How to Determine if You Should Get a Shingles Vaccine

January 26, 2016  | By Colby Evans, MD

I’m often asked by patients, “Should I get the shingles vaccine?” The answer to that question is “yes” for many people, but an explanation is in order.

 

What causes shingles and who is at risk?               

Shingles is caused by the same virus that causes chickenpox – it’s called varicella zoster (VZV). Simply put, shingles is a localized recurrence of VZV. Children started getting vaccinated against chickenpox in 1995. That means that most people currently ages 20 and older likely had the chickenpox when they were young (before vaccinations began), and as a result are at risk for it recurring as shingles.

After an initial chickenpox infection, VZV is then able to lie dormant in the nervous system for years before reappearing as shingles…and it when it does, it’s often with a vengeance. A triggering event, such as an infection, injury, surgery, or stress, can cause VZV to reappear on the skin where it becomes visible as painful shingles blisters.

While shingles can occur in anyone that has been previously infected by chickenpox, it most often occurs in the elderly. Additionally, people who have become immunosuppressed – such as those with HIV infection, on systemic steroids, or with poorly controlled diabetes – are especially susceptible to developing shingles.

 

What are the side effects of shingles? Is it contagious?

Shingles rash. Photo credit: Bart's Medical Library / Phototake via WebMD

Shingles rash. Photo credit: Bart’s Medical Library / Phototake via WebMD

In addition to painful blisters, shingles sometimes includes fever, chills, and muscle pain that can make you feel quite ill. The blistery rash itself can occur anywhere on the body, but is most often found on the back and abdomen.  

Shingles typically begins as an area of burning or pain and within several days, clusters of small fluid filled bumps appear. These then crust over and become scabs.

Shingles fluid-filled bumps. Photo credit: Peggy Firth and Susan Gilbert for WebMD

Shingles fluid-filled bumps. Photo credit: Peggy Firth and Susan Gilbert for WebMD

Throughout the time the bumps or scabs are present, the virus is transmissible to anyone who has not previously been infected by or vaccinated for chickenpox. The virus can be particularly dangerous to pregnant women, so care should be taken to avoid spreading it to others.

As the shingles rash goes away, typically so does the associated pain. Most people recover from shingles after 2 to 3 weeks, but it can take up to 6 weeks to fully recover. That said, shingles scars can remain in the affected areas after the rash is gone.  

Shingles scabs. Photo credit: N. M. Hauprich / Photo Researchers, Inc via WebMD

Shingles scabs. Photo credit: N. M. Hauprich / Photo Researchers, Inc via WebMD

In some cases, however, the pain of shingles can persist even after the rash is gone. This is a shingles complication called postherpetic neuralgia. This is a condition that causes pain in the areas that previously had the rash. The risk of postherpetic neuralgia increases with age and most commonly occurs when shingles has affected the face. Although there is no cure for postherpetic neuralgia, there are treatments available to reduce the symptoms and most people find that their condition improves over time.

 

What treatment is available for shingles?

There is an oral antiviral medication that can decrease the symptoms and duration of the shingles infection. However, this medication must be started soon after symptom onset. It’s important to know that even with medication, you could still experience some discomfort.

 

How can shingles be prevented?

As you can tell, shingles can be quite troublesome, making for an uncomfortable few weeks and perhaps even longer. Fortunately, there is a shingles vaccine available to help prevent shingles and its complications. The vaccine serves as a booster to your immune system, reminding it of the virus and preparing it to rev up in defense against a recurrence of VZV.

At Evans Dermatology we treat patients who have already developed rashes associated with shingles, however we do not administer the preventative vaccine. Particularly if you are over 60 or immunocompromised, it is a good idea to ask your primary care doctor if the vaccine might be right for you.

If you are concerned that you may be developing shingles, a trip to the dermatologist can help reduce the severity of the infection.

Colby Evans, MD
A native Texan, Dr. Evans completed his medical degree and residency in dermatology at the University of Texas Southwestern Medical Center in Dallas. Dr. Evans furthered his study with a Clinical Fellowship at the St. John’s Institute of Dermatology, an internationally acclaimed institution in London, England. He holds an undergraduate degree from Wesleyan University, where he graduated Phi Beta Kappa with high honors in Chemistry. Dr. Evans has been published in multiple peer-reviewed journals, including the New England Journal of Medicine and the Journal of The American Academy of Dermatology. He lectures at national medical conferences and has a particular interest in the treatment of skin cancer and psoriasis. He also recently published a medical textbook on geriatric dermatology.