

Shingles is rarely life threatening, but complications like those mentioned above mean around one in every 1,000 cases in adults over the age of 70 is fatal.

Shingles Vaccination

The best way of preventing or lowering the severity of a case of shingles is by being vaccinated. The vaccine, known as Zostavax, is given as a single injection into your upper arm and you’ll only need to have it once – at anytime of the year.

You are eligible for this vaccination if you’re aged 70 or 78-years-old, however there is some leeway as the NHS explain:

In addition, anyone who was eligible for immunisation in the previous three years of the programme but missed out on their shingles vaccination remains eligible until their 80th birthday.

This includes people in their 70s who were born after September 1, 1942 and those aged 79.

The vaccine itself contains a weakened chickenpox virus, which means that very occasionally people have developed a chickenpox-type illness following vaccination. Research suggests the shingles vaccine will protect you for at least five years, probably longer.

Once you’re eligible for the vaccination, your doctor will take the opportunity to vaccinate you when you attend the surgery for general reasons or for your annual flu vaccination.

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