Question: I'm 48 and recently had shingles. My doctor says she's seeing more cases of shingles in younger adults. Many of my friends had shingles or had a close friend or relative in their age group (40s to early 50s) who had it.
My doctor hypothesized that, with children being given the chickenpox vaccine, shingles is erupting in a younger population. Why would that be?
Also, I would like to get the Zostavax shingles vaccination to prevent further outbreaks. Why is it available only for people older than 60?
Answer: Shingles is caused by the chickenpox virus. After you've had chickenpox, the virus lies dormant in nerve pathways. Later in life it can reawaken painfully as shingles.
Zostavax is FDA-approved to prevent shingles in people 60 and older because this age group is most at risk and was the one studied in the Zostavax clinical trial.
Your doctor's ”getting shingles at a younger age“ theory also is advanced by others. The thinking goes as follows.
Varivax, the chickenpox vaccination, was introduced in 1995. Before that, there were about 4 million cases of chickenpox a year. Since then, the number of cases has dwindled to a few hundred a year.
More than 90 percent of adults have had chickenpox, which generates a natural immunity to the virus. The gradual waning of this immunity might pave the way for a shingles outbreak in later years.
Exposure to kids with chickenpox gives adults extra natural immunity, sort of like getting a booster vaccination, that helps extend their protection against shingles.
Now that Varivax has eliminated most childhood cases of chickenpox, this natural immunity-extender is no longer available. That leaves adults more vulnerable to getting shingles at an earlier age.
That's the theory in a nutshell.
Zostavax is a way to boost this waning immunity and thus keep shingles tamped down.
By the way, your doctor can prescribe Zostavax for you if she thinks it's warranted. Younger-than-60 readers who have had prior bouts with shingles report getting it.
Q: I had shingles five months ago with blisters about the size of a nickel. I'm still hurting on my chest, back and under my arm. Sometimes the pain is unbearable. Is there anything I can take or rub on the skin to relieve the pain?
A: You appear to have postherpetic neuralgia, the dreaded legacy left by a shingles outbreak in about 10 percent to 15 percent of cases. The risk of getting this condition is greater in those older than 50 and mounts with advancing age. It's a type of neuropathic pain that can be challenging to treat.
Prescribed oral agents include tricyclic antidepressants such as amitriptyline, anticonvulsants such as gabapentin (Neurontin) and pregabalin (Lyrica), and pain relievers such as NSAIDs (e.g., ibuprofen) and opioids (narcotics).
Capsaicin (cream, lotion, gel) and the lidocaine patch are pain relievers applied directly to the skin.
Ask your doctor about these pain-relieving options.