Most people of a certain age can recall having had a bout of chickenpox as a kid. The illness, which is caused by the varicella-zoster virus, can spread like wildfire through elementary schools and causes an itchy rash and flu-like symptoms.
Most kids who contract chickenpox don’t have serious complications and go on to feel better in a week or two. In fact, in the past, before a vaccine against chickenpox had been developed, so-called chickenpox parties would purposefully put a bunch of well children into close contact with an infected child so that the well children could get the illness and put that milestone of childhood behind them.
However, some kids who contract chickenpox can have more serious illness and may develop lasting scars from the itchy lesions. Today, such parties are no longer recommended. Instead, a safe and effective vaccine is now available beginning at 12 months of age.
Chickenpox In Childhood, Shingles In Adulthood
No matter the severity of the case of chickenpox in childhood, anyone who’s been infected with the varicella virus is at risk of developing a potentially more serious illness later in life called shingles, or herpes zoster.
“When we’re younger and have had chickenpox, the virus resides in nerve endings and can come out later in life in the form of shingles,” says Dr. Randell Wexler, a primary care physician at the Ohio State University Wexner Medical Center in Columbus.
The virus can lie dormant in the body for years and may reemerge decades after the initial chickenpox infection to cause shingles. The Centers for Disease Control and Prevention reports that one in three people develop shingles during their lifetime. Many people never develop shingles, but some unlucky people can experience it more than once.
In fact, some people can experience regular flares, says Dr. Michael Urban, a senior lecturer and director of the doctorate of occupational therapy program at the University of New Haven in West Haven, Connecticut. These flare ups may bring the full range of symptoms, or they may be more mild and barely noticeable. “Many people may not realize they’re having symptoms,” but when pressed will realize that “when I start getting stressed, I feel itchy or painful in that area,'” he explains.
Shingles is more common in adults over age 50, but it can appear any time after that initial chickenpox infection. Wexler says risk increases with age and other conditions. “Patients who are immunocompromised are at increased risk, such as those undergoing cancer treatment. Other potential triggers include being sick for another reason or being under a lot of stress.”
Urban says that in recent years, younger people have been developing shingles more often. “I’ve seen a lot of younger people with shingles because they’re just stressed to the max.” No longer is shingles mostly the domain of older adults, he says. It can happen any time.
Symptoms of Shingles
Symptoms of shingles include:
— Discomfort or disrupted sensation on the skin. This numbness or tingling often appears on a specific part of the skin before the rash develops. “This might even be all some people have (for symptoms) and so an actual diagnosis of shingles doesn’t occur,” Wexler says.
— A red, itchy, painful rash. This rash is the telltale sign of shingles. It nearly always affects just one side of the body and often appears in a band on the side near the ribs or abdomen. It’s commonly found on the torso, chest or back. It may also appear on the face in the eyes and ears or even in the mouth. It may cause a burning, stabbing or aching feeling that comes and goes. It may also resemble a chickenpox rash, but only appear in a few areas. In some cases, people don’t develop the red rash, but instead have acute pain on certain areas of skin. In others, the rash occurs with no pain.
— Fluid-filled blisters. For many people, the rash develops fluid-filled blisters that may burst or weep. These blisters may expand and merge, forming a red band that looks like a burn. Any touch can be excruciatingly painful. If someone who’s not been infected with the varicella-zoster virus comes into direct contact with the fluid from the blisters, it’s possible for transmission of the virus to take place. Until the blisters dry up and crust over, the person is contagious and can transmit the virus to others.
— Flu-like symptoms. Other symptoms may include fever, chills, headaches fatigue, muscle weakness, upset stomach and body aches.
The virus affects a cluster of nerves near the spinal cord. This is called the dorsal root ganglion, and this connection to a specific set of nerves is why the symptoms tend to be pinpointed in a certain area or areas, rather than being diffuse throughout the whole body.
[Read: Living With an HPV Infection.]
