The Virus That Time Forgot: Shingles
Shingles strikes when the chicken pox virus reawakens
Illustration by Stephen Sauer
Chilly snow days spent sledding down the backyard hill might be long gone, along with sleepovers and long summertime sessions of playing kick the can, but, for some adults, childhood can be revisited - although not in a pleasant way - when, after decades of hibernation, the same virus that causes chicken pox resurfaces and triggers shingles.
Who's at risk? Individuals over the age of 60 are most likely to develop shingles but the disease that brings a painful, blistering rash can occur at any age. Essentially, anyone who has had chicken pox or has received the chicken pox vaccine can develop shingles. That just about covers most of us. Indeed, 90 percent of people over the age of 40 have had chicken pox, says Jennifer Pelli Packard, MD, a dual board-certified physician in internal medicine and pediatrics at Family Health and Wellness Center at Bedford and at Catholic Medical Center. Some cases of chicken pox are so mild, however, that people don't know that they've had it or don't remember having it.
Shingles occurs when the virus that causes chicken pox, after remaining dormant in an individual for years, suddenly becomes active. The virus can hibernate for decades and "not cause any trouble until something shifts that distracts the immune system and lets the virus come back out," says Deborah Dennis, MD, a family medicine physician at SJ Family Medical Center and St. Joseph Hospital in Nashua. Why the virus suddenly awakens is not known, but the cause is believed to be tied to some kind of stress to the immune system. Individuals are more likely to get shingles if they have a weakened immune system due to illness or medication, Dennis says; people who take steroids or undergo chemotherapy, for instance, have a higher risk of developing shingles.
Initial symptoms of shingles typically include a tingling or burning sensation in the skin, with no visible sign of the virus. Usually within a day or two, a rash develops. The rash can appear anywhere on the body but, unlike chicken pox, is usually confined to one side, since it follows a specific nerve root, Dennis says, although occasionally shingles can affect more than one nerve.
Within three to four days, blisters erupt from the rash and then break open and leak fluid. "When the blisters break and weep, the fluid has active virus in it, so it is contagious to people who have never had chicken pox," Dennis says. It is important that shingles patients keep weepy areas covered up carefully and dispose of dressing or bandages properly so that they don't risk transmitting the disease to others. Covering up will also help prevent infection of the rash, she says, as well as provide an anti-chafing barrier between the sores and clothing.
Shingles symptoms can also include fever, chills, headache and joint pain. The overall pain from the rash varies a great deal from person to person, Dennis says. "Some people complain very bitterly; they have a lot of pain with the rash. Others have very little and maybe just some itching. So there's quite a lot of variability in the amount of pain, but it can be excrutiatingly painful in some." In fact, the skin can become so sensitive that wearing clothing becomes almost unbearable, she says, as the patient feels the material rubbing against his or her skin.
Complications from shingles can be serious and long-lasting. If the virus involves an eye or an ear, for instance, the patient can become temporarily or permanently blind. More commonly, patients develop a condition called postherpetic neuralgia, which features pain that can last for weeks, months or even years after the rash fades, Dennis says. "I had a patient years ago who continued to have severe pain in her skin after a bout of shingles," Dennis says. "She was a school teacher and she had trouble wearing tight-fitting clothes for more than a decade. It really can be devastating."
Early diagnosis and treatment of shingles is best; studies show that antiviral medication, administered early in the progression of shingles, can increase the healing of the rash and decrease pain symptoms, but the same medication given later appears to have little effect, Packard says. An early diagnosis can be difficult to achieve, however, since the telltale pattern of shingles-related rash and blisters takes time to develop. Patients "really have to be seen within two to three days of the onset of symptoms, which can be pretty tricky if they're just having this weird tingling sensation and they don't even have a rash yet," Packard says.
Arming yourself against shingles
Shingles triggers a blistering rash and lingering pain in about a million people in the United States each year, according to the National Foundation for Infectious Diseases, but a vaccine is available that can cut your risk in half. The vaccine is routinely recommended by doctors for most people over the age of 60. Anyone can get shingles - even children - but individuals over the age of 60 are most likely to develop the condition, says Deborah Dennis, MD, a family medicine physician at SJ Family Medical Center and St. Joseph Hospital in Nashua. In addition to reducing individuals' risk of developing shingles, the vaccine tends to lessen patients' likelihood of experiencing postherpetic neuralgia, which brings severe pain that can remain long after shingles initially occurs.
Many commercial insurance carriers cover the shingles vaccine for people who are over the age of 60, but Medicare recipients who want their doctor, as opposed to someone in a pharmacy, to administer the shot will find the process a bit cumbersome, Dennis says, because of Medicare complexities. The vaccine costs "almost $300, so it's not something you can just decide to go get and pay out of your pocket easily," she says, "but it's a good vaccine." The best route, as always, is to check with your own insurance provider.