The varicella zoster virus (Chickenpox virus) is insidious. It infects us when we are young then often lies in wait for decades. You can’t feel it. You can’t see it. But it’s there, waiting to strike again – as a rash called shingles.
The virus’s opportunity to cause shingles often comes when our bodies have been worn down by another illness, an immunosuppressive medication such as prednisone or a stressful life event. The virus starts to replicate; it emerges from its home in cell bodies called dorsal root ganglia near your spine or skull and travels down the nerves to a patch of skin where the virus erupts in a blistering, painful rash.
For many years, shingles was thought to be a mild condition – a painful rash that came, lasted a few weeks, then was gone. With time, shingles was recognized to carry the risk of serious long-term complications. For example, the virus that causes shingles can cause strokes or encephalitis (inflammation of the brain that can cause brain damage). If the virus reactivates in the facial nerve, shingles can cause paralysis of one side of the face and hearing damage. If the virus reactivates in a nerve that goes both to the nose and to the eye, then blindness can result (known as herpes ophthalmicus). So Red Alert: shingles on the face can be a vision or hearing emergency.
However, the much more common complication of shingles is “post-herpetic neuralgia,” which means nerve pain after herpes infection (VZV, the virus that causes shingles, is a member of the herpes family of viruses). Post-herpetic neuralgia is nothing to dismiss lightly. It is a neurologic syndrome of pain, tingling, itching or other discomfort that occurs often for months to years after the rash of shingles has gone away. The pain can at times be debilitating. There is no cure. One only hopes it improves with time. Medications like gabapentin can help treat the symptoms, but such medications carry their own side-effects and problems.
The CDC recommends that most individuals fifty years or older receive two shots of the Shingrix vaccine two to six months apart. Because protection from shingles is strongest only for the first five years after vaccination and most cases of shingles occur in those sixty and older, some physicians advocate getting vaccinated at age sixty or older instead of fifty. Dermatologists usually do not carry or administer the vaccine, so the exact age to be vaccinated should be discussed with your internist or family doctor as should any questions about whether re-vaccination is advisable after a number of years.
Why all the fuss? Is shingles really a common enough problem to worry about? Currently, about half of people living to age eighty five will develop shingles at some point in their lives, and post-herpetic neuralgia occurs in at least ten percent of cases of shingles. Shingles is not fun. Its Norwegian name is “helvetesild” which means “hell’s fire.” Many Norwegians are descendants of the Vikings, known to be a tough and stoic lot and if they call something “hell’s fire,” then it is worth avoiding!
Evidence is mixed, but treatment with valacylovir and other medications within 72 hours of the onset of shingles decreases pain and may decrease the chance of developing post-herpetic neuralgia. If you are ever worried you may have shingles, be sure to seek healthcare immediately and avoid and warn individuals who are pregnant, immunocompromised or who otherwise might be harmed by catching shingles, as the virus is contagious.
Dr. Brent Taylor is a board-certified dermatologist, fellowship-trained Mohs surgeon, and is certified by the American Board of Venous and Lymphatic Medicine. Surgical, medical and aesthetic services are available. If you or a loved one has a skin or vein care need, please consider making an appointment today.