Don't Mess with Shingles: Treatment and Prevention of Herpes Zoster
Update Date：2024/08/05，
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Shingles, also known as herpes zoster, and chickenpox are caused by the same virus: the varicella-zoster virus. Most people contract chickenpox during childhood. After recovering, the virus retreats to the nerve ganglia, where it remains dormant for life. When the immune system weakens, particularly due to aging or other health issues such as cancer, diabetes, chronic kidney disease, or long-term use of immunosuppressive medications for autoimmune diseases, the virus can reactivate. This reactivation travels along the nerves, leading to a shingles outbreak characterized by a painful, band-like rash, commonly known as "皮蛇" (Herpes zoster).
Since January 1, 2004, Taiwan has been administering the varicella (chickenpox) vaccine to children aged one year and older. This vaccination program has significantly reduced incidence of chickenpox. However, because the varicella vaccine is a live attenuated vaccine, it contains weakened virus particles. As a result, even if a person does not contract chickenpox, they may still be at risk of developing shingles (herpes zoster) later in life.
Prevalence of shingles increases with age, with risk being higher among individuals over 50 years an older. In Taiwan, statistics have shown that nearly 5 out of every 1,000 people develop shingles each year, and this number has been rising over time. Over a lifetime, approximately one-third of people will experience shingles.
Primary symptoms of shingles typically include a painful, band-like rash that appears on one side of the body. This rash consists of clusters of blisters with reddened skin underneath. The blisters are often accompanied by severe pain, burning, and tingling sensations, though some individuals may experience itching.
Sometimes, before the rash or blisters appear, patients may feel a tingling or burning sensation with no obvious cause. It is only when the rash or blisters emerge that they realize they have shingles. The pain associated with shingles can persist for weeks, months, or even years, a condition known as post-herpetic neuralgia, which can significantly impact quality of life for those affected.
In addition to post-herpetic neuralgia, shingles can also lead to a range of serious complications, particularly depending on the location of the rash. Special attention is needed for shingles in the following specific areas:
- Around the Eyes, Forehead, Scalp, and Nose: Shingles in these areas can potentially lead to keratitis, which can cause vision impairment.
- Genital and Buttock Areas: Shingles in these regions may result in difficulties with urination and bowel movements.
- Ears: Shingles affecting the ear can involve the nerves controlling facial muscles, leading to symptoms similar to a stroke, such as facial weakness or droop. It can also cause tinnitus, dizziness, and even hearing loss.
If shingles is not well-managed, the varicella-zoster virus can spread throughout the body, potentially leading to severe conditions such as pneumonia, hepatitis, and encephalitis, which affect major organs. This is particularly concerning for older adults or individuals with weakened or compromised immune systems. Therefore, timely treatment of shingles is crucial to prevent those serious complications and ensure better health outcomes.
Currently, primary treatment for shingles involves antiviral medications, which help shorten the duration of the illness and alleviate symptoms. Antiviral drugs are most effective when administered within the "golden window" of time, ideally within three days of the onset of symptoms. Early treatment can also help reduce the risk and severity of complications.
As for caring for the rash, it's important to avoid allowing the blisters to rupture. Ruptured blisters can create open wounds, which may lead to scarring and bacterial infections. The fluid within the blisters contains the virus, which can potentially infect those who have never had chickenpox or received the chickenpox vaccine. Therefore, individuals with shingles should avoid contact with infants under one-year-old and pregnant women to prevent transmission.
Pain management is a crucial component of shingles treatment. Proper use of pain relievers can significantly improve quality of life and sleep. Adequate rest and sleep are essential as they help the body fight the virus and promote faster recovery.
How to Prevent Shingles:
Vaccination is currently the most effective method for preventing shingles. Recent advancements have introduced new options for vaccination:
- Shingrix: This newer vaccine provides a strong option for shingles prevention. It is a recombinant vaccine and is recommended for adults aged 50 and older, as well as for those with weakened immune systems who may not be suitable for live attenuated vaccines.
- Zostavax: The traditional shingles vaccine, Zostavax, also offers good protection against shingles. However, it is a live attenuated vaccine and is not recommended for individuals with weakened or compromized immune systems or certain health conditions.
Both vaccines are effective, but Shingrix is preferred due to its higher efficacy and suitability for a broader range of individuals, including those with compromised immune systems.
The new "Shingrix" vaccine is a recombinant vaccine made from virus components, not a live attenuated virus. It is a non-live, inactivated vaccine, which means it is safe and suitable for individuals with weakened or compromised immune systems. This makes it an excellent choice for broader protection against shingles, even for those who may not be eligible for live attenuated vaccines.
Shingrix offers enhanced protection against shingles with clinical trials showing over 90% efficacy. Additionally, its protective effects last for more than 7 years. Even if a vaccinated individual does develop shingles, the likelihood of experiencing post-herpetic neuralgia is significantly reduced. This makes Shingrix a highly effective and long-lasting option for shingles prevention.
Individuals aged 18 and older can receive the Shingrix vaccine, with particular recommendations for those over 50 years old and individuals with weakened or compromised immune systems. It is also suitable for those who have previously had chickenpox or received the older Zostavax vaccine.
Post-vaccination, some may experience mild and temporary symptoms similar to a cold, including fever, chills, fatigue, redness and pain at injection site, headache, muscle aches, and gastrointestinal discomfort. These reactions are generally short-lived and manageable.
In summary, the Shingrix vaccine is a safe and effective option for preventing shingles, particularly suitable for individuals over 50 years old and those with weakened or compromised immune systems.
Dr. Liu Sheng-Wen is a board certified dermatologist in TSGH Dermatology Department.