Treatment and Prevention of Shingles
By Anelia Van Zyl
Recently, I had shingles; something that I’d heard of in the past as a disease that older and unhealthy people get. I was wrong. I'm 43. I eat nutritious food. I exercise three to four times a week. I sleep seven to eight hours a night. I do enjoy a glass of wine on occasion. Still, I'm generally fortunate to be strong and healthy. Or at least I was until shingles arrived. It started with a headache, which I thought was a migraine. After three days of headache treatment, the pain didn't subside. I contacted my brother, a doctor in Canada, who thought I might have shingles even though I had no rash yet, only a headache that worsened by the hour. My brother started me on antiviral medication (acyclovir) and the next day, I was admitted to hospital. My local doctor informed me that I was fortunate to have started my treatment early enough to avoid damage to my brain or eyes.
What is shingles?
Shingles is caused by the varicella-zoster virus (VZV), the same virus that causes chickenpox, and results from VZV reactivating in our bodies after dormancy. But what triggers this viral sleeper agent to awaken? The answer is complex. While anyone who has had chickenpox can develop shingles, the reactivation of the virus is a complex interplay of various factors, with the patient's overall health and age playing a significant role. The primary risk factor for shingles is a weakened immune system. If your immune system is compromised, VZV can return to life. This underscores the importance of a robust immune system in preventing shingles.
A number of factors can weaken our immune system (2,3). The first is age, as the strength of our immune system naturally declines as we age. There are also diseases that target the immune system such as human immunodeficiency viruses (HIV) or hypogammaglobulinemia, and a number of autoimmune diseases including rheumatoid arthritis, Crohn's disease, and lupus. Certain medications like chemotherapy, long-term use of corticosteroids, and anti-inflammatory medications also weaken our immune system, as does physical or mental trauma because hemorrhages, fractures, or prolonged psychological stress cause the release of cortisol and adrenaline, which can harm the immune system (3,4). Finally, our own lifestyle choices are important as an unhealthy lifestyle is likely to weaken our immune system.
Symptoms of shingles
Early symptoms include pain, itching, or tingling in the area where a rash will form. Some people also experience a fever or headache during this period (5). A few days after the early symptoms appear, the physical symptoms start to show. These include a raised rash in the affected area, fluid-filled blisters that eventually break open and scab over after approximately ten days, and mild to severe pain in the affected area (6). The most obvious symptom is the rash that mostly appears on the torso or face but can also show on other body parts. The rash is almost always limited to one side of the body and one particular dermatome—an area of skin linked to one specific nerve level in the spinal cord or brain.
Treatment of shingles
The sooner treatment starts, the better. Delaying treatment can cause severe health issues. If you suspect that you might have shingles, it is essential to contact your healthcare provider as soon as possible. Shingles treatment consists of antiviral and pain relief medication. The antivirals used for the treatment are acyclovir, famciclovir, or valacyclovir. Pain relief medications include nerve-calming medications like pregabalin, gabapentin, or amitriptyline, and anti-inflammatory agents like ibuprofen, and topical numbing agents like capsaicin. Your healthcare provider will prescribe the proper medication that suits your needs (7,8).
Prevention of shingles
Your approach to preventing shingles will depend on your age and health history, but here are some generally applicable ideas.
First off, avoid it. If you have never had chickenpox or its vaccine, it's essential to steer clear of anyone with active shingles or chickenpox. Exposure wouldn’t put you at risk of shingles, but it would put you at risk of developing chickenpox.
Secondly, consider getting vaccinated. The US Food and Drug Administration (FDA) has licensed Zostavax and Shingrix as effective vaccines against shingles and both of these are available in Thailand. Shingrix is the newer, more effective vaccine and provides protection for many years.
Thirdly, choose a healthier lifestyle. Our choices have consequences, and making the right ones is essential. Eating a nutritious diet, staying physically active, and getting adequate sleep are all vital for a healthy body and mind. Kicking the butt of smoking habits (mind the pun) and controlling how much alcohol you consume are a bonus! (9)
Finally, try to reduce your stress levels. Evidence shows that VZV can reactivate under stress. Numerous effective methods exist to alleviate stress, such as yoga, meditation, and engaging in a hobby or any other activity that you find soothing.
Shingles aftercare
Unfortunately many people suffer from post-herpetic neuralgia—a pain condition that persists for months or, in some people, years after the viral disease has cleared. This is because of damage to the nerve in which the virus made “a home” during the active phase. Fortunately the same medications that treat shingles can also help with the aftercare.
What I’ve learned
It's been a week since the feared virus showed its early symptoms. I’ve completed my antiviral course, rested, and started to take more care of my mental health. It is clear that, in my case, chronic stress played a huge role in the reactivation of the virus. Although I've been taking psychotropic medication for many years, I sometimes forget to make time for myself and my mental health. It's easy to get into a vicious cycle of constant work, unhealthy eating habits, no physical activity, and worry. Having shingles was terrible. It was the worst physical pain I have ever felt, and this is coming from someone who has had fractured ribs and a fractured skull, hip, and pelvis. But, with all the pain, I realized the importance of caring for "me". I recognized the times I neglected myself, was not a nice person to myself, and didn't listen to my body. All of this manifested as physical stress on my body and thus led to a decline in my immune system. Stress is a “silent killer”. It creeps closer and closer until it's too late and may cause havoc in your life when it transforms into a stress-related medical condition. Therefore, it is vital to find activities to deliberately combat stress and look after our bodies and minds.
It won't happen overnight, and that is OK, but day by day, I will build a healthier and happier me, and, in the process, stay grateful for the lessons I have learned during painful times. Shingles happened, but it could never steal my loud laugh, sense of humor, or lust for life. Onwards and upwards!
References & useful websites
- Minor, M & Payne, E. (2023). Herpes Zoster Ophthalmicus. National Library of Medicine. ncbi.nlm.nih.gov/books/NBK557779
- Garone, S. (2023) Understanding What Causes Shingles to Activate. Healthline. healthline.com/health/what-causes-shingles-to-activate
- Cleveland Clinic (2022) Shingles. my.clevelandclinic.org/health/diseases/11036-shingles
- Nichols, H. (2024) Shingles (Herpes Zoster). Medical News Today. medicalnewstoday.com/articles/154912
- CDC (2024) Shingles (Herpes Zoster). cdc.gov/shingles/signs-symptoms/index.html
- Sharon, A. (2023) What Does Shingles Look Like? Healthline. healthline.com/health/shingles-pictures
- American Academy of Dermatology Association. Shingles: Diagnosis and Treatment. AAD. aad.org/public/diseases/a-z/shingles-treatment
- Health New Zealand: Health Information and Services. (2024) Shingles. info.health.nz/conditions-treatments/infectious-diseases/shingles/
- Basaraba, S. (2022) Shingles Prevention. Verywell Health. verywellhealth.com/how-effective-is-the-shingles-vaccine-2224167
About the Author
Anelia is a performing artist from South Africa. She has been living and working as a teacher in Thailand for ten years. She also writes educational children’s books, makes music, and loves to spend time in the kitchen. Follow her adventures on IG @aneliavz.