Shingles or Zoster is a common painful rash which is a localized re-occurance of chickenpox (also known as varicella). If you have shingles now, then when you were young, you had chickenpox. Even if you are not certain, I can assure you that you did have it as it is not possible to have shingles if you never had chickenpox. After your body fought off the chickenpox virus, it migrated into your nerve root near your spinal cord. Here it normally lives, dormant, until we die. Your body’s immune system is blocked from going into this area as it would not be wise for your immune system to attack your spinal cord and nerves.

When a shingles outbreak occurs, the virus starts reproducing in the nerve that has been dormant. It moves through the nerve’s path on only one side of your body. Often there will be a few days of severe nerve pain in the skin from the inflammation of the virus spreading. Then patches of blister start popping up along the nerve’s path. Over time, your body will once again kill the virus and fight it back until it returns to its dormant location in the nerve root. This commonly takes a few weeks.

In some people, especially those who did not receive the shingles vaccine and did not receive treatment (as mentioned below), the nerve the virus is living in gets so inflamed and damaged that it causes a chronic nerve pain long after the shingles is resolved. Post-herpetic neuralgia is a chronic shingles-like pain syndrome caused by the damage the virus caused. You don’t want post-herpetic neuralgia! If appropriate, get vaccinated and if you have any suspicion that you may have shingles get checked sooner as time matters.

There is no cure for shingles, but there are ways to help prevent it and speed up your healing process when you have an outbreak.

Over time the antibodies you had when you first got chickenpox decrease in level in your body. By getting a booster vaccine (the shingles vaccine) it will reproduce these antibodies at a higher level, thereby strengthening your immune system. The vaccine cannot give you shingles, but it does give you a mild case of chickenpox. Be aware that the shingles vaccine is not right for everyone. It is a live injection of a weakened chickenpox virus. Most people’s immune system is strong enough to fight off the small amount of live, weakened, injected virus. But it is absolutely wrong for other people. Discuss this with your physician before getting the vaccine.

Even if you get the shingles vaccine, there is no guarantee you will not get shingles. However, people that have received the vaccine and still get shingles, typically have mild cases with less pain. It also should help reduce your risk of getting complications like chronic pain in the area of shingles outbreak.

If you think you may have shingles you should walk into Urgent Care or your physician as soon as possible. The sooner treatment is started the more effective it will be. The goal is to start treatment before 72 hours of symptoms. There are three common antiviral pills that we use orally: Valcyclovir (Valtrex), Acyclovir (zovirax) and Famcyclovir (famvir) all of which are effective in shortening the course of the illness and decreasing chances of chronic pain in the nerve afterwards. Topical creams are not effective. In severe cases IV medicine is available.

See our Physicians and P.A.s at Doctors Urgent Care for the highest quality medical evaluation and treatment. We are familiar with shingles and treat it regularly. Please come early in the condition as the longer you wait the less effective treatment will be.

David B. Dean, MD
Medical Director
Doctors Urgent Care