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 | Shingles on the face.
Source: CDC
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The Disease
For those unfamiliar, shingles is an infection caused by the varicella zoster virus (VZV), better known as the chicken pox virus. If you had chicken pox as a child, you carry the virus and it remains in the nerve cells of your body after the infection clears and it can be reactivated years later, causing shingles. No one knows why the VZV reactivates, but for some reason our immune systems harbor the dormant virus. When the immune system is either not working properly or is compromised, the shingles virus may be reactivated. VZV is classified under the category of Herpes Virus. However, herpes zoster is not caused by the same virus that causes genital herpes, a sexually transmitted disease.
According to the Centers for Disease Control, it is estimated that 1 million cases of shingles occur each year in this country and about 1 out of every 3 people in the United States will develop shingles in their lifetime. The risk of shingles increases as you get older and approximately half of all cases occur in men and women 60 years old or older. Anyone who has had chickenpox may develop shingles at any age, even children. I know of two people who had shingles, one at age 25 and the other at age 36. Also, you can contract shingles more than once; one of those people had it 5 times and the other had it twice.
Those at higher risk of developing shingles are:
- people who have medical conditions that keep their immune systems from working properly, such as those who have cancers such as leukemia and lymphoma, and human immunodeficiency virus (HIV), and
- people who receive immunosuppressive drugs, such as steroids and drugs given after organ transplantation.
Signs & Symptoms
Shingles causes a painful rash that develops on one side of the face or body. The rash forms blisters that typically scab over in 7 to 10 days and clear up within 2 to 4 weeks.
Before the rash develops, people often have pain, itching, or tingling in the area where the rash will develop. This may happen anywhere from 1 to 5 days before the rash appears.
 
Source: CDC
Most commonly, the rash occurs in a single stripe around either the left or the right side of the body. In other cases, the rash occurs on one side of the face. In rare cases (usually among people with weakened immune systems), the rash may be more widespread and look similar to a chickenpox rash. Shingles can affect the eye and cause loss of vision.
Other symptoms of shingles can include:
- Fever
- Headache
- Chills
- Upset stomach
My first symptom was shooting pain on the top of my scalp or right side of my head, that radiated throughout my body. At first I thought I strained a neck muscle, since I was using the foam roll to loosen my neck muscles. Then the pain started around my ear and jaw line to the point that my face was swollen. I tried taking Aleve to relieve the pain and also using an ice pack several times a day to get the swelling down, but neither helped. Needless to say, I could not sleep due to the pain.
Then a rash or 3 large bumps appeared on my face, near my hairline. I couldn't figure out how I had injured myself, or what I came in contact with to get the rash. I did not connect the pain and the rash as the onset of shingles, since I had never experienced or seen shingles before. When the rash didn't get better by day two 2, I began to worry. Just my luck this was happening over the 4th of July holiday weekend! But I decided it wasn't an emergency and I waited until Monday to call my PCPs office. The redness from the rash started to spread down my face.
I talked to the Nurse Practitioner (NP) and as soon as I said rash, she said shingles and asked me to come into the office that day. She and my PCP confirmed the shingles diagnosis and wanted me to see an ophthalmologist right away, because the shingles (three lesions under my eyelid and in my eyelid) had spread down to my eye and they were worried that the virus might affect my cornea and possibly cause blindness.
The NP prescribed an antiviral drug, valacyclorvir HCL (Valtrex), for 10 days to inactivate the virus and stop it from spreading. She also prescribed gabapentin (Neurontin) for the nerve pain. I got the generic version of both drugs. Gabapentin is used to prevent and control seizures, but it is also used to relieve nerve pain following shingles in adults, according to the prescribing information.
When I couldn't get an appointment with an ophthalmologist at Massachusetts Eye and Ear Hospital, I saw an optometrist. The optometrist said everything looked fine so far, but wanted me to come back in 2-3 days for an update. In the meantime, the optometrist prescribed an eye drop and an ointment to keep the eye moist. I was told the antiviral medication was the only thing that would inactivate the virus and that prescribing steroids could do more harm than good.
I went back to see another optometrist since the first one was not available, but by that time the rash was getting worse and my eyelid was so swollen it was half shut and I had to have someone drive me to my appointment. Thank goodness my eye was not affected by the virus, but I nevertheless had a follow-up in two weeks.
If this experience wasn't bad enough, I developed new lesions under my eye and had yet another course of antiviral treatment for seven days.
Even with the gabapentin, I still experienced pain; sharp pain, tingling pain and burning on my face as the rash and migrated further down my face and to the back of my scalp on the right side. I never knew I had so many nerves in my face. The rash followed the same path as the pain. I developed a tolerance to the gabapentin and I had to increase the dosage. Gabapentin causes drowsiness, so if I wasn't in pain, I was sleeping every time I took the gabapentin three times a day.
The rash lasted three weeks before the redness started to subside. I still have scarring or dark marks from where the lesions were and I have postherpetic neuralgia (PHN), pain from the shingles nine weeks later. The pain has lessened and isn't as frequent as it was initially, but the pain still reminds me that I had shingles. Postherpetic neuralgia is common after having shingles and the duration varies from individual to individual. In some people, PHN can persist for years.
Shingles Vaccine
I highly recommend that if you've had chicken pox, get the shingles vaccine Zostavax®. You don't want to go through what I experienced. The vaccine is a live attenuated (weaker) virus that builds up your immune system and keeps the virus dormant. The CDC recommends that anyone over the age of 60 should get the vaccine because the older you are, the more severe the experience. Zostavax reduces the overall risk of shingles by 51% for those 60+ years old and the risk of post-herpetic neuralgia by 67%. The vaccine is most effective in people 60-69 years old, but also provides some protection for older age groups.
Zostavax is approved and indicated for those who are 50 and older. There were two separate clinical trials. In the Zostavax Efficacy and Safety Trial (ZEST), a placebo-controlled, double-blind clinical trial in which 22,439 subjects 50 to 59 years of age were randomized to receive a single dose of either Zostavax (n=11,211) or placebo (n=11,228), Zostavax significantly reduced the risk of developing zoster by 69.8% (95% CI [54.1, 80.6%]).
The efficacy of Zostavax was evaluated in the Shingles Prevention Study (SPS), a placebo-controlled, double-blind clinical trial in which 38,546 subjects 60 years of age or older were randomized to receive a single dose of either Zostavax (n=19,270) or placebo (n=19,276). The efficacy was overall 51%; 64% for age 60-69, 41% for age 70-79 and 18% for those 80+. Due to this study, the CDC recommends those 60+ years of age get the vaccine, noting that the efficacy is best in the 60-69 year old age group.
My understanding is that you can still get shingles with the vaccine, but it would be a milder case. The vaccine also had the greatest reduction in the incidence of postherpetic neuralgia with the 70-79 age group at 55%, followed by the 80-89 age group at 26% and the 60-69 age group at 5% for an overall reduction of 39%.
Reimbursement
All Medicare Part D (prescription) plans cover the shingles vaccine. Depending on the plan, there may be a co -pay, or one pays a portion of the total cost.
You would need to check with your insurance company as to whether or not they cover the vaccine. At CVS, where they are pushing the vaccine, my pharmacist mentioned that depending on the insurance plan, people have paid anywhere from $0 up to $208 to get the vaccine.
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