A few days ago, someone comes into the pharmacy complaining about a burning pain down one side of their chest.
“No rash?” I ask.
“No.”
So they think they’ve pulled a muscle.
A couple of days later, the rash appears.
Suddenly everything makes sense.
Shingles.
It is one of those conditions that many people have heard of but don’t really understand.
And knowing what to look for matters because, in the right person, treatment is time-sensitive.
What exactly is shingles?
Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox.
After you have chickenpox, the virus doesn’t completely disappear.
It remains dormant in nerve tissue.
Years, sometimes decades, later it can become reactivated.
That’s when shingles appears.
And it usually follows the path of a particular nerve.
That is why the rash is often found on one side of the body rather than being spread everywhere.
What does it feel like?
This is where people can get confused.
Before the rash appears, there may be:
Burning.
Tingling.
Itching.
Extreme sensitivity to touch.
Or quite severe pain.
Someone may think they’ve pulled a muscle, have a trapped nerve or developed a problem with their back.
Then the rash arrives.
Typically, groups of small fluid-filled blisters appear in a band-like pattern on one side of the body.
The blisters eventually burst, crust over and heal.
But the pain can be surprisingly severe.
Who is most at risk?
Shingles becomes more common as we get older because the immune system changes with age.
It is also more likely in people whose immune systems are weakened, for example because of certain diseases or medicines.
But younger, otherwise healthy people can develop it too.
So don’t assume:
“I’m too young to have shingles.”
You’re not necessarily.
Why am I making such a fuss about it?
Because sometimes shingles causes complications.
The most important one is post-herpetic neuralgia.
This is persistent nerve pain that continues after the rash has disappeared.
For some people, the pain lasts weeks.
For others, months or even longer.
It can be burning, stabbing or extremely sensitive to touch.
Clothing brushing against the skin can become painful.
And this is where age matters.
The risk of prolonged nerve pain increases as people get older.
Shingles around the eye is different
If the rash appears on the forehead, nose or around the eye, don’t sit at home waiting for it to clear.
Shingles affecting the ophthalmic branch of the trigeminal nerve can affect the eye and potentially threaten vision.
That needs urgent medical assessment.
The same applies to shingles involving the ear, particularly if there is facial weakness, hearing problems or dizziness.
What can we do about it?
Antiviral medicines such as aciclovir, valaciclovir or famciclovir can reduce viral replication and may shorten the illness and reduce the severity of symptoms.
But timing matters.
Treatment is generally most effective when started early, ideally within 72 hours of the rash appearing.
There are circumstances where treatment may still be considered later, particularly if new blisters are continuing to appear or if there are complications.
So if you suspect shingles, don’t wait a week hoping it will disappear.
Get assessed promptly.
What about the pain?
Shingles pain can require proper treatment.
Depending on its severity, this may involve ordinary painkillers or medicines specifically used for nerve pain.
The important point is that nerve pain doesn’t always respond well to standard painkillers.
A person with severe shingles pain shouldn’t simply be told to “take some paracetamol and see how you get on.”
They may need something more appropriate.
Can you catch shingles?
You cannot catch shingles from someone who has shingles in the same way that you catch a cold.
However, the fluid from the shingles blisters contains the varicella-zoster virus.
Someone who has never had chickenpox or been vaccinated against it can potentially develop chickenpox after contact with the fluid.
Until the blisters have crusted over, it is sensible to avoid direct contact with people who are particularly vulnerable, such as pregnant women who are not immune to chickenpox, newborn babies and people with weakened immune systems.
Keep the rash covered where possible and wash your hands regularly.
What about the shingles vaccine?
This is one of the best developments in prevention.
Shingles vaccination can substantially reduce the risk of developing shingles and, importantly, reduce the risk of complications such as post-herpetic neuralgia.
Eligibility varies between countries and programmes.
In the UK, vaccination is offered routinely to certain older adults and people at increased risk.
Malaysia has its own vaccination recommendations and availability can depend on age, medical risk and whether the vaccine is obtained privately.
If you’re in the age group where vaccination is recommended, it is worth asking your doctor or pharmacist about it.
Can you get shingles twice?
Unfortunately, yes.
Having shingles does not guarantee that you will never get it again.
This is another reason vaccination may be worth considering even if you’ve already had shingles, depending on your age and circumstances.
My view as a pharmacist
The biggest mistake I see with shingles is waiting.
People think it is just a rash.
Or they think the pain is muscular.
Or they decide to see how it goes.
And sometimes that delay means they miss the opportunity for early antiviral treatment.
So remember the combination:
Pain, burning or unusual skin sensitivity followed by a one-sided blistering rash.
Think shingles.
And if the rash is near the eye, don’t wait.
Get medical help urgently.
Shingles isn’t usually life-threatening, but it can be extremely painful and can leave some people with long-lasting nerve pain.
The good news is that we have effective treatments and, importantly, a vaccine that can help prevent it.
Sometimes knowing what you’re looking at is half the battle.
Until next time take care of yourself.
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