The Virus That Was Already Inside You
A burning, stabbing pain on one side of your body, followed by a blistering rash that follows a band-like pattern. Shingles (herpes zoster) is caused by the reactivation of the varicella-zoster virus – the same virus that causes chickenpox. If you had chickenpox as a child, the virus has been dormant in your nerve cells ever since, waiting for your immune system to drop its guard.
At our practice in Zürich Seefeld, I treat shingles promptly and comprehensively – because early treatment reduces complications, and prevention through vaccination is now highly effective.
Why Does Shingles Happen?
After chickenpox resolves, the varicella-zoster virus retreats into dorsal root ganglia (nerve cell clusters near the spinal cord) where it remains dormant, kept in check by your immune system. When immunity wanes – due to ageing, stress, illness, immunosuppressive medication, or other factors – the virus can reactivate, travelling along a nerve to the skin and causing the characteristic dermatomal rash.
One in three people will develop shingles in their lifetime, with risk increasing significantly after age 50.
Symptoms and Complications
Shingles typically begins with pain, burning, or tingling in a specific area (prodrome), followed within days by a red rash that develops into fluid-filled blisters. The rash is almost always unilateral (one side only) and follows a dermatome (a band-like area supplied by a single nerve). Associated symptoms include fever, fatigue, and headache.
The most feared complication is postherpetic neuralgia (PHN) – persistent, often severe nerve pain that can last months or years after the rash heals. PHN is more common in older patients and those whose acute treatment was delayed. Other complications include eye involvement (herpes zoster ophthalmicus, which can threaten vision), secondary bacterial infection of the blisters, and rarely, neurological complications.
What We Do: Rapid, Comprehensive Treatment
Early antiviral therapy: Starting antiviral medication (valaciclovir or famciclovir) within 72 hours of rash onset significantly reduces the duration, severity, and risk of PHN. Time is critical.
Pain management: Adequate pain control during the acute phase – paracetamol, NSAIDs, and sometimes gabapentin or pregabalin for neuropathic pain.
Wound care: Keeping blisters clean and covered to prevent secondary infection and reduce transmission risk.
PHN management: If postherpetic neuralgia develops, targeted neuropathic pain management with gabapentinoids, tricyclic antidepressants, or topical treatments.
Immune support: Optimising vitamin D, zinc, and overall immune function to support viral clearance.
Prevention: The Shingles Vaccine
The recombinant vaccine Shingrix is over 90% effective at preventing shingles and PHN, even in older adults. It is recommended for adults over 65 (and over 50 for those with risk factors). Two doses are required, given 2-6 months apart. I strongly recommend vaccination for all eligible patients – the burden of shingles and PHN is substantial and largely preventable.
Conclusion
Shingles is common, painful, and potentially complicated – but treatable when caught early and largely preventable through vaccination. If you develop a painful, one-sided rash, seek medical attention immediately. And if you are over 50, ask about vaccination at our practice in Zürich Seefeld.
