Shingles

  • Overview
    shingles-herpes-zoster-landing.jpg
    Shingles: This disease often causes a painful, blistering rash.

    Shingles: Overview

    Also called herpes zoster

    Will insurance cover the cost of the new shingles vaccine?

    In October 2017, the U.S. Food and Drug Administration (FDA) approved a new vaccine that can prevent shingles. This is the second vaccine that the FDA has approved to prevent shingles. Insurance currently covers the cost of getting the shingles vaccine that the FDA approved some years ago.

    Who pays for the cost of this new vaccine, however, is causing confusion. Here’s what you should know.

    While this new vaccine is available, it takes time for insurance companies to cover the cost. It’s expected that insurance will cover the cost of getting this new vaccine, which requires 2 shots, in 2018.

    What exactly is shingles?

    Anyone who has had chickenpox can get shingles. After the chickenpox clears, the virus stays inside the body. If the virus reactivates (wakes up), the result is shingles — a painful, blistering rash.

    The risk of getting shingles increases with age. A vaccine can reduce your risk of getting shingles. Your doctor may recommend getting this vaccine after your 50th birthday or once you reach 60 years of age. There’s another — and maybe even more important — reason for getting the shingles vaccine. If you’ve had chickenpox, you can still get shingles after getting shingles vaccine. The vaccine also lessens your risk of developing serious complications from shingles, such as life-disrupting nerve pain.

    The nerve pain can last long after the shingles rash goes away. Some people have this nerve pain, called post-herpetic neuralgia (PHN), for many years. The pain can be so bad that it interferes with your everyday life. The shingles vaccine reduces your risk of developing this nerve pain, even more than it reduces your risk of getting shingles.

    An anti-viral medicine may also prevent long-lasting nerve pain if your get shingles. It’s most effective when started within 3 days of seeing the rash. The anti-viral medicine can also make shingles symptoms milder and shorter.


    Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

    References

    Centers for Disease Control and Prevention. “What everyone should know about the shingles vaccine.” Page last updated Oct 27, 2017. Last accessed December 4, 2017.

    Madkan V Sra K, et al. “Human herpesviruses.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1205.


    Shingles
  • Symptoms
      shingles-symptoms_widespread.jpg
    Shingles: The rash can be very painful and widespread.

    Shingles: Signs and symptoms

    Shingles tends to cause more pain and less itching than chickenpox. Common signs (what you see) and symptoms (what you feel) are:

    • The warning: An area of skin may burn, itch, tingle, or feel very sensitive. This usually occurs in a small area on 1 side of the body. These symptoms can come and go or be constant. Most people experience this for 1 to 3 days. It can last longer.

    • Rash: A rash then appears in the same area.

    • Blisters: The rash soon turns into groups of clear blisters. The blisters turn yellow or bloody before they crust over (scab) and heal. The blisters tend to last 2 to 3 weeks.

    •   shingles-symptoms_patch.jpg
      Shingles: This patch of skin was very painful before the shingles appeared.
    • Pain: It is uncommon to have blisters without pain. Once the blisters heal, the pain tends to lessen. The pain can last for months after the blisters clear.

    • Flu-like symptoms: The person may get a fever or headache with the rash.

     

    Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.



    Shingles
  • Causes

    Shingles: Who gets and causes

    shingle-sores.jpg
    To reduce your risk of spreading the virus to others while you have shingles, be sure to cover your blisters.

    Who gets shingles?

    A person must have had chickenpox to get shingles. Some people who have had chickenpox have a higher risk of getting shingles. You have a higher risk if you:

    • Are 50 years of age or older
    • Have an illness or injury
    • Are under great stress
    • Have a weakened immune system

    Some illnesses and medical treatments can weaken a person's immune system and increase the risk. These include:

    • Cancer
    • HIV/AIDS
    • Some cancer treatments, such as chemotherapy or radiation
    • Medicine taken to prevent rejection of a transplanted organ
    • Cortisone when taken for a long time

    What causes shingles?

    The virus that causes chickenpox also causes shingles. After chickenpox clears, the virus stays inside the body and travels to the nerves where it sleeps.

    Shingles appears when the virus wakes up. It is not clear what reactivates or "wakes up" the virus. A short-term weakness in immunity may cause this.

    Is shingles contagious?

    Shingles is much less contagious than chickenpox. Still, a person who has shingles can spread the virus. Anyone who has not had chickenpox (or the chickenpox vaccine) can get this virus. When this happens, the person develops chickenpox, not shingles.

    If you have shingles, what can you do to prevent spreading the virus?

