You probably know someone — whether a parent, sibling, uncle, friend, or even yourself — who has experienced the painful, blistering rash known as shingles. Approximately one-third of American adults, particularly those over the age of 50, will develop shingles at some point in their lives.
What Is Shingles?
“Shingles is a painful skin infection,” explains Dr. Joyce Chen, a primary care physician at Rush University Medical Center in Chicago. “It is actually caused by the same virus that causes chickenpox.” If you have had chickenpox, the virus does not completely leave your body. Instead, it remains dormant until a trigger reactivates it. The virus then travels to nerve cells along the skin, resulting in a blistering, painful rash, according to Chen.
Not everyone who had chickenpox will develop shingles. For some, the virus stays dormant forever, notes Dr. Graham Snyder, an infectious diseases expert at the University of Pittsburgh Medical Center. However, one in three American adults who had chickenpox will experience shingles in their lifetime.
Symptoms of Shingles
The primary symptom of shingles is a distinct rash. This painful, blistering, burning rash typically appears as a strip on one side of the body, such as across the torso, down the leg, across the thigh, or on the arm. The rash usually does not cross both sides of the body, Chen adds.
“It can appear anywhere on the body because we have nerves all over our body, but certain areas can lead to more potential complications,” Chen explains. “If that nerve is along or near the eye, it can lead to serious visual complications, even vision loss. If the affected nerve is along the ear, it can also cause hearing loss.”
Because shingles involves the nerves, it is extremely painful. “It can feel hot, be very itchy — usually people describe it as a burning pain,” Snyder says.
Is Shingles Contagious?
Shingles can be contagious, but only to people who have lost their immunity to chickenpox, says Dr. Abigail Waldman, medical director of Mohs and Dermatologic Surgery Center at Mass General Brigham. “If you have shingles, you are not necessarily going to give somebody shingles, but you might give somebody chickenpox if they haven’t had chickenpox or the chickenpox vaccine,” Waldman explains. It can be dangerous for newborns and pregnant people, as well as their unborn babies.
Generally, shingles tends not to pass from person to person because most people already carry the virus, Waldman notes.
Treatment and Prevention
It is important to seek treatment quickly if you have shingles. Antiviral medications are commonly used and come with few side effects. “The antivirals, if given early, can reduce the duration of the illness,” Snyder says. These antivirals also reduce the risk of a painful complication called postherpetic neuralgia, which causes pain or burning even after the rash disappears. “It can be prevented or reduced by the shingles vaccine, as well as early antiviral treatment if started within three days of shingles appearing,” Waldman adds.
Unfortunately, you can get shingles more than once. “You probably have about a one in 100 chance of getting shingles again in the next year, or several percent chance over the next several years,” Snyder says. “It is not a one-and-done for some people, which is why your doctor can give you guidance on getting a shingles vaccine, even if you have had shingles.” The vaccine can help reduce the likelihood of recurrence.
Who Is at Risk?
Older adults and people with weakened immune systems are at higher risk for shingles. The likelihood increases significantly after age 50. “As we get older, the likelihood goes up and up and up,” Snyder says. People with weakened immune systems due to medication or health conditions are also at higher risk. “It is pretty uncommon if you are young, but not impossible,” he adds.
In younger people, shingles can be triggered by factors that suppress the immune system, including stress. “If you are young and you get shingles, it should prompt you to stop and think,” Waldman says, noting that your doctor may want to run tests to identify an underlying cause.
The Shingles Vaccine
The best way to prevent shingles is through vaccination with the Shingrix vaccine. “The vaccine is indicated for anyone over 50 years old, because as you get older you are at higher risk for shingles,” Waldman says. Certain immunocompromised individuals under 50 may also be eligible. If you are younger but immunocompromised, consult your doctor about your options.
In addition to vaccination, managing stress and maintaining a healthy lifestyle can help protect your immune system. “Eat well, sleep enough, things like that,” Waldman advises. Taking care of your mental health and engaging in physical activity are also beneficial. “Just general wellness lifestyle can absolutely help protect you against shingles, because that is also trying to get your immune system nice and healthy,” Chen concludes.
