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How Do You Get Shingles? Who’s at Risk? (podcast)

Causes, treatments, and the vaccine that can prevent shingles

Mark Shalauta, MD, family medicine.

Dr. Mark Shalauta, Family Medicine, Scripps Clinic

Causes, treatments, and the vaccine that can prevent shingles

Shingles is a downright nasty virus — and if you’ve had chickenpox, you’re at risk. Shingles is basically a second round of the same virus that causes chicken pox, varicella-zoster, which remains in your system long after the common childhood infection clears.

 

In this episode of San Diego Health, host Susan Taylor and guest Mark Shalauta, MD, a family medicine physician at Scripps Clinic Rancho Bernardo, discuss shingles in-depth.

 

According to the Centers for Disease Control and Prevention (CDC), one in three adults will develop shingles at some point in their lives — and the older you get, the more painful it tends to be. It’s not contagious on its own, but in theory a person who’s never had chickenpox and built an immunity can end up with chickenpox after coming in contact with someone who has shingles. Dr. Shalauta also sheds light on the newest and highly effective shingles vaccine, Shingrix, which is recommended for those 50 and older.

Listen to the episode on the causes and treatments for shingles

Listen to the episode on the causes and treatments for shingles

Podcast highlights

Why are shingles and chicken pox connected? (0:50)

It’s actually the same virus. It’s the varicella zoster virus, varicella being chicken pox, and zoster being shingles. It’s actually the same virus.

How do you get shingles? (1:05)

You have to have had chicken pox, or even the vaccine possibly. It stays dormant in your body. It’s a herpes virus. The thing that they all have in common is you never get rid of it. When you get chicken pox, it stays dormant in your body until it decides to be reactive, and then you get shingles.

When do symptoms of shingles typically appear? (1:25)

It can be in your 20s. It can be in your 80s. The longer it’s been since you had chicken pox, the more likely it’ll come on.

What are symptoms of shingles? (1:41)

It can be itchy. It can be painful. It’s usually a skin sensation that people will have, where they feel like something is just hypersensitive and then the rash comes on after that.

 

It can start on one part of the body. Since it actually goes in the nerves right along the spine where it goes dormant, it can come out any of those parts of the body. It’s usually one side though.


Most of the time, depending on the person, people will feel kind of run down for a day or so. They feel like they’re getting something but they don’t have any cold symptoms or anything like that. And then a day or two later the rash can start popping up.

What does the shingles rash look like? How long does it last? (2:31)

It can be as simple as just a raised red rash. But for most people that transitions into blisters. You get this blistery rash that’ll be around for awhile, usually a few weeks. For most people, two to three weeks is the duration of everything, but the blisters hang around for the first week or two.

 

In terms of spreading, it’s going to do what it’s going to do for the most part. There are treatments that we can use to decrease the spread, but it will come down that one nerve. Once it decides it’s coming down that nerve, it’s going to come down that nerve and it doesn’t really spread to any other nerves. You can’t spread it to a different part of your body. If you have a rash that’s going all the way across, crossing your mid line, it’s probably not shingles.

Why do some people with shingles develop nerve pain? (3:38)

That’s neuralgia, or postherpetic neuralgia. That is the real reason why they made the vaccine. It’s because that can be so debilitating.

 

Since it comes down a nerve, it irritates that nerve. It can cause burning, itching, just lightning pain, things like that. For most people, it’s just during the rash, but for some people it’ll last even longer.

 

That nerve pain is usually right along where the rash is. So if you have it, if it’s coming down your arm, that pain will be right along there. For some people, if they get it on their chest, it’s not uncommon that we’ll see someone coming in complaining of chest pain. We do a big workup and it turns out to be shingles a couple days later.


Even though it’s not common, you can definitely have complications, especially if you get it on the face, right on the nerve that covers the eye as well. That could cause vision changes, blindness even. Any time you have shingles that also encompasses the face and the eye, it’s important to see the eye doctor.

