Shingles: The Chickenpox Comeback
June 2009
by Molly M. Ginty
It looked at first like a harmless rash. But it caused a month of itching, burning, stabbing pain.
When Marijke Vroomen-Durning developed shingles—caused by the same virus as chickenpox—she thought the scaly bumps on her back were eczema stemming from excessively dry skin.
“Like other shingles patients, I’d had chickenpox when I was younger,” says Vroomen-Durning, a writer in Montreal, Canada. “But I never expected the virus to return as shingles in my 40s, so I didn’t seek treatment immediately.”
Because Vroomen-Durning missed the 72-hour window within which medication can stop shingles in its tracks, her rash became a band of angry red blisters that stretched from the middle of her back around to her belly following the nerve pathway around her waist. The outbreak (which affects nerves as well as the skin) caused Vroomen-Durning so much pain that she couldn’t wear regular clothes. “For weeks, I dragged around the house in my pajamas, and was so fatigued that I had to sleep during the day,” she says.
Though shingles cost Vroomen-Durning four weeks of her routine, experts say the virus can be far worse. “In 20 percent of patients—particularly those who are older or whose immune systems are compromised—shingles can lead to nerve damage called postherpetic neuralgia, or PHN,” says Dr. Anne Louise Oaklander, an associate professor of neurology at Harvard Medical School. “The affected nerves become so sensitive that just feeling a mild breeze on your skin can be intolerable. This pain can last for months, even years.”
Named for the Latin word cingulum or “belt,” because its rash typically goes partially around the torso, shingles strikes 15 to 20 percent of people at some point in their lifetimes and has the highest annual incidence of any neurological disease. Affecting one million Americans per year, it can wreak so much suffering and damage that being able to recognize its symptoms—and seek treatment quickly—is crucial.
“My shingles case started as a small patch of blisters behind one ear, and luckily stayed that way,” says Jessica Brown, an editor in New York City. “Because I saw my doctor right away and got medication to prevent the rash from spreading, the blisters dried up within three days, and I only felt tired for a week.”
How can chickenpox return in later life—and return with a vengeance? Shingles is caused by the same varicella zoster virus that causes most people to get a scattering of itchy chickenpox sores during childhood. A cousin of the virus that causes herpes and cold sores, varicella zoster can hide out in the nerves for years after chickenpox passes. Decades later, when age, illness, or medications compromise the immune system, the virus can return and trigger a red itchy rash along affected nerve pathways. Blisters erupt in a confined patch. There is less itching—but more pain and fatigue—than with the earlier outbreak.
Fever. Chills. Headache. Stomach upset. Shooting pain in one area. These symptoms can come before shingles blisters arrive, when a full-blown attack can still be prevented.
One side of the neck. Right shoulder blade. The spot above one eye. The top of the left thigh, but not the right. Shingles blisters strike areas like these, breaking out on just one side of the body.
If you develop these symptoms, you should avoid people who haven’t had chickenpox or shingles so that you don’t pass the virus on to them. Especially vulnerable are women in the earliest stages of pregnancy, when shingles exposure is treatable and less dangerous than chickenpox exposure, but can still potentially affect a baby’s health.
After a shingles diagnosis, your doctor may give you antiviral drugs that reduce shingles’ duration and severity: acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir). These medications can halve your risk of developing postherpetic neuralgia, while tricyclic drugs such as amitriptyline and nortriptyline can treat PHN itself.
For the itching and burning of shingles rashes, a host of remedies can help. Prescription treatments include corticosteroids such as prednisone (which reduce inflammation), narcotics such as opioids (which relieve pain), and skin patches with anesthetics such as lidocaine or xylocaine (which numb itching skin). Over-the-counter options include hydrocortisone cream; cool, wet compresses; creams made with capsaicin (a substance found in chili peppers); cool baths with baking soda or colloidal oatmeal; and nonprescription anti-inflammatory drugs (such as Advil or Motrin).
The best medications, say experts, are the vaccines you can take to prevent shingles before it even starts. The chickenpox vaccine (called Varivax) can be administered to children or adults and can prevent chickenpox and shingles in both groups. The shingles vaccine (Zostavax) is recommended for people over 60 and reduces their risk of shingles by 50 to 60 percent while slashing their risk of PHN by 70 percent.
Another effective way to ward off shingles? Looking after the people you love. “Women get shingles at an older age than men, and epidemiologists think the reason for this is that women more frequently serve as caregivers for children with chickenpox,” says Oaklander.
“Contrary to what happens with most diseases, if you’ve already had chickenpox and take care of someone who has chickenpox or shingles, this will boost your own immunity to the shingles virus and lessen your personal risk.”
Molly M. Ginty lives in New York. Her work has appeared in Ms., Marie Claire, Redbook, and Women’s eNews.