Shingles: Symptoms, Treatment, and Recovery Insights

Shingles

Hello, Doctor.
Initially, I visited a nephrology clinic due to back pain (my family has a history of kidney stones), and the examination showed no abnormalities.
However, three days later, I developed small rashes on my back and abdomen.
I thought it was a drug rash (as I had applied a pain relief patch), but the next afternoon, I couldn't stand it anymore and rushed to a dermatology clinic.
The doctor immediately identified it as shingles.
At first, I was puzzled, thinking shingles only affected older adults.
The doctor explained that it could occur due to a weakened immune system and prescribed oral medication and a special injection.
I would like to ask the doctor a few questions:
1.
Since it has been four days from the onset of back pain to the diagnosis, will there be any long-term effects? Is it better to take antiviral medication within 72 hours? Does the 72-hour window start from the onset of the rash or from the back pain (I visited the clinic about 24 hours after the rash appeared)?
2.
I am 25 years old, under moderate stress, and my sleep schedule is reasonable (I usually sleep around 12:30 AM).
How did I get shingles? Should I go to a major hospital to check my immune system? If so, which department should I consult?
3.
Generally, how long does it take for complete recovery? Is there a risk of postherpetic neuralgia? Should I see a neurologist first, or is it okay to wait until the blisters have healed?
I apologize for the many questions as I am quite anxious.
Thank you for your assistance.

W, 20~29 year old female. Ask Date: 2020/06/05

Dr. Wu Yuxin reply Dermatology

1.
It is best to consume within 72 hours, but it is still effective if eaten within a week.
2.
It is not only the elderly who can be affected; the incidence is just higher in that age group.
3.
The skin typically forms a scab within a week, but nerve pain may not resolve immediately and could take longer; generally, both dermatologists and neurologists can manage these conditions.

Reply Date: 2020/06/05

More Info

Hello! Thank you for reaching out with your questions regarding shingles (herpes zoster). It's understandable to feel anxious about this condition, especially given the symptoms and the potential for complications. Let’s break down your concerns one by one.

1. Timing of Treatment and Potential for Complications: You mentioned that it has been four days since your back pain started, and you are concerned about the possibility of long-term effects. The critical window for starting antiviral treatment for shingles is ideally within 72 hours of the rash appearing. However, some studies suggest that initiating treatment within 72 hours of the onset of pain (even before the rash appears) can also be beneficial. Since you started treatment after the rash appeared, it’s essential to follow your healthcare provider's advice closely. While many individuals recover without complications, some may experience postherpetic neuralgia (PHN), which is persistent nerve pain that can occur after the rash has healed. The risk of PHN increases with age and the severity of the initial outbreak.

2. Understanding Your Risk Factors: You are 25 years old and have mentioned that your stress levels are manageable and your sleep patterns are relatively normal. Shingles can occur in younger individuals, especially if they have had a previous chickenpox infection, as the varicella-zoster virus remains dormant in the body and can reactivate when the immune system is weakened. Factors that can lower immunity include stress, illness, certain medications, or even lack of sleep. If you are concerned about your immune system, it may be worthwhile to consult with an immunologist or a general practitioner who can evaluate your health history and possibly recommend tests to assess your immune function.

3. Recovery Timeline and Follow-Up Care: Recovery from shingles varies from person to person. Most people will see significant improvement within 2 to 4 weeks, but some may experience lingering symptoms, particularly nerve pain. If you develop persistent pain after the rash has healed, it would be advisable to consult a neurologist for further evaluation and management. They can provide treatments that may help alleviate nerve pain, such as medications specifically for neuropathic pain.

In summary, while shingles can be distressing, many individuals recover fully with appropriate treatment. It’s crucial to monitor your symptoms and maintain open communication with your healthcare provider. If you notice any worsening symptoms or have concerns about your recovery, don’t hesitate to seek further medical advice. Remember, early intervention can significantly impact your recovery and quality of life. Take care, and I wish you a smooth and speedy recovery!

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