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There are a lot of rashes out there that can cause people grief, but none is more distressing than shingles.

This viral infection has a reputation for striking people, often older adults, without warning. One day you're fine, and the next day you find a cluster of excruciatingly painful blisters on your body. It's not an experience that is easily forgotten.

What is shingles? How can you treat or prevent it?

Shingles (also known as herpes zoster) is caused by the varicella zoster virus, which is also responsible for causing chicken pox.

If you have ever had chicken pox or been exposed to chicken pox, you are at risk of getting shingles. That's because once the chicken pox infection subsides, the virus hides in the nerves. Many years later (usually as a result of aging, immunosuppressive therapy, psychological stress or other factors), the virus resurfaces in the form of shingles.

It is estimated about four to 12 people out of 1,000 healthy individuals over the age of 65 will be affected by shingles every year. It is also estimated about 50 per cent of people who reach 85 years of age will have had shingles at least once (you can get shingles more than once in a lifetime).

The most common symptoms of shingles are burning pain on the skin, itching, hypersensitivity to touch, tingling sensation, headache, fever and feeling unwell. The pain can also be described as stinging, tingling, aching, numbness or throbbing, sometimes with quick stabs of agonizing pain.

Some of these symptoms will develop in one localized area, usually on one side of the body. Usually, after a few days or a week or two, a rash develops that is raised and red. Vesicles (fluid-filled blisters) soon develop and eventually crust over in about seven to 10 days. The rash usually develops on the torso, but can appear on the face, eyes or other parts of the body.

Older patients usually have a more severe form of shingles and develop more complications compared with children, adolescents and younger adults. Chronic severe pain - called post-herpetic neuralgia (PHN) - can persist after shingles. PHN can be difficult to treat and can lead to anxiety and depression. Other complications include sight-threatening eye infections, central nervous system infections, nerve palsies such as Ramsay-Hunt syndrome, neuromuscular diseases such as Guillain-Barré syndrome and secondary bacterial infections where the rash is located.

"The best way to avoid getting the disease is to get the herpes zoster vaccine Zostavax."

Fortunately, once shingles has developed, it can be treated with medications such as analgesics, steroids and anti-viral medication. But the best way to avoid getting the disease is to get the herpes zoster vaccine Zostavax.

The Canadian Immunization Guide, produced by the Public Health Agency of Canada, recommends the vaccine be given to adults over the age of 50. It is estimated the vaccine will prevent shingles in 50 per cent of those immunized and will reduce the severe pain of post-herpetic neuralgia in 66 per cent of those immunized.

It can be administered to those who have had shingles before to prevent repeat or severe occurrences. It can also be given to those who have been immunized against chicken pox and who also fit the criteria for Zostavax, since it is still possible to get shingles after being immunized against chicken pox. The chicken pox vaccine is similar to the herpes zoster vaccine, except the latter is 14 times more potent and is intended to induce immunity to varicella zoster in older adults rather than children. It is a one-time immunization that lasts for about seven years.

The likelihood of Zostavax causing an acute case of shingles is very small, but is more common in people who are severely immune-compromised. Therefore, the immunization is not recommended for those who are severely immune-compromised as well as those who are pregnant.

The cost for Zostavax is about $180 to $200 for one dose. However, it is well worth the money given the consequences and the high likelihood that many people, particularly as they grow older, will eventually develop shingles. If you have questions about this condition or whether you should be vaccinated for it, contact your health-care provider.

For more information on the shingles vaccine and other immunizations, visit gov.mb.ca.

Donna Alden-Bugden is a family nurse practitioner at the McGregor Quick Care Clinic in Winnipeg. This column was originally published in the Winnipeg Free Press.

Quick facts

Factors that may increase your risk of developing shingles include:

• Being older than 50.
• Having a disease that weakens your immune system such as HIV/AIDS or cancer.
• Taking certain medications: such as drugs that prevent rejection of transplant organs or prolonged use of steroids.