Beyond blisters and pain: How shingles is the ‘internal enemy’

Throughout her years of practice, Dr Carol Tan has encountered an array of patients who have endured varying levels of physical pain. The pain can even be triggered by the gentlest touch, a mere caress of clothing against their skin. 

The cause of this pain is shingles, a viral infection also known as herpes zoster, which often manifests as a blistering rash. Shingles stems from the reactivation of the dormant varicella-zoster (chickenpox) virus, which occurs when the body’s immunity is compromised. 

“For patients with shingles, the virus is already present in their body from the time they contracted chickenpox, often during childhood,” explained Dr Tan, a geriatrician from The Good Life Medical Centre. “When and how this ‘internal enemy’ resurfaces depends on the robustness of one’s immunity.” 

WHY THE MIDDLE-AGED ARE AT RISK

Startling statistics indicate that more than 90 per cent of adults over 50 years of age in Singapore carry the varicella-zoster virus. Moreover, figures gleaned from the general population living in the United States show that one in three adults will experience the reactivation of the virus in the form of shingles. 

Individuals in this age bracket are at higher risk of developing shingles due to changes in their immune systems that can potentially compromise their defences, said Dr Tan. Other at-risk groups include people who are immunocompromised, battling chronic conditions such as kidney impairment and diabetes, or undergoing treatment that affects one’s immunity. 

“Sometimes, all it takes for shingles to develop is stress or mental health triggers that weaken one’s defences,” she added.

Furthermore, Dr Tan shared that there is increasing evidence to suggest that those with weakened immune systems due to COVID-19 were 15 per cent more likely to develop shingles, while individuals who had been hospitalised due to COVID-19 were 21 per cent more prone to contracting the infection.

Despite these prevailing risks, a mere 3 per cent of Singaporeans aged between 50 and 79 years old perceive themselves as highly susceptible to developing shingles in the next 12 months, according to a survey of 200 respondents conducted by Ipsos MORI. 

Highlighting the need for vigilance, Dr Tan pointed out that the repercussions of shingles sometimes extend beyond the ailment itself: “Besides having to take time off work, one might have to deal with the financial cost of medical care, medication and in serious cases, hospitalisation.” 

COMPLICATIONS THAT LAST BEYOND THE INFECTION

According to Dr Tan, the hallmark symptom of shingles is a rash that is often accompanied by an “aching, burning or stabbing” pain. In most cases, the rash develops into fluid-filled blisters. 

The geriatrician noted that contrary to popular belief, the blisters do not always take the form of a snake-like band along a nerve pathway, such as around the torso. In fact, she has encountered patients who mistook the blisters for eczema. 

Other symptoms of a shingles infection include headaches, sensitivity to light, an upset stomach and fever. 

While the blisters usually subside after two to three weeks, the ramifications of shingles can persist far longer and severely affect one’s quality of life. For example, some patients continue to endure pain stemming from underlying nerve damage, a condition known as post-herpetic neuralgia.

“This can be very distressing, and in some cases, permanent,” said Dr Tan. “The pain caused by shingles is known to be difficult to treat. We can manage discomfort with a variety of drugs, but this can only moderate the pain, not cure it.” 

She added that among patients aged 50 and above, one in three continue to grapple with pain at the affected area for at least three months following the initial rash, while one in five experience discomfort for more than six months. 

Beyond persistent pain, shingles can lead to various complications, including skin scarring, secondary infection, vision and hearing loss, and muscle weakness.

At the more severe end of the spectrum lies Ramsay Hunt Syndrome, an affliction that paralysed half of pop star Justin Bieber’s face last year. “This is a very rare complication that affects the facial nerve,” said Dr Tan. “About half of these patients may not recover fully from the resulting facial paralysis.” 

WHEN PREVENTION IS BETTER THAN TREATMENT

Shingles is treatable and most patients eventually recover fully, with antivirals being the most effective treatment if administered within 72 hours upon the onset of rash. 

To reduce the severity and pain of the disease, antiviral treatment is typically given to affected individuals. Analgesics and corticosteroids are also common drugs used to relieve shingles-related discomfort.

Good lifestyle habits such as regular exercise, a balanced diet, stress management and quitting smoking will go a long way in bolstering your defence against shingles. You might also want to consult your doctor about your eligibility for a shingles vaccination. 

“For eligible persons, the shingles vaccine significantly reduces the likelihood of being afflicted,” said Dr Tan. Even in the event of an infection, the vaccine is likely to reduce the duration and severity of the disease as well as lower the risk of post-herpetic neuralgia, she added.

Learn more about shingles and prevention options for adults aged 50 and above. 

This advertorial is meant for disease awareness and educational purposes only, and does not endorse, make reference to and/or recommend any product. Speak to your healthcare professional to learn more about treatment options and prevention methods. Information in this article is valid till August 2024.