Shingles

What Is Shingles? What Are the Types of Shingles?

Shingles is a painful and sometimes debilitating condition caused by the reactivation of the varicella-zoster virus—the same virus responsible for chickenpox. In Singapore, many individuals, especially those over 50, are at risk of developing shingles due to a weakened immune system or other factors. 

Shingles, also known as herpes zoster, is a viral infection that leads to a painful rash, typically appearing on one side of the body or face. After a person recovers from chickenpox, the varicella-zoster virus remains dormant in the nerve tissues and can reactivate years later as shingles. This reactivation can result in severe nerve pain and long-term complications if left untreated.

Other than the conventional type of shingles, there are two less common types:

1. Zoster Sine Herpete: This type occurs without the classic shingles rash but still causes nerve pain.
2. Ophthalmic Zoster: This affects the area around the eyes and can lead to serious complications, such as vision loss.

What Causes Shingles?

Shingles is caused by the reactivation of the varicella-zoster virus. Anyone who has had chickenpox in the past is at risk of developing shingles. However, it is unclear why the virus reactivates in some people but not in others. Factors that can trigger the virus include:

• Weakened immune system: Ageing, certain medications (such as immunosuppressants), and illnesses like cancer can compromise the immune system, allowing the virus to reactivate.
• Stress: High levels of stress or emotional trauma can weaken the body’s ability to suppress the virus.
• Infections: Other infections or conditions that lower your immune defences can increase the risk of shingles.

What Are the Symptoms of Shingles?

The symptoms of shingles typically develop in stages. Initially, you may feel a tingling or burning sensation in a specific area of the body, usually along the path of a nerve. This can be accompanied by:

• Pain: One of the hallmark symptoms of shingles is intense nerve pain, which can range from mild to severe.
• Rash: A few days after the pain begins, a rash of fluid-filled blisters develops. The rash usually appears on one side of the body or face.
• Itching or tingling: Before the rash, the skin may feel sensitive or itchy.
• Fatigue and malaise: Shingles can be accompanied by general feelings of tiredness or fever.

If shingles affects the face or eye (ophthalmic zoster), it can lead to more serious complications, including vision problems or even permanent damage to the eye.

Is Shingles Painful?

Yes, shingles is known for its significant and often severe pain, which can persist long after the rash has healed. This lingering pain is called postherpetic neuralgia (PHN) and is caused by damage to the nerves from the virus. PHN can last for months or even years after the initial shingles episode, and it can severely affect quality of life, particularly in older adults.

Who Is at Risk of Getting Shingles in Singapore?

Anyone who has had chickenpox is at risk of developing shingles, but certain factors increase that risk. In Singapore’s hot and humid climate, stress and infections are common triggers for shingles reactivation. Common risk factors include:

• Age: People over 50 are more likely to develop shingles, as the immune system weakens with age.
• Weakened immune system: Conditions such as HIV, cancer, or taking immunosuppressive drugs can increase the risk of shingles.
• Stress: High levels of stress can weaken the immune system, making the body more vulnerable to the virus.
• Exposure to chickenpox: People who have never had chickenpox or the vaccine can contract the varicella-zoster virus from someone with shingles, although this is rare.

How Is Shingles Diagnosed?

Shingles is typically diagnosed based on a combination of clinical symptoms and a physical examination. The distinctive rash and pain pattern make it easier for doctors to identify shingles. However, in cases where the rash is not present (zoster sine herpete), other diagnostic tools may be used, such as:

• Blood tests: To detect the presence of the varicella-zoster virus.
• Skin sample: In some cases, a small sample of the skin or fluid from the blisters may be taken to confirm the diagnosis.
• Eye examination: If shingles affects the area around the eyes, an ophthalmologist may perform an eye exam to check for complications.

What Are the Treatment Options for Shingles in Singapore?

Early treatment is crucial to reduce the severity of symptoms and lower the risk of complications such as postherpetic neuralgia. In Singapore, several treatment options are available, including:

• Antiviral Medications: Drugs such as acyclovir, valacyclovir, or famciclovir are prescribed to shorten the duration of the outbreak and reduce the risk of complications. These are most effective when started within 72 hours of the onset of the rash.
• Pain Management: Over-the-counter pain relievers such as paracetamol or ibuprofen may help with mild pain. For more severe pain, doctors may prescribe stronger painkillers, nerve-blocking medications, or topical lidocaine patches.
• Steroids: In some cases, corticosteroids may be prescribed to reduce inflammation and prevent nerve damage, especially in cases of ophthalmic zoster.
• Vaccination: A shingles vaccine (Shingrix) is available and recommended for adults over 50 to reduce the risk of shingles and its complications. Singaporean adults, particularly those at higher risk, should consider getting vaccinated as a preventive measure.

In more complex cases, particularly for those suffering from postherpetic neuralgia, treatments like nerve blocks, anticonvulsants, or antidepressants may be recommended to manage chronic pain. Early diagnosis and treatment are critical in managing symptoms and preventing long-term complications like postherpetic neuralgia. Schedule a consultation with Dr Charles Siow for vaccination or treatment of shingles and other neurological conditions.