Shingles, a painful rash caused by the varicella-zoster virus – the same virus responsible for chickenpox – is a condition that many adults may face in their lifetime. If you’ve had chickenpox as a child, the virus remains dormant in your body and can reactivate later in life as shingles. You might be wondering, “Why Do I Keep Getting Shingles?” or perhaps you’re concerned about your risk of developing it. While shingles typically occur once in a lifetime, understanding the factors that increase your risk and what might feel like recurrent episodes is crucial.
Shingles affects a significant portion of the population, with about one in three people in the U.S. experiencing it during their lives, and approximately one million new cases reported each year according to the Centers for Disease Control and Prevention (CDC). To shed light on this common health concern, we consulted with Dr. Ankush Bansal, a lifestyle medicine physician and hospitalist, to clarify what you need to know about shingles and why understanding your risk factors is essential.
The Chickenpox-Shingles Connection: It’s the Same Virus
“Shingles is caused by the varicella zoster virus. Varicella is the scientific term for chickenpox, and zoster is the term for shingles. It’s crucial to understand that chickenpox and shingles are manifestations of the same virus,” Dr. Bansal explains. Most people contract chickenpox in childhood, and after recovery, the virus doesn’t leave the body. Instead, it lies dormant in nerve tissue near the spinal cord and brain.
Later in life, particularly as the immune system weakens due to age, stress, or certain medical conditions, this dormant virus can reactivate. This reactivation manifests as shingles, a painful rash characterized by blisters, often appearing in a band on one side of the body. “When your immune system is robust, it keeps the virus suppressed. However, when immunity wanes, the virus can re-emerge, leading to a shingles outbreak,” Dr. Bansal notes.
How Shingles Spreads: Contagious but Different from Chickenpox
While you might not “keep getting” shingles in the sense of repeated infections like a cold, it’s important to understand its contagious nature. “Shingles is contagious, but it’s not spread in the same way as chickenpox,” Dr. Bansal clarifies. Chickenpox is airborne and spreads through respiratory droplets. Shingles, on the other hand, spreads through direct contact with the fluid-filled blisters of the rash.
“The fluid within shingles blisters is highly infectious and contains the varicella-zoster virus. If someone who has never had chickenpox or the chickenpox vaccine comes into contact with this fluid, they can develop chickenpox, not shingles,” he emphasizes. Therefore, covering the rash and practicing good hygiene are essential to prevent the spread of the virus, especially to vulnerable individuals who have never had chickenpox or the vaccine.
Recognizing Shingles: The Primary Symptom is a Rash
The hallmark symptom of shingles is a distinctive rash. “The primary sign of shingles is a rash. It may initially resemble chickenpox with small, fluid-filled blisters that eventually crust over,” Dr. Bansal describes. However, unlike chickenpox, shingles typically presents in a localized area, often in a band-like pattern on one side of the body.
“The rash usually appears on one side of the body, such as the torso, arm, or leg, following the path of affected nerves,” he adds. This characteristic pattern, often described as a “sunray pattern,” along nerve pathways, is a key indicator of shingles. The rash can last for several days, typically about a week to ten days, with crusting usually occurring within 48 to 96 hours.
Shingles on the Head: A Serious Concern
While shingles can appear anywhere on the body, shingles on the head, particularly affecting the eyes, requires immediate medical attention. “Shingles on the head can be particularly serious if it involves the eye. Ocular shingles can lead to severe complications and necessitate prompt treatment by an ophthalmologist,” Dr. Bansal warns.
If shingles affects the eye, it can cause vision problems and even vision loss. Hospitalization might be necessary for antiviral medication to manage the infection and prevent serious outcomes. Any signs of shingles near the eye area should be considered a medical emergency requiring immediate consultation with a healthcare professional.
Postherpetic Neuralgia: Lingering Nerve Pain After Shingles
One of the most concerning complications of shingles is postherpetic neuralgia (PHN), a condition characterized by persistent nerve pain even after the shingles rash has resolved. “Postherpetic neuralgia is a significant concern for many people who develop shingles. It refers to nerve pain that persists long after the shingles rash disappears,” Dr. Bansal explains.
Approximately one in ten people with shingles may develop PHN. This pain can be debilitating, described as a burning, stabbing, or shooting sensation in the area affected by the shingles rash. “The pain can be chronic and significantly impact quality of life, lasting for months or even years,” he notes. Early treatment of shingles can help reduce the risk and severity of PHN.