 

It can also affect your hearing because it’s going down that nerve and damaging the nerve. It can effect your brain as well. It can even cause death. Those are uncommon things, but certainly possible.

Is shingles contagious? (6:19)

You cannot get shingles from shingles. If someone has shingles and you’ve had chicken pox, you’re already immune. You can’t get shingles from shingles. However, you can theoretically get chicken pox from shingles. I say theoretically because it’s a little difficult for that to happen.

Can you get shingles more than once? (7:11)

You can. It’s not as common, but certainly possible. I’ve had patients that have had it a few times, and they’re just very unlucky. Most people get it once though.

Who’s most at risk for shingles? (7:23)

Anybody who is immunocompromised, anybody who is on chemotherapy medication, if they have a medical condition that compromises their immune system, or just bad luck or really stressed. I got mine in medical school.

If you get shingles, should you cover yourself? (7:49)

You should get seen by a physician because there are things that we can do to make it not last as long, or hopefully not even be as painful. But the key thing is keeping it covered. If it’s on a part of your body that’s covered anyway, then you’re pretty set. But if it’s on an exposed part, because it is theoretically possible to get chicken pox from shingles, keeping it covered makes it less of a problem.

If you have shingles, should you isolate yourself? (8:22)

You might feel like you want to for a few days at least, but you really don’t have to isolate yourself, again depending on the location. What we generally tell people is you don’t want to be around little kids, like under one year of age, because they haven’t been vaccinated yet for chicken pox. But otherwise it is okay to go out and still do your things. If it’s on your face, you may not want to go out for a week or two anyway.

How do you treat shingles? What drugs are available? (9:03)

There are antiviral drugs. Those will decrease the duration by a little bit and hopefully make it not go as big, perhaps decrease the chance of getting pain. There are pain medications that sometimes we’ll use. Sometimes we’ll use a steroid orally that you take by mouth, and that can help as well.


It could also be something as simple as ibuprofen, Motrin, Advil or something like that. When it gets so severe, sometimes we actually will use more like opioid, hydrocodone, oxycodone and that’s treating the nerve pain because it can be so severe.

 

As for treating the itchiness and the open blisters, you can do anything that you would do for chicken pox, such as calamine lotion, any kind of oatmeal baths, topical things, such as hydrocortisone, would be fine to do.

 

A wet compress or something that’s kind of cold and wet, that would be kind of soothing.

What is the shingles vaccine? (10:16)

For the past few years there was Zostavax, which worked okay, about 40 to 70 or 80 percent. The older you were, the worse it worked, which is exactly opposite of what we want. We want it to work better when you’re older because they’re the ones that we see it more often. There is a new vaccine that has come out. Unfortunately because of supply issues, it’s kind of hard to come by right now, but that shouldn’t be an issue soon. It’s called Shingrix. It’s two shots, taken two to six months apart. It works 90 to 95 percent compared to 40 to 80 percent.

At what age should you get the shingles vaccine? (11:02)

It’s 15 and above unless they have an allergy to something that would be in the vaccine, which would be rare. Right now, you get those two shots. There are no boosters, but we’ll see.

Should you get tested for chicken pox before getting the shingles vaccine? (11:42)

The CDC says no. Basically if you’re 15 and above, the chance is you’ve already been exposed, even if you don’t remember having chicken pox or never had a rash. The chances of you having been exposed and having immunity is extremely high. If you’re 15 and above, don’t even test, just go ahead and get the shingles vaccine.

Why is the shingles virus so much worse for older people? (12:41)

We don’t really know, but we do know that it happens a lot more frequently. The older you get the more likely you are to get it. That’s why the older you are, the more we want you to have the vaccine. It does seem to be more painful the older you are. We don’t really know why that is.

Watch the San Diego Health video on shingles

Watch the San Diego Health video with host Susan Taylor and Dr. Mark Shalauta discussing the causes and treatments for shingles.