By Jeanette Beebe, AARP Dec 2021
Here are the facts behind the painful disease, including how you can help escape its wrath.
Myth 1: Shingles is the same as chickenpox
It’s true that shingles is the result of the same virus that causes chickenpox (called varicella zoster virus), but they're not that similar — more distant cousins than siblings. For most people, chickenpox is a childhood annoyance, ever so itchy but usually not too serious, although complications can occur.
Shingles usually pops up later in life, and it's more than merely annoying. It’s painful for most, and the disease's complications — from long-term nerve pain to hearing issues to brain inflammation — can seriously hurt your health, sometimes for months or years.
If you’ve ever had chickenpox — and you probably have; according to federal data, more than 99 percent of Americans born before 1980 have had it — you are at risk for shingles. The reason? After a person recovers from chickenpox, the virus stays dormant in the body. But it can reactivate, typically later in life. "Our natural immune function decreases with age, putting older patients at risk of varicella zoster virus reactivation,” explains Anisha B. Patel, a dermatologist at the University of Texas MD Anderson Cancer Center in Houston.
Myth 2: Shingles can't be prevented
Not true. You can get a shingles vaccine. The Centers for Disease Control and Prevention recommends the two-dose Shingrix vaccine for most people 50 and older, including adults who have chronic health conditions, although it’s always important to consult with your doctor first. You can get vaccinated at a doctor's office or pharmacy; just be sure to return between two and six months later for your second shot.
Shingrix is approximately 90 percent effective with two shots and stays 85 percent effective for four years, the CDC says. And since the shingles vaccine became available in 1995, hospitalizations and deaths due to the virus have dropped significantly: 93 percent and 94 percent, respectively.
Had shingles in the past? Even if that’s the case, Patel says, “the vaccine can help keep you from having subsequent reactivation.”
Note that Zostavax, another shingles vaccine, is no longer available in the U.S. The so-called live vaccine was approved by the Food and Drug Administration in 2006 and discontinued in November 2020. The CDC recommends that individuals who received Zostavax in the past get Shingrix.
Myth 3: If you think you have shingles, it’s best to wait it out
On the contrary, it's important that you get to a health care provider as soon as you suspect you have shingles. Your doctor can prescribe antiviral medications that can significantly lessen your pain, and these drugs are most effective when taken as soon as possible.
"That's really, really important. We really want to emphasize [that]," says Lisa Garner, a dermatologist with 35 years of experience in private practice in Clearwater, Florida. "If a patient called my office and said, 'I think I have the shingles,' I always worked them in the same day. And still do.”
Myth 4: Shingles isn't that serious
Shingles isn't usually mild. Though the disease may run its course relatively quickly (for many, the outbreak is gone within a month), a red rash isn't the worst of it. In most cases the blisters come with deep pain that can be debilitating, reducing a person’s ability to go about their day.
"What some people don't realize is how terrible the pain associated with shingles can be and how long it can last," Garner says.
After the rash is gone, burning, stabbing, throbbing pain can reappear as a chronic condition, called postherpetic neuralgia (PHN). It occurs where the rash was and can continue for months, even years. As the most common complication of shingles, PHN can usher in more problems, including depression, fatigue, loss of appetite, and trouble with sleeping and concentrating.
According to the CDC, between 10 and 18 percent of people with shingles develop PHN. That's roughly 1 or 2 people out of every 10. Your risk for developing PHN increases with age. Also, the more pain you experienced during your shingles outbreak, the more likely you are to develop PHN.
This part is important: If your shingles rash appears on your face, it can be serious, especially if it's near your eyes. “This is particularly urgent, and the patient should also be evaluated by an ophthalmologist," Patel says, as it can pose a risk to vision and result in corneal scarring and, rarely, blindness.
"We consider that an ophthalmological emergency," Garner adds.
Shingles pain and PHN are more common among older people and those who didn't act quickly and took antiviral medication 72 or more hours after noticing the red rash — yet another reason to talk with a health care provider as soon as you suspect shingles.
The disease has also been associated with pneumonia, brain inflammation (encephalitis), meningitis, hearing issues and even death, though the link isn't well established and may be rare.
Myth 5: Shingles looks like one thing: a red rash
A red rash that occurs on one side of the body is typically what you should look for. Still, some people experience pain without a red and blister-filled rash. Or they may get the rash only after a few days. Most of the time, though, sufferers experience burning and tingling on one side of the body, often on the back, chest or stomach. Then the painful, itchy red rash with small blisters develops, scabbing in a week to 10 days and fully clearing up within two to four weeks.
"It can occur from the top of your head to the bottom of your toes. I don't think there's any part of skin that I have not seen it occur in over many, many years," Garner says. Shingles can also cause fever, chills, bad headaches, muscle weakness and other pain.
Myth 6: You don’t need to worry about being contagious
Shingles, as a disease, isn't contagious — in other words, you can’t get shingles from someone who has shingles. But the virus that causes it is quite contagious and can be spread easily by way of droplets dispersed in the air when, say, someone talks or breathes.
It can also spread if someone comes in contact with the virus-causing skin blisters, which is why, if you have shingles, it’s important to keep your rash covered. If someone hasn't had chickenpox or isn't vaccinated for it, they can get infected with the virus if they come in contact with the ooze from the lesions (via clothes, sheets or towels). People with shingles cannot spread the virus before rash blisters appear or after the rash crusts, the CDC notes.
Finally, you can get shingles more than once (though it's rare) if your immune system is strained. So take care of yourself: Minimize stress, get enough sleep, eat good-for-you foods, and stick to an exercise routine. And if you think you have shingles, get yourself to a doctor as soon as possible.