A Rash Decision

According to the Centers for Disease Control and Prevention (CDC), nearly one in three Americans will develop shingles, or herpes zoster, in their lifetime, with the majority of cases occurring in people over age 50. With 40% of Alameda County residents over age 50, Washington Health is offering a Health & Wellness seminar on the painful viral condition.

Washington Health Medical Group internal medicine physician Magin Alexander, MD, will host the seminar, “Shingles: What You Need to Know About Prevention and Treatment,” on Wednesday, Oct. 22, at 5 p.m. Dr. Alexander will discuss risk factors, the latest vaccines and ways to reduce complications.

“Shingles is a painful rash that usually appears on one side of the body,” Dr. Alexander explained. “It’s a viral infection caused by reactivation of the varicella zoster virus, the same virus that causes chickenpox. After you recover from chickenpox, the virus stays dormant in nerve cells in the body. Later in life, it can become active again, causing the shingles rash. It is estimated that by the age of 80, about half of all people will have had an episode of herpes zoster.”

Shingles is usually diagnosed based on symptoms and a physical examination. In uncertain cases, a doctor may take a sample of fluid from the rash to confirm the diagnosis. Shingles typically begins with sensation changes like itching, burning or tingling in an area of skin on one side of the body. This may be associated with fever, headache and fatigue. Within one to two days, a rash appears on one side of the body in a band-like pattern, which later develops into fluid-filled blisters. The rash most commonly affects the trunk, including chest, abdomen and back, though it can involve any part of the body. Skin lesions usually scab over within seven to 10 days and the rash generally disappears within three to four weeks. Scarring and associated skin changes may persist for a long time after shingles has resolved.

An Ounce of Prevention

Aside from age, people with weakened immune systems — such as those taking immune-suppressing medications, undergoing chemotherapy or living with chronic illnesses — are at higher risk for shingles. Most people only get shingles once in their lifetime, but up to 6% of individuals may experience a second episode of herpes zoster. Multiple recurrent infections are rare. Dr. Alexander noted the best way to prevent shingles is to get the two-part shingles vaccine. Even if you’ve had shingles in the past, vaccination is still recommended because it reduces the chance of future episodes.

“The CDC Advisory Committee on Immunization Practices recommends the Shingrix vaccine for all healthy adults age 50 or older,” she said. “It is also recommended for adults age 19 and older who are immunocompromised or about to receive immunosuppressive medical therapy. Patients should check with their health care provider to see if they qualify for the vaccination.”

Studies have shown the shingles vaccine is more than 90% effective in preventing shingles in adults aged 50 and older. It’s given in two injected doses, with the second shot given two to six months after the first dose. As with all vaccines, the shingles vaccine has potential for side effects. Dr. Alexander said injection site soreness, fatigue, chills or fever may occur for two to three days following immunization. It’s all part of the discussion she has with her patients before they begin the vaccine process.

Treatment and Complications

Dr. Alexander said the best treatment for shingles is a course of antiviral medication, begun as soon as possible after diagnosis. The goal is to speed healing, reduce pain and discomfort, and prevent new lesions from forming.

“We prescribe acyclovir, valacyclovir or famciclovir to treat the infection,” she explained. “These medications are most effective when taken within 72 hours of the onset of symptoms. Short-term pain is usually managed with over-the-counter pain relievers, including ibuprofen or acetaminophen. For more severe pain, we may prescribe a short course of opiate pain medication or steroids. For persistent nerve pain, we may prescribe medications like amitriptyline, gabapentin or pregabalin.”

The most common complication of shingles is post-herpetic neuralgia (PHN), which is nerve pain lasting more than three months after the rash appears. Other complications can include secondary bacterial skin infections, vision loss if the eye is affected, facial weakness, or hearing loss if the ear is involved. In people with weakened immune systems, more serious issues such as pneumonia, hepatitis or encephalitis can occur.

“As your age goes up, so does your risk of developing shingles,” Dr. Alexander reiterated. “The best way to prevent shingles is getting vaccinated. If you do develop shingles after receiving the vaccine, your infection may be less severe and you are less likely to develop long-term pain or other complications.”

For more information about shingles, plan to attend Dr. Alexander’s seminar on Wednesday, Oct. 22, at 5 p.m. Following the presentation, the seminar will be added to WH’s video library at www.YouTube.com/@Washington_Health.