Fact vs. fiction: what you need to know about shingles

You might think shingles isn’t such a big deal – it’s just a grown-up version of chickenpox, right? After all, it’s caused by the same virus. Unfortunately, that’s not exactly the case. The large, red clusters of fluid-filled shingles blisters, which can often wrap around the side of your torso, often feel as bad as they look. “If you saw a case of shingles, you would head straight to the pharmacy to get your vaccine,” says Kathryn A. Boling, M.D., a family physician for Mercy Medical Center in Lutherville, Maryland. 

So what makes shingles so bad? Even a mild case hurts, says Dr. Boling. And, like any illness, you don’t know ahead of time what your case will be like. Plus, more serious side effects are possible – there’s a chance you could be left with long-term pain or even hearing or vision loss. The odds of getting shingles are 1 in 3, according to the Centers for Disease Control and Prevention (CDC),1 so it's important to take it seriously.

Luckily, there’s a way to prevent shingles. But first, let’s learn more about the illness and get the real story behind some of the most common misconceptions about it. 

Fact: if you’ve had chickenpox, you’re at risk of getting shingles

The same varicella zoster virus (VZV) causes both diseases. After you’ve had chickenpox, the virus lies dormant in your nervous system, explains Scott A. Kaiser, M.D., a family physician and geriatrician at Pacific Neuroscience Institute in Santa Monica, California. “And it can be reactivated if your immune system is weakened for a variety of reasons,” he says. 

Stress can weaken your immune system. So can your age. The older you are, the more vulnerable you are, says Dr. Kaiser. And if you can’t remember having had chickenpox, well, you probably did. After all, more than 99% of Americans born before 1980 have had this childhood illness.1

Fact: shingles can cause more than a rash

It can also cause pain. “Before you even develop a rash, the number one thing you’ll likely notice is that it hurts to just touch your skin,” says Dr. Boling. The key is to call your doctor and try to get ahead of what comes next.

According to Dr. Kaiser, about 75% of patients develop pain – which may be constant or come and go – prior to developing a rash. The pain typically shows up about 2 to 3 days before the rash appears. Then a painful red rash erupts, usually in a line along one side of the torso (though the rash can develop anywhere on your body). You’ll also probably have blisters that break open and crust over.2 Other symptoms include headaches and a fever, says Dr. Kaiser.

Fiction: the pain goes away after the rash is gone

Shingles can cause complications even after the rash disappears. The most common complication is chronic nerve pain called postherpetic neuralgia (PHN). For some people, the pain disrupts their daily lives. Having PHN can cause depression and fatigue and make it difficult to sleep and focus, says Dr. Kaiser.  

About 10% to 18% of people who get shingles get PHN, according to the CDC.1 The older you are, the more you’re at risk of developing this lifelong nerve pain. Medications like gabapentin and pregabalin can help ease the pain, but you may need to use them long-term. 

Another less common complication: a shingles outbreak near your eye, or even in it, that can be serious enough to affect your eyesight, says Dr. Boling. 

Fact: shingles can be contagious

Shingles blisters are filled with fluid. When the blisters break open, the fluid weeps out. “Those open blisters could give someone chickenpox, particularly if they haven’t had chickenpox or haven’t been vaccinated against it,” says Dr. Kaiser.

Avoid seeing anyone who might be susceptible to chickenpox while you have an active shingles outbreak. That includes pregnant women, people with weakened immune systems and little kids who haven’t yet gotten the chickenpox vaccine. Kids usually get the shots between 12 and 15 months old and at 4 to 6 years old.3

Fact: shingles will go away on its own

It’s true that the rash typically resolves within a few weeks. But why deal with pain and the increased risk of complications if you don’t have to? Even if your skin is just tingling or painful to the touch, call a doctor. “Most people do call their doctor anyway because it noticeably hurts,” says Dr. Boling.

And that’s a good thing. Your health care provider will prescribe an antiviral, and you’ll want to start taking it within 48 hours of developing symptoms.4

“The whole point of getting the antiviral treatment early is to try to minimize the rash and to reduce the risk of developing that long-lasting nerve pain,” says Dr. Kaiser. So don’t wait to contact your health care provider.

Fact: you can prevent shingles

All it takes is 2 doses of the Shingrix vaccine. The CDC recommends that everyone over 50 get the vaccine, even if you’ve already had shingles.5 (Yes, you can get shingles again.)

The CDC also recommends the vaccine if you’re between 19 and 49 and have a weakened immune system. 5 That includes people with cancer or an autoimmune condition. 

You’ll get a primary shot, then another 2 to 6 months later. If you have a weakened immune system, you can get the second shot 1 to 2 months later.5

How well does the Shingrix vaccine work? It is 97% successful at preventing shingles in healthy 50- to 69-year-olds. And it is 91% effective in those over 70.5 It also really lowers your odds of developing PHN.

There can be side effects from the vaccine. “It may feel like you have a cold for a day or so,” says Dr. Boling. You may also have a sore arm or feel queasy. But the side effects last 1 or 2 days at most. And that’s far better than getting shingles.

The bottom line, say both doctors: Get the vaccine. That way, says Dr. Kaiser, you can prevent a painful illness. Even better, he says, “you’ll prevent potentially debilitating nerve pain that could really set you back from living your best life.”

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