Shingles Can Be Contagious
If you have shingles, you can’t give that illness directly to another person, Wexler says. “However, if an individual who has never had chickenpox or has not been immunized for chickenpox comes in direct contact with the shingles lesion, you can give them chickenpox.” And thus potentially set them up for developing shingles later on.
The CDC reports that people with shingles cannot spread the virus before the rash blisters appear or after the rash crusts. The fluid in the blisters is what transmits the varicella virus to other people. There are a few ways to stop the spread of this fluid and thus the virus:
— Cover the blisters. It’s important to take care to cover the blisters to prevent passing that fluid on to someone else who might be vulnerable to infection, Urban says. “During that phase when the blisters form and pop and start to ooze, that’s when you’re contagious. So we recommend covering that area to minimize transmission.” Cover with a clean dressing and change it regularly as directed by your doctor.
— Don’t share towels and washcloths. “It might sound gross but some people may share washcloths,” Urban says. But that’s a bad idea if a member of the household has shingles. Get your own towel and launder it in hot water after each use.
— Separate your laundry. Similarly, keeping laundry from the person with shingles separate from other laundry in the household can reduce risk of transmission.
— Change the sheets daily. Washing sheets in hot water after each use can also cut down on risk.
— Wipe down after yourself. If you have blisters on the upper thighs, buttocks or around the genital area, be sure to wipe down the toilet seat after use.
What makes shingles generally more dangerous than chickenpox is its ability to impact other parts of the body that can lead to lasting problems. Some people can have long term complications from shingles including:
— Postherpetic neuralgia. This is a form of ongoing nerve pain that can last long after the rash has disappeared and is the most common complication of shingles. The CDC reports that about 10% to 18% of people who’ve had shingles will develop this complication, and the risk of it increases with age.
— Vision loss. The virus can affect the ophthalmic nerve that goes into the eyes, which can lead to pain and swelling in and around the eye. In severe cases, this can lead to a temporary or even permanent loss of vision.
— Hearing loss and balance issues. When symptoms advance into or around the ear, that can cause balance and hearing problems. Muscle weakness on the affected side can also occur. The changes can be permanent.
— Pneumonia. Though this complication is rare, shingles can invade certain internal organs, such as the lungs, causing pneumonia.
— Hepatitis. If shingles enters the liver, that can disrupt function, causing hepatitis.
— Mouth lesions. Tenderness or pain in the mouth, lesions inside the mouth and toothaches can also occur with shingles, making it difficult to eat or drink.
In older adults especially, shingles can be debilitating, Urban says. “Postherpetic neuralgia can cause intense pain that can radiate down the whole leg, for example. Some people, because of the pain, can begin to feel unsteady or have balance issues. People come in and they’re in a lot of pain so they don’t move. Their muscles get weaker and tighter. And that’s when they fall.”
These individuals may stop moving out of fear and pain, and become bedridden. And that’s when an occupational therapist like Urban may come in to help that individual regain some mobility, teach pain management techniques and offer safety recommendations.
Get Vaccinated Against Shingles
The best way to deal with shingles is to not get it at all. And while there are certain lifestyle means of reducing your risk, including eating right, getting plenty of sleep and reducing stress, those efforts may not be enough to avoid getting shingles if the virus is already in your body.
However, a vaccine against shingles does exist. “The vaccine works by triggering an immune response to the disease should there be a reactivation of the virus, therefore blocking the development of shingles,” Wexler explains.
The vaccine is about 90% effective in preventing illness and is indicated for adults 50 years of age and older. “It also has indications for individuals with certain chronic diseases such as renal failure, COPD and diabetes among others,” he says.
“A routine part of care now in seniors over the age of 60 is to vaccinate them against shingles,” Urban says.
In addition to the vaccine, there are treatments that can “shorten the duration of the virus symptoms,” Urban adds. Getting access to pain medications can help you feel better, and antiviral medications can help shorten the course of the outbreak and reduce the risk of serious complications. If you develop symptoms of shingles, contact your health care provider for advice and support.
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