    When you have shingles, you're only contagious while you have blisters. To prevent spreading the virus while you have blisters, the Centers for Disease Control and Prevention (CDC) recommends that you:

    • Cover the rash
    • Wash your hands often and try to avoid touching the rash
    • Avoid being around people for whom catching the virus could be dangerous

    Virus especially dangerous for these people

    Catching this virus and getting chickenpox can be dangerous for women who are pregnant and have not had chickenpox or gotten the chickenpox vaccine. In this situation, the virus can harm the woman’s unborn baby.

    Babies less than 1 month old and people who have a weak immune system can also have complications if they catch the virus. People who have a weak immune system include those who are:

    • HIV positive
    • Taking medicine that weakens their immune system
    • Receiving chemotherapy or radiation treatments

    You’re not contagious before you develop blisters or after the blisters scab over. Be sure to take precautions while you have blisters.


    Shingles
  • Treatment
      shingles-treatment-eye.jpg
    Shingles: Shingles can involve the eye.

    Shingles: Diagnosis and treatment

    How do dermatologists diagnose shingles?

    To diagnose shingles, a dermatologist will look at the skin and ask some questions.

    If there is any doubt, the dermatologist may scrape a blister to get a sample. This sample will be examined under a microscope. Also, the dermatologist may send the fluid from a blister to a laboratory for testing.

    How do dermatologists treat shingles?

    Without treatment, the rash clears in a few weeks. Dermatologists, however, strongly recommend treatment. Without it, many people get pain, numbness, itching, and tingling that can last for months — or years.

    It is best to get treatment immediately. Treatment can include:

    • Pain relievers to help ease the pain: The pain can be very bad, and prescription painkillers may be necessary.

    • Anti-viral medicine: This medicine may be prescribed when a doctor diagnoses shingles within 72 hours of the rash first appearing. The earlier anti-viral treatment is started, the better it works. Anti-viral medicines include famciclovir, valacyclovir, and acyclovir. These can lessen the pain and the amount of time the pain lasts.

    • Nerve blocks: Given for intense pain, these injections (shots) contain a numbing anesthetic and sometimes a corticosteroid.

    • Corticosteroids: To lower swelling and pain, some patients may get corticosteroid pills with their anti-viral medicine. This treatment is not common because it can make the rash spread.

    Treatments for pain after the rash clears: Certain anti-depressants, pain relievers, anesthetic creams and patches, and anti-seizure medicines can help.

    Ask your dermatologist about possible side effects (health problems that can result from the medicines).

    Outcome

    Patients with shingles rarely need a hospital stay. But shingles can cause serious problems such as:

    • Post-herpetic neuralgia (post-her-PET-ic noo-RAL-jah):
      This is the most common problem. It can cause pain, numbness, itching, and tingling. It can last for months — or even years. People who get this also may have fatigue, little appetite, and trouble sleeping. Sometimes they experience intense pain from something as harmless as a light touch. People over age 60 are most likely to have this complication.

    • Eye problems: Shingles that involve the eye are called ocular shingles or herpes zoster ophthalmicus. Signs and symptoms of shingles in the eye are blisters around the eye or on the eyelid, swelling and redness of the eye or eyelid, and eye pain. Some people become sensitive to light. After a bout with shingles that involves the eye, a person can have blurred vision or feel that something is in the eye.
      If blisters appear on the tip of the nose, it may be a warning of possible eye problems. Anyone who gets blisters on the nose should see a doctor immediately. Without treatment, permanent eye damage can result. Glaucoma, scarring, and even blindness are possible. People who have shingles in the eye also may have a higher risk for having a stroke.

    • Bacterial infection: The blisters can become infected, which can slow healing. Lasting pain and redness warn of an infection. If either occurs, see your dermatologist. You may need antibiotic treatment. An infection can lead to scars without prompt treatment.

    Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.



    Shingles
  • Tips

    Shingles: Tips for managing

    When talking about shingles, dermatologists recommend the following to their patients:

    Pain relief

    To relieve the pain and itching of shingles, you can:

    • Cool the rash with ice packs, cool wet cloths, or cool baths.
    • Apply calamine lotion to the blisters.
    • Cover the rash with loose, non-stick, sterile bandages.
    • Wear loose cotton clothes around the body parts that hurt.

    Prevention

    A shingles vaccine is available for people ages 50 years and older. The benefits of getting this vaccine include the following:

    • In one study, this vaccine lowered the risk of getting shingles by 50 percent.
    • If you develop shingles after getting the vaccine, you are likely to have less pain.


    Shingles