Shingles.

It’s a word that stings just coming out of your mouth. And it’s certainly an illness you want to avoid.

There are time-tested treatments for the disease that’s associated with chickenpox – namely an effective vaccine. But new research from the University of Pennsylvania and New York University (NYU) gives hope to people who have suffered eye complications from shingles.

“It’s promising,” says Fred Burke, MD, an emergency medicine physician who provides care at OSF HealthCare.

Shingles basics

Dr. Burke says shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. Chickenpox is common in children, who typically suffer from a blistering rash for four to seven days.

“That virus will lie dormant in the nerve cells of the body. For some unknown reason, it gets activated later in life,” causing shingles, Dr. Burke says. “Generally, that’s in people 50 and over. You’ll get a localized blistering rash. It’s painful. It can last for three to five weeks. We treat it with antiviral medication.”

Catching the disease early is key.

“If the rash has already crusted over, the antiviral medication won’t be effective,” Dr. Burke says. “You can treat the pain, but you have to just ride it out.”

You’re not contagious at that point, Dr. Burke says, but you’ll want to rest.

Aside from older adults, people with a compromised immune system – for example, someone with cancer or a transplanted organ – are at a higher risk for shingles. The disease spreads through the air – like when you cough on someone – or by direct contact.

In some cases, the pain from shingles can linger for months or years, Dr. Burke says. It’s called neuropathic pain, and there’s medicine available for that too. Meningitis and facial paralysis are other shingles complications.

Shingles can also impact the eyes, causing redness, swelling, itching and impaired vision. This is called herpes zoster ophthalmicus (HZO).

“We treat that with antiviral medication. We consult an ophthalmologist because the person may also need steroids,” Dr. Burke says. “It’s good to treat this quickly because it can lead to vision loss.”

Treating eye complications

That’s where the new research comes in.

Elisabeth J. Cohen, MD, a professor of ophthalmology at NYU, did the study after she was impacted by shingles-related vision loss. The research looked at the antiviral treatment valacyclovir, which is typically short term.

“The researchers showed that using valacyclovir for a year can decrease the risk of new or worsening eye disease by 26 percent at 18 months after initiating treatment. Patients treated with valacyclovir also were 30 percent less likely than those not receiving the treatment to have multiple HZO flare-ups at a year or a year-and-a-half later,” a news release announcing the research results says.

“I was very, very impressed,” Dr. Burke says after reading the results.

Importance of vaccines

Like any new research, more study is needed of long-term use of valacyclovir. In the meantime, Dr. Burke says vaccines for chickenpox and shingles are 90% effective.

The United States Centers for Disease Control and Prevention says children under 13 should get two doses of the chickenpox vaccine – one at 12 to 15 months and the other at four to six years. People 13 and older who never got chickenpox or the vaccine should also get two doses 28 days apart.

But be warned: Dr. Burke says if you don’t get chickenpox as a child, you can still get shingles as an adult.

“It’s the same virus,” that’s associated with both ailments, he says. “So if you catch it from someone [as an adult], you’ll probably get chickenpox first. And you could get shingles later.”

Meanwhile, Dr. Burke says the two-shot shingles vaccine is for healthy people 50 and older and people 19 and older who are immunocompromised.

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Often we’ve heard people say, “I meant to get the shingles vaccine, but I just didn’t get around to it.”

About one out of every three people in the United States will develop shingles in their lifetime. Most medical providers agree that taking time for the shingles vaccine should be high on your checklist.

“Shingles is a rash that you develop when a latent virus from chickenpox essentially decides that it's going to make itself known again after being dormant in our body for decades,” says BreAnne Gendron, an advanced practice registered nurse (APRN) for OSF HealthCare. “And it is usually very painful and it's contagious to people who have never had chickenpox, or been vaccinated for it.”

Shingles tends to pop up on one side of the face or body and in one small area. Typical symptoms include chills, fever, headache, sensitive skin and an extremely painful rash. If the rash appears on your face, there is additional risk of it impacting your eye and causing serious vision problems.

According to Gendron, everyone who has had chickenpox is at risk of getting shingles. But those who are at greater risk are older people and people who have trouble fighting infections.

“If our immune system is suppressed, or we're stressed out, or we're sick with something else, that virus can become active again and it presents as pain and some kind of strange sensation in the place where the rash is going to develop," says Gendron. 

Most cases of shingles last between three to five weeks. It starts with burning or tingling pain, followed by a rash. A few days later, the rash turns into blisters before drying up and crusting over about 10 days later. Treatment for shingles includes antiviral medicines and pain medicine. Wet compresses, calamine lotion and oatmeal baths can help relieve itching.

“It is self-limiting and will go away on its own, but it is good to come and seek treatment in the first two or three days of your rash so that we can give you an antiviral because it reduces your risk of post herpetic neuralgia (PHN), which is even after your rash is gone," says Gendron. "The pain sticks around so we want to reduce the risk of that by giving you some treatment.”

The Centers for Disease Control and Prevention (CDC) recommends that adults 50 and older get two doses of the shingles vaccine, called Shingrix, between two and six months apart. Potential side effects include arm soreness, fever and headache for a couple of days.

For people between the ages of 50 and 69, the vaccine is about 97 % effective; protection stays above 85% for at least the first four years following vaccination.

Most insurance plans will cover the shingles vaccine, but the coverage varies. Out-of-pocket costs vary by plan and deductible but may be covered as a preventive care benefit. Check with your provider or insurance plan for more details.

For people who are on the fence about getting the vaccine, Gendron offers some advice.

“Shingles is preventable with vaccine," she says. "It's painful and contagious to people who haven't had chickenpox or been vaccinated. And it's an easy thing to get done. Get the vaccine so that you don't have to have a painful couple of weeks and have to keep yourself away from your loved ones who may have suppressed immune systems.”

Gendron recommends talking to your doctor about shingles and the importance of vaccination. For more information on shingles, visit OSF HealthCare.

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