Age as a Risk Factor: Why Older Adults are More Susceptible
Age is a significant factor in shingles risk. “The risk of developing shingles increases significantly as you age. Most cases of shingles occur in individuals aged 50 and older,” Dr. Bansal states. The primary reason for this age-related increase is the natural decline in immune function.
“As we get older, our immune system naturally weakens, making it less effective at keeping the varicella-zoster virus dormant,” he explains. Every decade after age 50 further elevates the risk. While aging is a primary risk factor, it’s not a guarantee of developing shingles, but it significantly increases susceptibility. Interestingly, studies suggest women are slightly more prone to shingles than men, although the reasons for this are not yet fully understood.
Other Factors Increasing Shingles Risk
Besides age, other factors can compromise the immune system and elevate shingles risk. These include:
- Organ or Bone Marrow Transplant: Individuals who have undergone transplants and are on immunosuppressant medications to prevent organ rejection are at higher risk.
- Immunosuppressant Medications: Conditions like Crohn’s disease or rheumatoid arthritis treated with biologic IV medications or other immunosuppressants can increase susceptibility to shingles.
- HIV/AIDS: Compromised immune systems due to HIV or AIDS increase the risk of varicella-zoster virus reactivation.
- Prolonged Steroid Use: Long-term or high-dose steroid use can suppress the immune system and elevate shingles risk.
- Head Trauma: Research has indicated a correlation between head trauma in older adults and an increased risk of shingles, although the exact mechanisms are still being investigated.
Understanding these risk factors is crucial for individuals to be proactive about prevention and early management of shingles.
Vaccination: A Key Preventive Measure Against Shingles
Vaccination is a highly effective strategy to reduce the risk of developing shingles and its complications. “The shingles vaccine is recommended for adults aged 50 and older, and for those over 19 with certain immunocompromising conditions,” Dr. Bansal advises. Vaccination is not recommended for everyone, particularly those undergoing cancer treatment or with specific medical contraindications.
“Generally, vaccination is recommended for all healthy adults over 50. While the vaccine is not a 100% guarantee against shingles, it significantly reduces the likelihood of developing the condition and, if shingles does occur, it tends to be less severe,” he clarifies. The shingles vaccine is a safe and effective way to boost the immune system’s ability to suppress the varicella-zoster virus.
Stress as a Potential Trigger for Shingles
While the exact trigger for shingles reactivation isn’t always identifiable, stress is often implicated as a contributing factor. “Stress, both physical and mental, is often associated with shingles outbreaks,” Dr. Bansal notes. Physical stressors can include injuries, illnesses, or trauma. Mental stress from various life events can also impact the immune system.
“Severe physical or emotional stress can weaken the immune system, creating an opportunity for the dormant varicella-zoster virus to reactivate,” he explains. Managing stress through healthy lifestyle practices, including adequate sleep, a balanced diet, and stress-reduction techniques, can support a robust immune system.
Being Mindful of Exposure and Seeking Prompt Treatment
Preventive measures also include being mindful of potential exposure to the varicella-zoster virus and seeking prompt medical attention if shingles is suspected. “Be aware of those around you. If someone reports a rash or feeling unwell, maintaining distance can help prevent potential exposure,” Dr. Bansal suggests. Individuals with compromised immune systems should be particularly cautious about contact with anyone who might have shingles or chickenpox.
“If you develop a rash that you suspect could be shingles, or if you’ve been exposed to someone with chickenpox or shingles, seek medical advice immediately. Early treatment is crucial,” he emphasizes. Antiviral medications like acyclovir, valacyclovir, or famciclovir are most effective when started as soon as possible after the rash appears, reducing the duration and severity of shingles and lowering the risk of complications like PHN.
Seek Immediate Medical Attention for Suspected Shingles
In conclusion, while you are unlikely to “keep getting” shingles repeatedly like some infections, understanding your risk factors and taking preventive measures is essential. If you suspect you have shingles, prompt medical attention is crucial. “Early diagnosis and treatment can significantly impact the course of shingles, reduce the severity of symptoms, and minimize the risk of long-term complications like postherpetic neuralgia,” Dr. Bansal advises. Don’t hesitate to contact your healthcare provider if you suspect shingles, especially if you are over 50, have a weakened immune system, or experience any concerning symptoms.
