Is your immune system weaker after shingles

Intense pain, burning, tingling and a blistering rash – these are some of the common symptoms of shingles. 

If you’ve ever had chicken pox, the varicella-zoster virus that causes shingles is dormant in your nerve tissue.

So what causes shingles to spring to life wreaking havoc on your body and what can you do about it? Here are seven things you should know about the shingles virus.

1. Shingles is chicken pox coming back to get you

If you’ve had chicken pox, you can get shingles. According to the Centers for Disease Control and Prevention (CDC), almost 1 out of every 3 people in the United States will develop shingles.

Shingles can be very painful and debilitating. The rash consists of little vesicles of clear fluid on a red base. They appear linear because they follow the distribution of a single nerve. Shingles never crosses the midline so if you have an outbreak, it’s either going to be just on the right side of the body or just on the left side of the body. It could be on your face, your arm, your back, your tummy, your leg but it’s only one place at a time.

2. A common cold could trigger shingles

Our immune system tends to wane as we get older, which is why shingles usually occurs in adults over 50. If you get sick with a cold or a sinus infection, your immune system is focused on fighting the cold, which can trigger shingles. Other risk factors include stress, sun exposure, medications to prevent organ rejection and cancer treatments. 

3. You can get shingles more than once

Having had shingles once doesn’t mean that you won’t get it again. Some people get shingles repetitively. There’s no way to know who that person is going to be. 

4. You can’t give someone shingles

A person with shingles can’t give it to someone else but they can give someone chicken pox if that person hasn’t had it or if they’ve not been immunized against it. 

Shingles is spread through direct contact with the open sores. If you keep the rash covered and prevent people from touching the area, it should be fine. Shingles is no longer contagious once it dries up and becomes scabs.

5. Vaccination can prevent shingles

The new CDC recommendation is that healthy people age 50 and older get the Shingrix vaccine. It’s a two shot series that is upwards of 98 percent effective. 

The previous shingles vaccine Zostavax was 65 to 70 percent effective. Anyone who has had Zostavax should be re-immunized with Shingrix. This also applies to people who have had shingles or are unsure if they’ve had chicken pox.

6. Treatment options vary

We treat shingles with antiviral medications to help reduce the outbreak. Sometimes steroids are helpful. We can also use an anti-seizure medication to help settle down the nerve and the pain coming from that nerve.

7. It’s rare but shingles can cause blindness

I don’t see it very often but if shingles is in the eye, it’s a threat to your vision. I immediately refer patients to an ophthalmologist for treatment. Another uncommon potential complication is disseminated zoster, which is an overwhelming viral infection throughout the body. Some people end up being treated in the intensive care unit. 

There is no cure for shingles, but treatment can help ease your symptoms until the condition improves. In many cases, shingles gets better within around two to four weeks.

However, it's still important to see your GP or pharmacist as soon as possible if you recognise the symptoms of shingles, as early treatment may help reduce the severity of the condition and the risk of potential complications.

Self-care

If you develop the shingles rash, there are a number of things you can do to help relieve your symptoms, such as:

• keeping the rash as clean and dry as possible – this will reduce the risk of the rash becoming infected with bacteria
• wearing loose-fitting clothing – this may help you feel more comfortable
• not using topical (rub-on) antibiotics or adhesive dressings such as plasters – this can slow down the healing process
• using a non-adherent dressing (a dressing that will not stick to the rash) if you need to cover the blisters – this avoids passing the virus to anyone else

Calamine lotion has a soothing, cooling effect on the skin and can be used to relieve the itching.

If you have any weeping blisters, you can use a cool compress (a cloth or a flannel cooled with tap water) several times a day to help soothe the skin and keep blisters clean.

It's important to only use the compress for around 20 minutes at a time and stop using them once the blisters stop oozing. Don't share any cloths, towels or flannels if you have the shingles rash. 

Antiviral medication

As well as painkilling medication, some people with shingles may also be prescribed a course of antiviral tablets lasting 7 to 10 days. Commonly prescribed antiviral medicines include aciclovir, valaciclovir and famciclovir.

These medications cannot kill the shingles virus, but can help stop it multiplying. This may:

• reduce the severity of your shingles
• reduce how long your shingles lasts
• prevent complications of shingles, such as postherpetic neuralgia (although the evidence for this is uncertain)

Antiviral medicines are most effective when taken within 72 hours of your rash appearing, although they may be started up to a week after your rash appears if you are at risk of severe shingles or developing complications.

Side effects of antiviral medication are very uncommon, but can include:

Who may be prescribed antiviral medication?

If you are over 50 years of age and have symptoms of shingles, it is likely you will be prescribed an antiviral medication.

You may also be prescribed antiviral medication if you have:

• shingles that affects one of your eyes
• a weakened immune system
• moderate to severe pain
• a moderate to severe rash

Pregnancy and antiviral medication

If you are pregnant and have shingles, it is likely your GP will discuss your case with a specialist to decide whether the benefits of antiviral medication significantly outweigh any possible risks. Shingles will not harm your unborn baby.

If you are under 50 years of age, you are at less risk of developing complications from shingles anyway, so you may not need antiviral medication.

Children and antiviral medication

Antiviral medication is not usually necessary for otherwise healthy children because they usually only experience mild symptoms of shingles and have a small risk of developing complications.

However, if your child has a weakened immune system, they may need to be admitted to hospital to receive antiviral medication directly into a vein (intravenously).

Painkilling medication

To ease the pain caused by shingles, your GP or pharmacist may recommend painkilling medication. Some of the main medications used to relieve pain associated with shingles are described below.

Paracetamol

The most commonly used painkiller is paracetamol, which is available without a prescription. Always read the manufacturer's instructions to make sure the medicine is suitable and you are taking the correct dose.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are an alternative type of painkilling medicine also available without a prescription.

However, NSAIDs may not be suitable if you:

• have stomach, liver or kidney problems, such as a stomach ulcer, or had them in the past
• have asthma
• are pregnant or breastfeeding

Ask your GP or pharmacist if you are unsure about whether you should take NSAIDs. 

Opioids

For more severe pain, your GP may prescribe an opioid, such as codeine. This is a stronger type of painkiller sometimes prescribed alongside paracetamol.

Occasionally, your GP may consider seeking specialist advice before prescribing an even stronger opioid, such as morphine.

Antidepressants

If you have severe pain as a result of shingles, you may be prescribed an antidepressant medicine. These medications are commonly used to treat depression, but they have also proven to be useful in relieving nerve pain, such as the pain associated with shingles.

The antidepressants most often used to treat shingles pain are known as tricyclic antidepressants (TCAs). Examples of TCAs most commonly prescribed for people with shingles are amitriptyline, imipramine and nortriptyline.

Side effects of TCAs can include:

• constipation
• difficulty urinating
• blurred vision
• dry mouth
• weight gain
• drowsiness

If you have shingles, you will usually be prescribed a much lower dose of TCAs than if you were being treated for depression. This will usually be a tablet to take at night. Your dose may be increased until your pain settles down.

It may take several weeks before you start to feel the antidepressants working, although this is not always the case.

Anticonvulsants

Anticonvulsants are most commonly used to control seizures (fits) caused by epilepsy, but they are also useful in relieving nerve pain.

Gabapentin is the most commonly prescribed anticonvulsants for shingles pain.

Side effects of these medications can include:

• dizziness
• drowsiness
• increased appetite
• weight gain
• feeling sick
• vomiting

As with antidepressants, you may need to take anticonvulsants for several weeks before you notice it working.

If your pain does not improve, your dose may be gradually increased until your symptoms are effectively managed.

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