What is shingles?
Shingles, or Herpes Zoster, is an infection caused by the Varicella Zoster Virus (VZV). VZV is the same virus that causes chickenpox. After an initial chickenpox infection, the virus lies dormant in the body, and reactivates to cause shingles in times of weakened immunity or stress.
Shingles presents with itchy or painful rashes and blisters that can occur anywhere on the body or face. Pain may be the first symptom of shingles, and may occur for a couple of days before the appearance of the rashes. The rashes usually follow the distribution of the nerves (dermatomes) and tend to affect only a localized area on one side of the body.
The rashes usually dry up within 1-2 weeks, and for a large proportion of cases the pain resolves within a month.
Shingles is contagious and spreads through direct contact with the fluid from the blisters. The exposed individual will develop chickenpox rather than shingles.
How common is shingles?
In Singapore, it is said that more than 80% of adults have had chickenpox, and there are an estimated 30000 cases of shingles a year.
According to the US CDC, about 1 in 3 people in the US will get shingles in their lifetime.
Who is at risk of getting shingles?
Anyone who has ever had chickenpox can develop shingles.
However, it is more common in people who are over 50 years of age, with those more than 60 years of age having a higher risk of severe complications.
It is also more common in patients with weakened immune systems, from conditions such as HIV or cancer, and medications such as chemotherapy or long-term steroids.
What are the complications of shingles?
The most common complication of shingles is postherpetic neuralgia (PHN), a nerve pain that lasts for months to years after the shingles rashes resolve. This occurs in approximately 10% of cases, and is more common in older patients. The pain can be debilitating and interfere with daily life.
Shingles affecting the area around the eyes may lead to eye infection and vision loss, while that affecting the area around the ears may lead to hearing loss.
The rashes of shingles can also be infected by bacteria.
Rarely, shingles can lead to lung or brain infections, or even death. This occurs more in people with weakened immune systems.
How is shingles treated?
There is no cure for shingles and the illness will usually run its course and resolve eventually. There are, however, medications that can help to reduce the symptoms.
Antivirals, such as acyclovir or valacyclovir, can help reduce the length and severity of illness. These should be started as soon as possible, ideally within 72 hours of symptom onset.
Pain relief is important, and analgesia can be prescribed to reduce the pain felt from shingles. Medications for itch may also be given.
How can I prevent shingles?
Vaccination is the best way to protect against shingles and its complications.
Shingles vaccine is recommended for adults more than 50 years of age, or those 19 years and older who have weakened immune systems, regardless of their prior exposure to chickenpox.
Those who have had shingles before are also recommended to take the vaccine.
For children who have not been exposed to chickenpox prior, the chickenpox vaccine can be considered.
What are the types of shingles vaccine available?
There are 2 types of shingles vaccine – Shingrix and Zostavax.
Shingrix, a recombinant non-live vaccine, has been shown to be more than 90% effective in preventing shingles and postherpetic neuralgia. It is given as 2 doses, 3 months apart.
Zostavax, a live vaccine, has been shown to be 50-60% effective. As a live vaccine, it is not suitable to be administered to pregnant women and those with weakened immune systems.
The US CDC recommends those who have had Zostavax in the past receive Shingrix.
How can we help at Oaklife Family Clinic?
At Oaklife Family Clinic, we are able to make the diagnosis of shingles and provide appropriate treatment.
We are also able to administer the shingles and chickenpox vaccines. Contact us to find out more.
Written by Dr Lim Chong Soon Daniel on 26 October 2023.
References:
Disclaimer: this article is written for educational purposes and does not substitute for medical diagnosis and treatment.